Low‑intensity focused ultrasound with EGFR‑targeted T‑cell therapy for newly diagnosed unmethylated glioblastoma

Phase I Clinical Trial of Anti-CD3 × Anti-EGFR Bispecific-armed T Cells (EGFR BATs) and Low-Intensity Focused Ultrasound (LIFU) Blood-brain Barrier Opening in Patients With MGMT Unmethylated Glioblastoma (GBM)

This trial is testing whether opening the blood–brain barrier with low‑intensity focused ultrasound can help autologous EGFR‑bispecific antibody‑armed T cells reach and treat newly diagnosed MGMT‑unmethylated, IDH‑wildtype glioblastoma.

Quick facts

• Phase: PHASE1
• Study type: Interventional
• Enrollment: 12 (estimated)
• Ages: 18 Years to 70 Years
• Sex: All
• Sponsor: University of Virginia (other)
• Drugs / interventions: cetuximab, immunotherapy
• Locations: 1 site (Charlottesville, Virginia)
• Trial ID: NCT07343986 on ClinicalTrials.gov

What this trial studies

This is a Phase 1 safety and feasibility trial combining autologous EGFR‑bispecific antibody‑armed T cells (EGFR‑BATs) with low‑intensity focused ultrasound (LIFU) to transiently open the blood–brain barrier (BBB) in patients with newly diagnosed, MGMT‑unmethylated, IDH‑wildtype supratentorial glioblastoma that express EGFR. Participants receive repeated infusions of radiolabeled (89Zr‑oxine) EGFR‑BATs to enable PET imaging of cell trafficking, with two different LIFU timing schedules across arms to compare BBB opening before or after multiple cell infusions. The NaviFUS system is used to target non‑eloquent tumor regions within a specified treatment envelope, and safety, feasibility, and PET‑based biodistribution are key outcomes. The study enrolls adults with good performance status and limited postoperative residual contrast enhancement and is conducted at a single center with integrated imaging and neurosurgical oversight.

Who should consider this trial

Good fit: Ideal candidates are adults 18–70 with newly diagnosed supratentorial, IDH‑wildtype, MGMT‑unmethylated glioblastoma that express EGFR, have KPS ≥70, limited postoperative residual contrast enhancement (≤2 cm3), and lesions suitable for NaviFUS targeting.

Not a fit: Patients with IDH‑mutant or MGMT‑methylated tumors, multifocal disease, tumors in eloquent brain areas or outside the NaviFUS treatment envelope, large residual tumor burden, or poor functional status are unlikely to benefit from this protocol.

Why it matters

Potential benefit: If successful, the approach could increase delivery of therapeutic T cells into the tumor and improve local immune control of glioblastoma.

How similar studies have performed: Early human trials have shown LIFU can safely open the BBB and PET labeling can track cell trafficking, but combining LIFU with EGFR‑BATs is a novel and unproven approach.

Eligibility criteria

Inclusion Criteria:

1. Newly diagnosed supratentorial glioblastoma or gliosarcoma IDH wildtype and MGMT unmethylated that express EGFR (score ≥ 1 by IHC)) and confirmed by UVA pathology review.
2. Age ≥ 18 and ≤ 70 years at the time of signing informed consent.
3. Karnofsky Performance Status (KPS) ≥ 70.
4. Be willing and able to provide written informed consent for the trial.
5. Females of childbearing potential, and males, must be willing to use an effective method of contraception.
6. Maximal surgical debulking of the tumor was performed where residual contrast enhancement is 2 cm3 or less on immediate post-operative MRI. Intraoperative post-resection MRI is acceptable.
7. Able to communicate during the LIFU BBB opening procedure.
8. BBB opening target(s) must lie in non-eloquent area(s).
9. The brain tumor to be treated must be in the treatment envelope of the NaviFUS system with a minimum distance of 30 mm from the inner skull table.
10. Females of childbearing potential should have a negative serum pregnancy test. Males who are partners of females of childbearing potential must agree to use an acceptable method of contraception throughout the study and for 1 month following completion of the EGFR BATs infusions.
11. Demonstrate adequate organ function as defined in Table 1. All screening labs should be performed within 10 days before leukapheresis.

Exclusion Criteria:

1. Patients with a diagnosis of another malignancy within 2 years of being on-study. Exceptions include basal cell carcinoma of the skin, squamous cell carcinoma of the skin that has undergone potentially curative therapy, or any type of in situ cancer. Patients must not be on any treatment for another malignancy.
2. Patients undergoing only biopsy (partial resection or greater is required).
3. Patients with cerebellar or brainstem tumors.
4. Patients with evidence of leptomeningeal dissemination or subependymal spread on initial MRI.
5. Patients with extracranial metastases.
6. Patients with evidence of acute intracranial hemorrhage.
7. Known hypersensitivity to cetuximab or another EGFR antibody.
8. Known sensitivity to gadolinium-based contrast agents.
9. Known sensitivity to Lumason® ultrasound contrast agent.
10. Alpha 1,3 Galactose IgE ("alpha gal") test result outside of the reference range (indicating likely hypersensitivity to cetuximab).
11. Patients with claustrophobia.
12. Clips, shunts, or other non-MRI compatible metallic implanted objects in the skull or the brain.
13. Evidence of active bleeding or bleeding diathesis.
14. Unable to discontinue use of anticoagulant therapy as per local standard.
15. Scalp atrophy or scars in the expected location of the ultrasound transducer.
16. Cardiac Status: Patients will be ineligible for treatment on this protocol if (before protocol entry):

    * There is a history of a recent (within one year) myocardial infarction or stroke.
    * There is a current or prior history of angina/coronary symptoms requiring medications and/or a history of depressed left ventricular function (LVEF \< 45%).
    * Patient has a pacemaker.
17. There is clinical evidence of congestive heart failure requiring medical management.
18. Has Human Immunodeficiency Virus (HIV) (HIV 1/2 antibodies) or known active Hepatitis B (e.g., HBsAg reactive) or Hepatitis C (e.g., HCV RNA \[qualitative\] is detected).
19. Has received a live vaccine within 30 days of leukapheresis.
20. Has received any treatment for GBM besides surgery.
21. Females must not be pregnant or breastfeeding.
22. Ongoing immunosuppressive therapy except for corticosteroids
23. Has a history or current evidence of any condition, therapy, or laboratory abnormality that might confound the results of the trial, interfere with the subject's participation for the full duration of the trial, or is not in the best interest of the subject to participate, in the opinion of the treating investigator.
24. A patient may be excluded if, in the opinion of the treating investigator, the patient is not capable of being compliant.

Where this trial is running

Charlottesville, Virginia

• University of Virginia — Charlottesville, Virginia, United States (RECRUITING)

Study contacts

• Principal investigator: Camilo Fadul, M.D. — University of Virginia
• Study coordinator: Bettina Wagner, B.A.

Conditions: Glioblastoma, Focused Ultrasound, Unmethylated, Immune Therapy