Comparing Blood Brain Barrier Opening with Pembrolizumab for brain tumor

Inclusion

• +Known sensitivity to DEFINITY® ultrasound contrast agent or hypersensitivity to perflutren microsphere or its components, e.g., polyethylene glycol, as found in MiraLAX and bowel prep products.
• +Known presence of leptomeningeal disease.
• +Participant has an infectious viral infection such as active Hepatitis B, Hepatitis C or detectable HIV viral load or participants with active bacterial infection such as TB (Bacillus tuberculosis) that may, in the opinion of the investigatorPrincipal investigatorThe doctor or researcher responsible for running the study at a site.Read more →, interfere with the subject receiving the study therapy or procedures or otherwise impact their participation in the trial.
• +Subjects with significant liver dysfunction, (cirrhosis, hemochromatosis, severe alcohol abuse, or active hepatitis (autoimmune or infectious))
• +Has a diagnosis of active autoimmune disease (e.g., autoimmune Hepatitis, Guillain-Barre Syndrome, etc.) requiring systemic treatment in the past 2 years (i.e., with use of disease modifying agents, corticosteroids, or immunosuppressive drugs). Replacement therapy (e.g., thyroxine, insulin, or physiologic corticosteroid replacement therapy for adrenal or pituitary insufficiency, etc.) is not considered a form of systemic treatment. History of (non-infectious) pneumonitis that requires steroids or has current pneumonitis
• +Participant is ≥ 18 years of age
• +The participant provides written informed consentInformed consentThe process of being told what taking part involves, then choosing freely.Read more → for the trial
• +Participant is willing to comply with all study procedures for the duration of the study
• +ScreeningScreeningThe checks done before joining, to see whether a study fits.Read more →/BaselineBaselineYour starting measurements, taken before treatment begins.Read more → laboratory values Screening/Baseline should adhere to local standard of careStandard of careThe treatment normally given for a condition outside a study.Read more → lab values for ICI therapy
• +Exclusion CriteriaExclusion criteriaThe things that would prevent someone from taking part.Read more →
• +Participant has evidence of acute intracranial hemorrhage
• +Participant at risk for spontaneous intracranial hemorrhage (e.g., history of metastatic melanoma or other tissue histology).
• +Participant has signs and symptoms of increased intracranial pressure or symptomatic mass effect, midline shift or evidence of subfalcine, uncal or tonsillar herniation.
• +Participant receiving Bevacizumab (Avastin) therapy, or other drugs with a proclivity for causing bleeding.
• +History of bleeding disorders or tissue pathologies which increase the subject's risk of hemorrhage for anticoagulation medications, implement pre-surgical standard procedure to avoid increased risk of a bleeding event.
• +Subjects with evidence of cranial or systemic infection.
• +Participant has received a solid organ or hematopoietic stem cell transplant.
• +Participant has received a live vaccine within 28 days prior to the first on-study ICI infusion with or without Exablate.
• +Contraindications to MRI and gadolinium-DTPA including non-MRI-compatible implanted devices, severe claustrophobia, unable to lie supine in MRI.
• +Has a known additional malignancy that requires active treatment that would interfere with study procedures.
• +Has a history or current evidence of any condition, therapy, or laboratory abnormality that might confound the results of the study, interfere with the subject's participation for the full duration of the study, or is not in the best interest of the subject to participate, in the opinion of the treating investigator.
• +Subject is currently enrolledEnrolmentThe number of participants a study plans to include, or has included.Read more → in another intervention based clinical trialInterventional studyA study where participants are given something to see what happens.Read more →
• +Participant has a Karnofsky Performance Status ≥ 70% and/or ECOG 0-2
• +Female subject is not planning pregnancy during the study duration and confirmed NOT PREGNANT each procedure day.
• +Participant is a NSCLC subject prescribed immune checkpoint inhibitor systemic therapy according to on-label use with the target brain lesion(s) measuring ≥ 0.5 cm in longest diameter. Target mets may include: De novo mets for which surgery and radiation can be deferred, Mets with or without history of prior radiation, Mets with history of radiation after at least 8 weeks since last radiation treatment, and In the event a previously treated met has progressed according to institutional practice within 4 weeks post radiation treatment, the met may be study eligible, and/or if in the opinion of the Investigator, the subject may benefit from the study procedure.
• +Has a diagnosis of immunodeficiency or is receiving chronic systemic steroid therapy (in dosing exceeding 10 mg daily of prednisone equivalent) or any other form of immunosuppressive therapy within 7 days prior to the first on-study ICI infusion with or without Exablate. Note: prophylactic steroid use for ICI and chemotherapy infusion per institutional practice is allowed per protocolProtocolThe detailed plan a study must follow.Read more →.