Anti-CD3 × Anti-EGFR Bispecific-Armed T Cells (EGFR BATs) and Low-Intensity Focused Ultrasound (LIFU) Blood-Brain Barrier Opening for the Treatment of MGMT Unmethylated Glioblastoma

Inclusion Criteria

• Newly diagnosed supratentorial glioblastoma or gliosarcoma IDH wildtype and MGMT unmethylated that express positive EGFR and confirmed by University of Virginia (UVA) pathology review
• Age ≥ 18 and ≤ 70 years at the time of signing informed consent
• Karnofsky performance status (KPS) ≥ 70
• Be willing and able to provide written informed consent for the trial
• Females of childbearing potential, and males, must be willing to use an effective method of contraception
• Maximal surgical debulking of the tumor was performed where residual contrast enhancement is 2 cm^3 or less on immediate post-operative MRI. Intraoperative post-resection MRI is acceptable
• Able to communicate during the LIFU BBB opening procedure
• BBB opening target(s) must lie in non-eloquent area(s)
• 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
• 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
• Absolute lymphocyte count ≥ 500/mm^3 (within 10 days before leukapheresis)
• Granulocytes > 1,000/mm^3 (within 10 days before leukapheresis)
• Absolute neutrophil count (ANC) ≥1,000 /mcL (within 10 days before leukapheresis)
• Platelets ≥ 100,000 /mcL (within 10 days before leukapheresis)
• Hemoglobin ≥ 9 g/dL (or ≥ 5.6 mmol/L without transfusion or epoetin alfa (EPO) dependency (within 7 days of assessment) (within 10 days before leukapheresis)
• Blood urea nitrogen (BUN) ≤ 1.5 X upper limit of normal (ULN) (within 10 days before leukapheresis)
• Serum creatinine within the normal limits OR Measured or calculated creatinine clearance* ≥ 60 mL/min/1.73m^2 (within 10 days before leukapheresis) * (glomerular filtration rate [GFR] can also be used in place of creatinine or creatinine clearance [CrCl]) * Creatinine clearance should be calculated per institutional standard.
• Serum total bilirubin ≤ 1.5 X ULN OR Aspartate aminotransferase (AST)(serum glutamic oxaloacetic transaminase [SGOT]) and alanine aminotransferase (ALT) (serum glutamic pyruvic transaminase [SGPT]) ≤ 5 X ULN (within 10 days before leukapheresis)
• Albumin > 2.5 mg/dL (within 10 days before leukapheresis)
• International Normalized Ratio (INR) or Prothrombin Time (PT) Activated Partial Thromboplastin Time (aPTT) ≤ 1.5 X ULN unless the subject is receiving anticoagulant therapy as long as PT or PTT is within the therapeutic range of the intended use of anticoagulants (within 10 days before leukapheresis)

Exclusion Criteria

• 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
• Patients undergoing only biopsy (partial resection or greater is required)
• Patients with cerebellar or brainstem tumors
• Patients with evidence of leptomeningeal dissemination or subependymal spread on initial MRI
• Patients with extracranial metastases
• Patients with evidence of acute intracranial hemorrhage
• Known hypersensitivity to cetuximab or another EGFR antibody
• Known sensitivity to gadolinium-based contrast agents
• Known sensitivity to Lumason® ultrasound contrast agent
• Alpha 1,3 Galactose IgE (“alpha gal”) test result outside of the reference range (indicating likely hypersensitivity to cetuximab)
• Patients with claustrophobia
• Clips, shunts, or other non-MRI compatible metallic implanted objects in the skull or the brain
• Evidence of active bleeding or bleeding diathesis
• Unable to discontinue use of anticoagulant therapy as per local standard
• Scalp atrophy or scars in the expected location of the ultrasound transducer
• 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
• There is clinical evidence of congestive heart failure requiring medical management
• Has human immunodeficiency virus (HIV) (HIV 1/2 antibodies) or known active hepatitis B (e.g., hepatitis B surface antigen [HBsAg] reactive) or hepatitis C (e.g., hepatitis C virus [HCV] ribonucleic acid [RNA] [qualitative] is detected)
• Has received a live vaccine within 30 days of leukapheresis
• Has received any treatment for GBM besides surgery
• Females must not be pregnant or breastfeeding
• Ongoing immunosuppressive therapy except for corticosteroids
• 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
• A patient may be excluded if, in the opinion of the treating investigator, the patient is not capable of being compliant