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Brain TumorPhase 3LIMITLESSNCT05317858

Blood-brain Barrier (BBB) Opening Using Exablate Focused Ultrasound With Standard of Care Treatment of NSCLC Brain Mets

A Phase 3 study testing Blood Brain Barrier Opening - Oncology, Pembrolizumab and Atezolizumab in people with Brain Tumor and Non Small Cell Lung Cancer, run by InSightec at 16 sites in 3 countries.

Recruiting

Looking for participants now. Contact the study team or a site below to ask about taking part.

Sites and contacts
Official record
Search all trials

Trial summary

The purpose of this study is to evaluate the safety and efficacy of targeted blood brain barrier opening with Exablate Model 4000 Type 2.0/2.1 for the treatment of NSCLC brain metastases in patients who are undergoing planned FDA approved, on-label systemic therapy utilizing immune checkpoint inhibitors. Read more about this study

Who is it for?
Ages 18 to 100 years
Conditions the study is for
Brain Tumor, Non Small Cell Lung Cancer
What is being tested?
Blood Brain Barrier Opening - Oncology, Pembrolizumab and Atezolizumab
Could I receive a placebo?
No, everyone receives an active treatment
How many people
96 participants
Where
16 sitesin 3 countries
Study dates
12 Aug 2022to 1 Dec 2031
Phase
Phase 3
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 100 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Participant is ≥ 18 years of age
  • The participant provides written informed consent for the trial
  • Participant is willing to comply with all study procedures for the duration of the study
  • Participant has a Karnofsky Performance Status ≥ 70% and/or ECOG 0-2
  • 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.
  • Female subject is not planning pregnancy during the study duration and confirmed NOT PREGNANT each procedure day.
  • Screening/Baseline laboratory values Screening/Baseline should adhere to local standard of care lab values for ICI therapy

Who cannot join

  • 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.
  • 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 investigator, interfere with the subject receiving the study therapy or procedures or otherwise impact their participation in the trial.
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  • 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.
  • 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.
  • Contraindications to MRI and gadolinium-DTPA including non-MRI-compatible implanted devices, severe claustrophobia, unable to lie supine in MRI.
  • Subjects with significant liver dysfunction, (cirrhosis, hemochromatosis, severe alcohol abuse, or active hepatitis (autoimmune or infectious))
  • 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 protocol.
  • Has a known additional malignancy that requires active treatment that would interfere with study procedures.
  • Known presence of leptomeningeal disease.
  • 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
  • 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 enrolled in another intervention based clinical trial

Trial locations and contacts

16 sites in 3 countries. Contact the study team or a site near you to ask about taking part.

16 sites in 3 countries

United States12 sites, 10 recruiting
  • University of Maryland

    Baltimore, Maryland, 21201

    Kaitlyn Henry, 410-328-0939, KHenry@som.umaryland.edu

    Rayne Noyes, 410-328-5332, anoyes@som.umaryland.edu

    Recruiting
  • Duke University

    Durham, North Carolina, 27708

    Julia Hurrelbrink - Assistant Research Practice Manager, BA, BSN, RN, (919)681-7460, julia.hurrelbrink@duke.edu

    Laura Alder, Medical Oncology, Internal Med

    Recruiting
  • Broward Health

    Fort Lauderdale, Florida, 33316

    Shirley Cheraime, RN, BSN, 954.712.3904, scheraime@browardhealth.org

    Simone Dockery Franklin, Sfranklin@browardhealth.org

    Recruiting
  • Miami Cancer Institute at Baptist Health

    Miami, Florida, 33176

    Natalie Brunelle, 786-533-9460, Natalie.Brunelle@Baptisthealth.net

    Manmeet S Ahluwalia, MD

    Recruiting
  • Hoag Memorial Hospital Presbyterian

    Newport Beach, California, 92663

    Simon Khagi, MD, MBA, FACP, 949-764-4060, Simon.Khagi@hoag.org

    Julie Nguyen, (949) 764-6271, Julie.Nguyen@hoag.org

    Recruiting
  • St. Joseph's Hospital and Medical Center

    Phoenix, Arizona, 85013

    Withdrawn
  • UPMC Presbyterian Hospital - University of Pittsburgh

    Pittsburgh, Pennsylvania, 15213

    Kristy Boggs, PhD, 412-647-8952, boggskd@upmc.edu

    Constantinos Hadjipanayis, Neurosurgery

    Not yet recruiting
  • Oregon Health & Science University

    Portland, Oregon, 97239

    Michael McGehee, MS, 971-509-4932, nsgclinicalresearch@ohsu.edu

    Ahmed Raslan, MBBCh, MSc, MD, FAANS

    Recruiting
  • Rhode Island Hospital

    Providence, Rhode Island, 02903

    Maria Duffy, (401) 444-2243, mduffy@brownhealth.org

    Owen Leary, (401) 606-8388, owen.leary@brownhealth.org

    Recruiting
  • Johnston Willis Hospital

    Richmond, Virginia, 23235

    Active, not recruiting
  • Moffitt Cancer Center

    Tampa, Florida, 33612

    Carie Bliss, (813) 745-2131, Carie.Bliss@moffitt.org

    Yolanda Pina, Neuro-Oncology

    Recruiting
  • Atrium Health Wake Forest Baptist

    Winston-Salem, North Carolina, 27103

    Adrian Laxton, BA, MA, MD, FRCSC, FAANS, 336-716-6438, Adrian.Laxton@wfusm.edu

    Wendy Jenkins, RN, BSN, 336-716-3842, Wendy.Jenkins@Advocatehealth.org

    Recruiting

Other trials in United States

South Korea3 sites, 3 recruiting
  • Samsung Medical Center

    Seoul, Seoul, 06351

    Kyung-won Chang, +82-10-7209-8001, kyungwon.chang@samsung.com

    Kyung-won Chang

    Not yet recruiting
  • Seoul National University Hospital

    Seoul

    Eun-jung Lee, +82-10-4110-0121, eunjlee21@snu.ac.kr

    Eun-jung Lee

    Not yet recruiting
  • Severance Hospital, Yonsei University Health System

    Soeul

    Hyun Ho Jung, +82-10-8797-3815, JUNGHH@yuhs.ac

    Hyun Ho Jung

    Not yet recruiting

Other trials in South Korea

Canada1 site
  • Sunnybrook Research Institute

    Toronto, Ontario, M4N 3M5

    Active, not recruiting

Other trials in Canada

About this study

Official title: A Randomized Pivotal Study Assessing the Safety and Efficacy of Targeted Blood-brain Barrier (BBB) Opening Using Exablate Focused Ultrasound During the Standard of Care Treatment of Brain Metastases of Non-small Cell Lung Cancer (NSCLC) Origin

The purpose of this study is to evaluate the safety and efficacy of targeted blood brain barrier opening with Exablate Model 4000 Type 2.0/2.1 for the treatment of NSCLC brain metastases in patients who are undergoing planned FDA approved, on-label systemic therapy utilizing immune checkpoint inhibitors.

Read the detailed description

This is a prospective, multi-center, randomized, two-arm, controlled, pivotal clinical trial to evaluate the safety and efficacy of targeted blood brain barrier opening using Exablate Model 4000 Type 2 for the treatment of NSCLC brain metastases in subjects who are undergoing planned FDA approved, on-label systemic therapy utilizing immune checkpoint inhibitors for their primary disease. The study will be conducted at up to 30 centers in the US. The immunotherapy regimen (every 3 weeks for 6 cycles) of prescribed ICI therapy is per the FDA approved labeling and the subjects prescribed standard of care therapy for their primary NSCLC. The study aims to demonstrate superiority of Exablate BBBO targeted to their brain metastases over the standard of care without Exablate BBBO with respect to the percentage of subjects achieving Objective Response Rate (ORR) by 6 months follow-up.

Being tested
Blood Brain Barrier Opening - Oncology, Pembrolizumab, Atezolizumab, Cemiplimab, Nivolumab
Keywords
MRgFUS, NSCLC, Low Frequency Ultrasound
Medical subject headings
Brain Neoplasms, Carcinoma, Non-Small-Cell Lung

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Blood Brain Barrier Opening - OncologyDevice

    Also called Exablate BBBO

    BBB opening via Exablate Type 2 system with microbubble resonators on the day of ICI infusion to treat brain metastases.

  • PembrolizumabDrug

    Also called KEYTRUDA

    Pembrolizumab infusion

  • AtezolizumabDrug

    Also called Tecentriq

    Atezolizumab infusion

  • CemiplimabDrug

    Also called LIBTAYO

    Cemiplimab infusion

  • NivolumabDrug

    Nivolumab infusion

  • IptilimumabDrug

    Iptilimumab infusion

Study groups in NCT05317858
Study groupRoleWhat they receive
ICI Systemic Therapy with Exablate BBBOExperimentalUsing Exablate Model 4000 Type 2 for the treatment of NSCLC brain metastases in subjects who are undergoing planned ICI Systemic Therapy.
Receives: Device: Blood Brain Barrier Opening - Oncology; Drug: Pembrolizumab; Drug: Atezolizumab; Drug: Cemiplimab; Drug: Nivolumab; Drug: Iptilimumab
Control Arm (ICI Systemic Therapy on-label use only)Active comparatorsubjects will undergo planned on-label ICI Systemic Therapy.
Receives: Drug: Pembrolizumab; Drug: Atezolizumab; Drug: Cemiplimab; Drug: Nivolumab; Drug: Iptilimumab

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Adverse events

    Adverse events [ Time Frame: Through study completion, up to 6 months]. All adverse events and/or Serious Adverse Events will be documented and reported according to CTCAE criteria.

    Measured: up to 6 months

  2. tumor lesion(s) on the MRI images

    Efficacy will be determined by the response of the tumor lesion(s) compared to baseline. Tumor lesions on the MRI images (units: mm) will be measured every three weeks up to six months.

    Measured: up to 6 months

Secondary outcomes (2)
  1. evaluation of Neuro Oncology Brain Mets (RANO-BM) response

    The evaluation of the percentages of subjects that achieved the stable disease (SD), partial response (PR) as the best objective response using the response assessment in Neuro Oncology Brain Mets (RANO-BM) response criteria measured at baseline and every 3 weeks during each treatment cycle to up to 6 months of therapy.

    Measured: up to 6 months

  2. Time to response for brain metastases by treatment arm [applicable to the completed stage 1a only]

    The time to achieve a confirmed complete response or partial response for brain metastases by treatment arm as assessed using the RANO-BM criteria evaluated every 3 weeks up to 6 months during treatment cycles.

    Measured: up to 6 months

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted8 Apr 2022
  2. Study start12 Aug 2022
  3. Primary completion1 Jun 2031 (estimated)
  4. Study completion1 Dec 2031 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 3
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Model description
Multiple staged study design: 1a early feasibility (not randomized, unblinded), 1b feasibility of Pivotal (randomized, blinded, no crossover), 2 Pivotal (randomized, blinded, crossover allowed for eligible control patients with progression of brain mets)
Masking
Single blind
Who is masked
Outcomes assessor
Enrolment
96 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05317858
Sponsor's protocol ID
BT012
Acronym
LIMITLESS
Status last verified
Oct 2026
First submitted
1 Mar 2022
Last updated
13 Oct 2026
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
Yes
FDA-regulated device
Yes
Individual data sharing
No

Questions about this trial

What is this clinical trial studying?

A Phase 3 study testing Blood Brain Barrier Opening - Oncology, Pembrolizumab and Atezolizumab in people with Brain Tumor and Non Small Cell Lung Cancer, run by InSightec at 16 sites in 3 countries.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 7 inclusion and 18 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: looking for participants now, as of the sponsor's last update on 13 Oct 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 16 sites in United States, South Korea, Canada. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 3 studies compare the treatment with the current standard treatment or a placebo in a large group, to confirm how well it works and watch for side effects.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

Contact Alyssa Voelker-Christy (817-948-5219, clinicalresearchquestions@insightec.com), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Adverse events (time frame: up to 6 months). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 13 Oct 2026.

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