Surgical Tissue Flap to Bypass the Blood Brain Barrier in GBM

Glioblastoma (GBM) is the most common primary central nervous system malignancy in adults,
and accounts for over half of all malignant brain tumors. The prognosis for newly diagnosed
GBM is extremely poor even with Stupp protocol consisting of surgery followed by temozolomide
and radiotherapy. Present therapies are inadequate, as evidenced by the low 5-year survival
rate for brain cancer patients, with median survival at approximately 12 months and treatment
for GBM remains a significant unmet clinical need in oncology.

All subjects included in the study will initially undergo standard surgical resection for
newly diagnosed GBM. Following the resection, the surgical cavity will be lined with a long
pedicled, autologous piece of tissue called a temporoparietal fascial flap or pericranium.
The patient's dura, bone and scalp will be closed as is customary. The permeability of the
blood vessels of the TPF or pericranial flap should allow for improved delivery of
therapeutics and immune cells (macrophages and T cells) into the vicinity, extracellular
space and microenvironment of the resected tumor cavity including the brain adjacent to the
GBM. The TPF or pericranial flap would easily conform to many resected GBM cavities in our
human patients with acceptable risk. The TPF and pericranial flap with its predictable and
rich vascular anatomy have been shown to be an ideal flap for cases of previously irradiated
and/or infected wound beds.

The investigators hypothesize that a TPF or pericranial flap that is harvested in our
patients with resected GBM may be used as a readily available and accessible means of
circumventing the blood brain barrier selectively and focally. The investigators aim to prove
that this surgical technique is safe in a small human cohort of patients with resected newly
diagnosed GBM and may improve progression-free survival (PFS).

Inclusion Criteria:

- Subject is a male or female 18 years of age or older.

- Subject is undergoing planned resection of known or suspected GBM.

- Subject has a Karnofsky Performance Status (KPS) 70% or greater.

- Subject has a life expectancy of at least 6 months, in the opinion of the
Investigator.

- Based on the pre-operative evaluation by neurosurgeon, the subject is a candidate for
≥ 80% resection of enhancing region.

- Subject must be able to undergo MRI evaluation.

- Subject meets the following laboratory criteria:

- White blood count ≥ 3,000/µL

- Absolute neutrophil count ≥ 1,500/µL

- Platelets ≥ 100,000/µL

- Hemoglobin > 10.0 g/dL (transfusion and/or ESA allowed)

- Total bilirubin and alkaline phosphatase ≤ 2x institutional upper limit of normal
(ULN)

- Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) < 3 x ULN

- Blood urea nitrogen (BUN) and creatinine < 1.5 x ULN

- Females of reproductive potential must have a negative serum pregnancy test and be
willing to use an acceptable method of birth control.

- Males of reproductive potential must be willing to use an acceptable method of birth
control to ensure effective contraception with partner.

- Able to understand and willing to sign an institutional review board (IRB)-approved
written informed consent document (legally authorized representative permitted).

Inclusion criteria considered during surgery:

- Subject has a histologically confirmed (frozen section) diagnosis of WHO Grade IV
glioblastoma multiforme (GBM).

- TPFF and/or pericranial flap is technically feasible.

Exclusion Criteria:

- Subject, if female, is pregnant or is breast feeding.

- Subject has initiated chemotherapy or radiation treatment for diagnosis of or GBM.

- Subject intends to participate in another clinical trial.

- Subject intends to undergo treatment with the Gliadel® wafer at the time of this
surgery.

- Subject has an active infection requiring treatment.

- Subject has radiographic evidence of multi-focal disease or leptomeningeal
dissemination.

- Subject has a history of other malignancy, unless the patient has been disease-free
for at least 5 years. Adequately treated basal cell carcinoma or squamous cell skin
cancer is acceptable regardless of time, as well as localized prostate carcinoma or
cervical carcinoma in situ after curative treatment.

- Subject has a known positive test for human immunodeficiency virus infection, or
active hepatitis B or hepatitis C infection.

- Subject has a history or evidence of any other clinically significant disorder,
condition or disease that would pose a risk to subject safety or interfere with the
study evaluation, procedures or completion.