A Phase 1 interventional study of Chimeric Antigen Receptor (CAR) Therapy Infusion and Bevacizumab (Avastin) in Neuroblastoma (NBL), Ewing Sarcoma and Osteosarcoma, sponsored by Universität Münster. Not yet recruiting at 1 site in Germany. Open to participants aged 1 Year to 25 Years. Per ClinicalTrials.gov, last updated 2026-11-03.
Sponsored by Universität Münster · Phase 1, Interventional, and Treatment
This study will test a chimeric antigen receptor (CAR) T-cell treatment combined with bevacizumab in children and young adults with relapsed or refractory neuroblastoma, Ewing sarcoma, or osteosarcoma.
The CAR T-cell treatment, called GD2IL18CART, is made from a patient's own T cells. The T cells are genetically modified to recognize GD2, a molecule found on the surface of these cancers, and to release the immune-stimulating protein interleukin-18 (IL-18) when they encounter tumor cells. Bevacizumab is an antibody that blocks vascular endothelial growth factor (VEGF), a protein that affects tumor blood vessels and may make it difficult for immune cells to enter tumors. Combining bevacizumab with GD2IL18CART may therefore help more CAR T cells reach the tumor and improve their antitumor activity.
The main goals of this study are to determine whether the combination can be given safely, identify a recommended dose of GD2IL18CART for use with bevacizumab, and look for early evidence of antitumor activity. The study will also examine blood and tumor samples to better understand how the treatment affects CAR T cells and the tumor environment.
This is an international, prospective, multicenter, open-label, non-randomized phase Ib dose-escalation and dose-expansion study evaluating GD2IL18CART in combination with bevacizumab in children, adolescents, and young adults with relapsed or refractory GD2-positive neuroblastoma, Ewing sarcoma, or osteosarcoma.
GD2IL18CART is an autologous chimeric antigen receptor (CAR) T-cell product directed against the tumor-associated antigen GD2 and engineered for antigen-inducible secretion of interleukin-18 (IL-18). Clinical investigation of GD2IL18CART as a single agent demonstrated robust CAR T-cell expansion and established doses that could be administered with a manageable safety profile. However, clinical activity remained limited, particularly at non-osseous tumor sites and in Ewing sarcoma and osteosarcoma.
The combination with bevacizumab is intended to address tumor microenvironmental barriers that may limit CAR T-cell access and activity. Bevacizumab is a monoclonal antibody that neutralizes vascular endothelial growth factor A (VEGF-A). Persistent VEGF signaling contributes to abnormal tumor vasculature that can restrict immune-cell trafficking and promote local immunosuppression. In preclinical models of Ewing sarcoma and neuroblastoma, vascular endothelial growth factor/vascular endothelial growth factor receptor (VEGF/VEGFR) pathway inhibition increased intratumoral accumulation and antitumor activity of GD2-directed CAR T cells. Bevacizumab also enhanced the antitumor activity of the clinical GD2IL18CART product. These findings provide the rationale for evaluating the combination clinically.
Following leukapheresis and manufacture of the autologous GD2IL18CART product, participants will receive lymphodepleting chemotherapy with fludarabine and cyclophosphamide on days -6 to -4. Bevacizumab will be administered intravenously at 15 mg/kg on day -3, followed by a single intravenous infusion of GD2IL18CART on day 0. Additional bevacizumab doses will be administered every 3 weeks for up to five doses in total, unless treatment is discontinued earlier according to protocol-defined criteria. The timing of bevacizumab is intended to initiate VEGF inhibition before CAR T-cell infusion and maintain VEGF inhibition during the early period of CAR T-cell trafficking, expansion, and persistence.
GD2IL18CART dose escalation will follow a cohort-based single ascending dose design. The starting dose is lower than the doses established during previous clinical investigation of GD2IL18CART as a single agent because bevacizumab may increase tumor infiltration and biological activity of the CAR T cells. Cohorts of three participants will be treated sequentially, with predefined stopping rules and independent Data Monitoring Committee review guiding dose escalation. The objective of the dose-escalation phase is to characterize the safety of the combination and determine a recommended GD2IL18CART dose for use with bevacizumab.
After determination of the recommended combination dose, disease-specific expansion cohorts will enroll participants with neuroblastoma, Ewing sarcoma, and osteosarcoma, with up to six participants per disease entity treated at the recommended dose. The expansion phase will further characterize safety, feasibility, biological activity, and preliminary antitumor activity of the combination.
Tumor response will be assessed at weeks 6 and 12 and at months 6 and 12. Participants will be followed within this study through month 12. Long-term follow-up after genetically modified cell therapy will continue for up to 15 years in a separate long-term follow-up study.
An integrated translational research program will investigate the biological effects of the combination. Longitudinal analysis of blood samples will assess CAR T-cell expansion, persistence, phenotype, and immune responses. Mandatory on-treatment tumor biopsies obtained on day 14 will be analyzed using molecular and spatial approaches to investigate CAR T-cell trafficking and function within the tumor microenvironment and to identify potential biological determinants of response and resistance.
675 studies on the registry are indexed under Neuroblastoma; 127 are open to participants now.
This study's planned enrollment of 30 is close to the median of 32 across 507 interventional studies indexed under Neuroblastoma.
Browse Neuroblastoma studies →Universität Münster is the lead sponsor of 30 studies on the registry; 19 are open to participants now.
Counted across the registry records on this site, refreshed daily.
The criteria were revised on the registry on Nov 3, 2026. See what changed
Go through the criteria one by one — yes, no or not sure — and take the list to your doctor or the study team. Kept in this browser only.
Participants must have neuroblastoma, osteosarcoma, or Ewing sarcoma judged to be incurable with conventional treatment and meet the following disease-specific requirements:
All participants must additionally meet the following criteria:
Exclusion Criteria:
Bevacizumab-specific exclusion criteria:
Concurrent or recent prior therapies:
Underlined terms in the criteria open these too. Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Relapsed: the illness came back after treatment had worked. Refractory: it did not respond to treatment, or stopped responding while still on it.
Cancer that has spread from where it began to other parts of the body. “Metastatic” cancer is cancer that has spread this way.
A biopsy takes a small piece of tissue to examine. “Archival tissue” is a sample already taken, for example at diagnosis, and kept by the hospital.
Whether a stored sample will do depends on when it was taken, how much there is and what the study needs. Ask whether the study accepts your stored sample or needs a new biopsy.
The standard rules for measuring tumours on CT or MRI scans, to tell whether a cancer is shrinking, stable or growing during treatment.
“Measurable disease per RECIST 1.1” usually means at least one tumour 10 mm or more at its longest on a CT scan, or a lymph node 15 mm or more across its short axis.
A scale of how much an illness limits everyday activity. For people being assessed to join a study, scores run from 0 (fully active) to 4; lower is more active.
Studies most often ask for 0–1 or 0–2. Your doctor gives the score; the WHO scale uses the same steps. The full scale also has 5, which records death.
Able to become pregnant: from the first period until menopause, unless permanently unable to through surgery (removal of the womb, or of both ovaries or both fallopian tubes).
Criteria for people of childbearing potential usually ask for a negative pregnancy test and for contraception during the study and for a time after it.
Before you join, the study team explains what taking part involves — its purpose, what happens, the risks and possible benefits — and answers your questions, so you can decide freely. Consent is usually recorded on a form (the informed consent form, ICF) signed by you or, where the law allows, by someone legally authorised to decide for you.
You can keep asking questions during the study, you are told of new information that matters, and you can choose to leave at any time.
A condition in which the immune system attacks the body’s own tissues, such as rheumatoid arthritis, lupus, psoriasis, type 1 diabetes or inflammatory bowel disease.
Immunotherapy studies often leave out active autoimmune disease, and some name exceptions, such as thyroid disease on replacement hormone. Check the exceptions this study lists.
Judged by the study doctor to matter for your health or for the study. It is a doctor’s decision, so ask the study team if you are unsure whether something counts.
Malignancy means cancer. Criteria about another or earlier malignancy ask whether you have had a different cancer, usually within a set number of years.
Some are commonly allowed, such as treated skin cancers other than melanoma and early cancers removed completely — check the exceptions this study lists.
The share of blood the heart’s main pumping chamber (the left ventricle) pushes out with each beat, measured by an echocardiogram (heart ultrasound) or a MUGA scan. About 50–70% is normal.
GFR (glomerular filtration rate) is how much blood the kidneys filter each minute. It is usually estimated from a blood test — eGFR, by formulas such as CKD-EPI or MDRD — and some studies ask for it to be measured directly instead. Usually given in mL/min/1.73 m².
Check the method, the units and the minimum the study states. A value of 90 or above is in the normal-or-high range, but kidney damage can show in other tests too.
How quickly the kidneys clear creatinine, a waste product, from the blood. A study may estimate it from a blood test with age, weight and sex (often by the Cockcroft–Gault formula), or measure it using blood and urine collected over a set time. Given in mL/min; higher is better.
A yellow substance made when red blood cells are broken down, which the liver clears. A high level can mean a problem with the liver or the bile ducts.
Criteria often allow more for people with Gilbert’s syndrome, a harmless inherited condition that raises bilirubin.
The top of the normal range for a blood test, as set by the laboratory that runs it. Each lab prints its own range next to your result.
“≤ 2.5 × ULN” means the result can be up to two and a half times that top value.
Two enzymes measured in a routine blood test of the liver. Higher levels can mean the liver is under strain or damaged. SGPT and SGOT are older names for ALT and AST.
Criteria usually give a limit as a multiple of the upper limit of normal (ULN), often higher when cancer has spread to the liver.
The number of neutrophils, white blood cells that help fight infection, in a given amount of blood. Too few raises the risk of infection.
It is a count, not a percentage of the white cells. Limits are written in units that mean the same: ≥ 1.5 × 10⁹/L is ≥ 1,500 per mm³ (µL). Each lab has its own reference range.
Blood cells that help blood clot. Too few raises the risk of bleeding and bruising. A usual adult range is about 150–400 × 10⁹/L (150,000–400,000 per µL); each lab has its own reference range.
A “mini-stroke”: temporary stroke-like symptoms caused by reduced blood flow to part of the brain, spinal cord or eye, without signs of a new stroke on a scan.
Stroke symptoms need emergency care at once, even if they go away.
Stem cell (bone marrow) transplants. Allogeneic uses cells from a donor; autologous uses your own cells, collected earlier and given back.
PD-1, PD-L1 and CTLA-4 are proteins that act as brakes on the immune system. Checkpoint inhibitors, such as pembrolizumab or nivolumab, block them so the immune system can attack a cancer.
PD-L1 can also be measured in a tumour sample. Some scores count stained tumour cells only (TPS); others also count certain immune cells (CPS). The study names the score and the minimum it uses.
After a transplant from a donor, the donor’s immune cells attack the recipient’s body, often the skin, gut or liver.
A weakened immune system. It can come from an illness, such as HIV or some blood cancers, or from medicines that turn the immune system down, for example after an organ transplant or for an autoimmune disease; steroids at higher doses count.
Read whether the line is about a condition or about medicines, and which medicines and doses it means.
Anti-inflammatory medicines such as prednisone, prednisolone and dexamethasone — not the anabolic steroids used for muscle.
Studies differ in what they allow: check which steroid medicines, routes (tablets, injections, creams, inhalers, eye drops) and doses this study accepts.
Vaccines made with a weakened form of the germ, such as measles–mumps–rubella (MMR), chickenpox and yellow fever. They can be risky when the immune system is weakened. Flu injections are not live; the nasal flu spray is.
An allergy, or another reaction of the immune system, to a substance. “Hypersensitivity to the study drug” means a known allergic reaction to it — not every side effect a medicine can have.
A reason a treatment, test or procedure should not be given to a particular person, such as an allergy, another illness or a medicine they take.
Ways of preventing pregnancy. “Highly effective” methods fail less than 1% of the time a year when used correctly — for example an IUD or an implant.
Criteria usually say which methods count and how long to keep using them after the last dose, sometimes for male participants too. Some studies accept a partner’s vasectomy if it was confirmed successful and that person is the participant’s only sexual partner.
Relapsed and refractory
Relapsed: the illness came back after treatment had worked. Refractory: it did not respond to treatment, or stopped responding while still on it.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Metastases
Cancer that has spread from where it began to other parts of the body. “Metastatic” cancer is cancer that has spread this way.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Biopsy and archival tissue
A biopsy takes a small piece of tissue to examine. “Archival tissue” is a sample already taken, for example at diagnosis, and kept by the hospital.
Whether a stored sample will do depends on when it was taken, how much there is and what the study needs. Ask whether the study accepts your stored sample or needs a new biopsy.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
RECIST
The standard rules for measuring tumours on CT or MRI scans, to tell whether a cancer is shrinking, stable or growing during treatment.
“Measurable disease per RECIST 1.1” usually means at least one tumour 10 mm or more at its longest on a CT scan, or a lymph node 15 mm or more across its short axis.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
ECOG performance status
A scale of how much an illness limits everyday activity. For people being assessed to join a study, scores run from 0 (fully active) to 4; lower is more active.
Studies most often ask for 0–1 or 0–2. Your doctor gives the score; the WHO scale uses the same steps. The full scale also has 5, which records death.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Childbearing potential
Able to become pregnant: from the first period until menopause, unless permanently unable to through surgery (removal of the womb, or of both ovaries or both fallopian tubes).
Criteria for people of childbearing potential usually ask for a negative pregnancy test and for contraception during the study and for a time after it.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Informed consent
Before you join, the study team explains what taking part involves — its purpose, what happens, the risks and possible benefits — and answers your questions, so you can decide freely. Consent is usually recorded on a form (the informed consent form, ICF) signed by you or, where the law allows, by someone legally authorised to decide for you.
You can keep asking questions during the study, you are told of new information that matters, and you can choose to leave at any time.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Autoimmune disease
A condition in which the immune system attacks the body’s own tissues, such as rheumatoid arthritis, lupus, psoriasis, type 1 diabetes or inflammatory bowel disease.
Immunotherapy studies often leave out active autoimmune disease, and some name exceptions, such as thyroid disease on replacement hormone. Check the exceptions this study lists.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Clinically significant
Judged by the study doctor to matter for your health or for the study. It is a doctor’s decision, so ask the study team if you are unsure whether something counts.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Cancer (malignancy)
Malignancy means cancer. Criteria about another or earlier malignancy ask whether you have had a different cancer, usually within a set number of years.
Some are commonly allowed, such as treated skin cancers other than melanoma and early cancers removed completely — check the exceptions this study lists.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
LVEF (left ventricular ejection fraction)
The share of blood the heart’s main pumping chamber (the left ventricle) pushes out with each beat, measured by an echocardiogram (heart ultrasound) or a MUGA scan. About 50–70% is normal.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
GFR and eGFR (kidney filtering)
GFR (glomerular filtration rate) is how much blood the kidneys filter each minute. It is usually estimated from a blood test — eGFR, by formulas such as CKD-EPI or MDRD — and some studies ask for it to be measured directly instead. Usually given in mL/min/1.73 m².
Check the method, the units and the minimum the study states. A value of 90 or above is in the normal-or-high range, but kidney damage can show in other tests too.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Creatinine clearance (CrCl)
How quickly the kidneys clear creatinine, a waste product, from the blood. A study may estimate it from a blood test with age, weight and sex (often by the Cockcroft–Gault formula), or measure it using blood and urine collected over a set time. Given in mL/min; higher is better.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Bilirubin
A yellow substance made when red blood cells are broken down, which the liver clears. A high level can mean a problem with the liver or the bile ducts.
Criteria often allow more for people with Gilbert’s syndrome, a harmless inherited condition that raises bilirubin.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
ULN (upper limit of normal)
The top of the normal range for a blood test, as set by the laboratory that runs it. Each lab prints its own range next to your result.
“≤ 2.5 × ULN” means the result can be up to two and a half times that top value.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
ALT and AST (liver enzymes)
Two enzymes measured in a routine blood test of the liver. Higher levels can mean the liver is under strain or damaged. SGPT and SGOT are older names for ALT and AST.
Criteria usually give a limit as a multiple of the upper limit of normal (ULN), often higher when cancer has spread to the liver.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Absolute neutrophil count (ANC)
The number of neutrophils, white blood cells that help fight infection, in a given amount of blood. Too few raises the risk of infection.
It is a count, not a percentage of the white cells. Limits are written in units that mean the same: ≥ 1.5 × 10⁹/L is ≥ 1,500 per mm³ (µL). Each lab has its own reference range.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Platelets
Blood cells that help blood clot. Too few raises the risk of bleeding and bruising. A usual adult range is about 150–400 × 10⁹/L (150,000–400,000 per µL); each lab has its own reference range.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
TIA (transient ischaemic attack)
A “mini-stroke”: temporary stroke-like symptoms caused by reduced blood flow to part of the brain, spinal cord or eye, without signs of a new stroke on a scan.
Stroke symptoms need emergency care at once, even if they go away.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Allogeneic and autologous transplant
Stem cell (bone marrow) transplants. Allogeneic uses cells from a donor; autologous uses your own cells, collected earlier and given back.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
PD-1, PD-L1 and checkpoint inhibitors
PD-1, PD-L1 and CTLA-4 are proteins that act as brakes on the immune system. Checkpoint inhibitors, such as pembrolizumab or nivolumab, block them so the immune system can attack a cancer.
PD-L1 can also be measured in a tumour sample. Some scores count stained tumour cells only (TPS); others also count certain immune cells (CPS). The study names the score and the minimum it uses.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
GVHD (graft-versus-host disease)
After a transplant from a donor, the donor’s immune cells attack the recipient’s body, often the skin, gut or liver.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Immunosuppression
A weakened immune system. It can come from an illness, such as HIV or some blood cancers, or from medicines that turn the immune system down, for example after an organ transplant or for an autoimmune disease; steroids at higher doses count.
Read whether the line is about a condition or about medicines, and which medicines and doses it means.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Corticosteroids (steroids)
Anti-inflammatory medicines such as prednisone, prednisolone and dexamethasone — not the anabolic steroids used for muscle.
Studies differ in what they allow: check which steroid medicines, routes (tablets, injections, creams, inhalers, eye drops) and doses this study accepts.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Live vaccines
Vaccines made with a weakened form of the germ, such as measles–mumps–rubella (MMR), chickenpox and yellow fever. They can be risky when the immune system is weakened. Flu injections are not live; the nasal flu spray is.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Hypersensitivity
An allergy, or another reaction of the immune system, to a substance. “Hypersensitivity to the study drug” means a known allergic reaction to it — not every side effect a medicine can have.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Contraindication
A reason a treatment, test or procedure should not be given to a particular person, such as an allergy, another illness or a medicine they take.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Contraception
Ways of preventing pregnancy. “Highly effective” methods fail less than 1% of the time a year when used correctly — for example an IUD or an implant.
Criteria usually say which methods count and how long to keep using them after the last dose, sometimes for male participants too. Some studies accept a partner’s vasectomy if it was confirmed successful and that person is the participant’s only sexual partner.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Participants receive a single intravenous infusion of freshly prepared autologous GD2IL18CART cells in combination with intravenous bevacizumab administered every 3 weeks for up to 5 doses.
Genetic: Chimeric Antigen Receptor (CAR) Therapy Infusion · Drug: Bevacizumab (Avastin)
Combination of GD2IL1CART (IMP1, EU CT 2022-501725-21-00) with a monoclonal antibody against vascular endothelial growth factor, bevacizumab (IMP2) to promote effective CAR T-cell accumulation and function within the immunosuppressive tumor microenvironment (TME).
Also known as: GD2IL18CART
In combination with GD2IL18CART (IMP1, EU CT 2022-501725-21-00)
Incidence and severity of adverse events
Incidence and severity of adverse events (AEs), graded according to CTCAE version 6.0
Time frame: Through 12 months after GD2IL18CART infusion
Dose-limiting toxicities and recommended dose - dose-finding part
Incidence of protocol-defined dose-limiting toxicities (DLTs) and determination of the recommended dose (RD) of GD2IL18CART in combination with bevacizumab using a rule-based small-cohort design
Time frame: 28 days after IMP infusion
Recommended dose of GD2IL18CART in combination with bevacizumab
Determination of the recommended dose (RD) of GD2IL18CART in combination with bevacizumab using a rule-based small-cohort dose-escalation design, based on observed dose-limiting toxicities (DLTs) and protocol-defined dose-escalation and stopping rules.
Time frame: Through completion of the protocol-defined DLT assessment period of 28 days for the final dose-finding cohort
Overall response rate at week 6 - dose-extension part
Proportion of participants achieving a complete response (CR) or partial response (PR) at week 6
Time frame: Week 6
Intratumoral infiltration of GD2IL18CART
Presence and extent of GD2IL18CART-cell infiltration in on-treatment tumor biopsies
Time frame: Day 14
Expansion and persistence of GD2IL18CART
Longitudinal assessment of GD2IL18CART-cell expansion, persistence and phenotype in peripheral blood
Time frame: From GD2IL18CART infusion through 12 months
Plan to share: Yes — De-identified individual participant data underlying the published results may be made available to qualified researchers upon reasonable request following publication, subject to applicable informed consent, ethical and data-protection requirements, and execution of an appropriate data-use agreement.
Supporting information: Study protocol, Statistical analysis plan, Informed consent form
Time frame: Beginning after publication of the primary study results and for a period of 5 years thereafter.
Access criteria: De-identified individual participant data underlying the published results may be made available to qualified researchers upon reasonable request. Requests will be evaluated based on scientific merit and compatibility with the participants' informed consent, applicable data-protection requirements, and institutional policies. Data will be shared following approval of the request and execution of an appropriate data-use agreement.
Start is estimated for Oct 2027; primary completion for Sep 2031, 47 months later.
Of 73 non-industry phase 1 interventional studies under Neuroblastoma, half reached primary completion within 89 months of starting (the median), counting those still running; a quarter within 65 and three quarters within 117. This study's planned 47 months is below that.
Counting every sponsor, half of 86 studies reached it within 83 months; a quarter within 60 and three quarters within 114.
How these figures are worked out, and which studies are left out of them.
From the registry record's own update history. This site started tracking changes on Sep 25, 2026; for anything earlier, see the record history on ClinicalTrials.gov ↗
This study is not yet recruiting, as verified in Oct 2026. You cannot join it, but the record below documents what was studied.
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Studies of the drug tested here: Bevacizumab
Universität Münster