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Gut Microbiota Reconstruction for NSCLC Immunotherapy

Primary Purpose

Non-Small Cell Lung Cancer

Status
Unknown status
Phase
Phase 1
Locations
China
Study Type
Interventional
Intervention
Capsulized Fecal Microbiota Transplant
Anti-programmed cell death protein 1/programmed death-ligand 1 monoclonal antibody
Platinum based chemotherapy
Sponsored by
Shanghai Zhongshan Hospital
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Non-Small Cell Lung Cancer

Eligibility Criteria

18 Years - 75 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

1.Volunteer to participate in this trial, fully understand this trial, and sign the Informed Consent Form (ICF).

2.18-75 years old on the day of signing the ICF. 3.Locally advanced/metastatic non-small cell lung cancer diagnosed by histology or cytology. no epidermal growth factor receptor (EGFR) sensitive mutations, anaplastic lymphoma kinase (ALK) gene rearrangement, ROS Proto-oncogene 1 (ROS1) gene fusion.

4.Have stable disease (SD) defined by Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1 after receive at least 2 doses of anti-PD-1/PD-L1 for first-line treatment.

5.Have not received systemic treatment for locally advanced/metastatic NSCLC before immunotherapy.

6.Have measurable target lesions judged by the investigator according to Response Evaluation Criteria In Solid Tumors (RECIST V1.1).

7.0~1 ECOG score. 8.Life expectancy ≥ 12 weeks. 9.Have sufficient organ function, evaluated based on blood routine, renal function, liver function, and coagulation laboratory test results (and have not received blood transfusion or infusion of apheresis components within 14 days before the study drug administration , Erythropoietin, granulocyte colony stimulating factor and other medical support treatments).

10.Women of Childbearing Potential (WOBCP) must undergo a serum pregnancy test within 7 days before the first medication, and the result is negative; WOBCP or men and their WOBCP partners should agree from signing the ICF to the last one. Take effective contraceptive measures within 6 months after taking the study drug.

Exclusion Criteria:

  1. Before the first administration of the anti-PD-1/PD-L1 reatment: a) have received previous systemic cytotoxic chemotherapy for metastatic disease; b) have received other targeted or biological anti-tumor therapy for metastatic disease ; c) received major surgery (<3 weeks before the first dose); d) received lung radiotherapy >30 Gy within 6 months before the first dose of the trial treatment; e) the first trial treatment Palliative radiotherapy was completed within 7 days before administration.
  2. Any other form of anti-tumor therapy is expected during the study period.
  3. Have progressive disease (PD) or response(CR or PR) defined by RECIST v1.1 after receive at least 2 doses of anti-PD-1/PD-L1 for first-line treatment.
  4. Unable to tolerate anti-PD-1/PD-L1 treatment due to adverse events or other reasons.
  5. Unable to swallow FMT capsules.
  6. Received antibiotic treatment within 30 days before the planned FMT started.
  7. Fecal occult blood test or calprotectin positive; have ulcerative colitis, Crohn's disease, ischemic enteritis, infectious enteritis, etc not suitable to take intestinal bacteria capsules, but not include anti-PD-1/PD-L1-related colitis.
  8. Live virus vaccines have been vaccinated within 30 days before the planned treatment. Seasonal influenza vaccine without live virus is allowed.
  9. A history of past malignant disease is known, unless the subject receives potentially curative treatment and there is no evidence of disease recurrence within 5 years after starting treatment.
  10. Accompanying known active central nervous system (CNS) metastasis and/or cancerous meningitis.
  11. According to the standard of Common Adverse Event Terminology (CTCAE) 4th edition, peripheral neuropathy has been ≥2 grade.
  12. Severe hypersensitivity reactions to other monoclonal antibody treatments have occurred in the past.
  13. Accompanied by active autoimmune diseases, systemic treatment (ie, use of disease modifiers, corticosteroids or immunosuppressive drugs) is required within the past 2 years.
  14. Are receiving long-term systemic steroid therapy. Subjects with asthma who require intermittent use of bronchodilators, inhaled steroids, or topical steroid injections are not excluded.
  15. Have received any other anti-PD-1 or PD-L1 or PD-L2 drugs or antibodies in the past, or small molecule therapy that targets other immunomodulatory receptors or mechanisms. Participated in any other anti-PD-1/PD-L1 trials and received anti-PD-1/PD-L1 treatment. Such antibodies include (but are not limited to) antibodies against IDO, PD-L1, IL-2R and GITR.
  16. Active infections requiring treatment.
  17. Known human immunodeficiency virus (HIV) history (known HIV1/2 antibody positive). Accompanied by known active hepatitis B or C.
  18. Being pregnant or breastfeeding, or expecting to conceive or conceive during the period of study drug treatment and within the required contraceptive period after the last administration of the study drug.
  19. The researcher believes that there are any circumstances that are not suitable for selection.

Sites / Locations

  • Zhongshan Hospital, Fudan University

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

FMT with anti-PD-1/PD-L1 treatment

Arm Description

Outcomes

Primary Outcome Measures

Incidence of FMT-related Adverse Events
Number of patients with adverse events after FMT
Incidence of anti-PD-1/PD-L1-related Adverse Events
Number of patients with adverse events related to anti-PD-1/PD-L1 after FMT

Secondary Outcome Measures

Changes in diversity and composition of gut microbiota
Compare the difference of gut microbiota diversity and composition between pre-FMT and post-FMT samples. Microbiota diversity will be quantified by α-diversity ( Faith's Phylogenetic Diversity) based on meta-genomics sequencing. Microbiota composition will be quantified by the operational taxonomic unit (OTU) in the stool.
Efficiency of FMT engraftment
Evaluate the acquired similarity of the recipient microbiota to the donor microbiota by measuring the Euclidian distance between donor microbial composition and every available time point of the corresponding recipients, starting from the pre-FMT sample.
Changes in concentration of peripheral blood mononuclear cells
Compare composition and content of peripheral blood mononuclear cells (CD8+T-cells, NK cells and myelin-sourced inhibitory cells) between pre-FMT and post-FMT samples. The composition and content of CD8+T-cells, NK cells and myelin-sourced inhibitory cells were analyzed by flow cytometry.
Changes in concentration of tumor immune related cytokines
Compare the contents of tumor immune related cytokines (IFNγ、TNF、Granzyme A/B、Perforin and et al) between pre-FMT and post-FMT samples. The contents of tumor immune related cytokines were analyzed by enzyme-linked immunosorbent assay.
Objective response rate (ORR)
Number of patients with objective responses divided by the total number of evaluable patients, according to imaging studies (RECIST 1.1) and iRECIST

Full Information

First Posted
August 12, 2021
Last Updated
August 12, 2021
Sponsor
Shanghai Zhongshan Hospital
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1. Study Identification

Unique Protocol Identification Number
NCT05008861
Brief Title
Gut Microbiota Reconstruction for NSCLC Immunotherapy
Official Title
Safety of Gut Microbiota Reconstruction Plus PD-1/PD-L1 Monoclonal Antibodies to Treat Locally Advanced or Metastatic Non-Small Cell Lung Cancer
Study Type
Interventional

2. Study Status

Record Verification Date
August 2021
Overall Recruitment Status
Unknown status
Study Start Date
September 1, 2021 (Anticipated)
Primary Completion Date
December 30, 2022 (Anticipated)
Study Completion Date
December 30, 2022 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Shanghai Zhongshan Hospital

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
No

5. Study Description

Brief Summary
In this study, patients with locally advanced or metastatic NSCLC after first-line treatment with PD-1/PDL-1 monoclonal antibody will be treated with Gut Microbiota reconstruction(such as FMT) combined with PD-1/PDL-1 monoclonal antibody. We will evaluate the safety of FMT in the treatment of advanced NSCLC, and analyze the effect of FMT on intestinal flora and immunophenotype of patients.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Non-Small Cell Lung Cancer

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
20 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
FMT with anti-PD-1/PD-L1 treatment
Arm Type
Experimental
Intervention Type
Procedure
Intervention Name(s)
Capsulized Fecal Microbiota Transplant
Other Intervention Name(s)
Capsulized FMT
Intervention Description
Capsules contained washed fecal microbiota.
Intervention Type
Drug
Intervention Name(s)
Anti-programmed cell death protein 1/programmed death-ligand 1 monoclonal antibody
Other Intervention Name(s)
Anti-PD-1/PD-L1 mAb, Anti-PD-1/PD-L1, Pembrolizumab, Nivolumab, Durvalumab, Sintilimab, Tislelizumab, Camrelizumab
Intervention Description
Standard dose of one of anti-PD-1/PD-L1 mAbs administered as a 1 hour infusion every 3 weeks.
Intervention Type
Drug
Intervention Name(s)
Platinum based chemotherapy
Other Intervention Name(s)
Platinum based Chemotherapy drugs
Intervention Description
Standard dose of Platinum based Chemotherapy every 3 weeks.
Primary Outcome Measure Information:
Title
Incidence of FMT-related Adverse Events
Description
Number of patients with adverse events after FMT
Time Frame
2 years
Title
Incidence of anti-PD-1/PD-L1-related Adverse Events
Description
Number of patients with adverse events related to anti-PD-1/PD-L1 after FMT
Time Frame
2 years
Secondary Outcome Measure Information:
Title
Changes in diversity and composition of gut microbiota
Description
Compare the difference of gut microbiota diversity and composition between pre-FMT and post-FMT samples. Microbiota diversity will be quantified by α-diversity ( Faith's Phylogenetic Diversity) based on meta-genomics sequencing. Microbiota composition will be quantified by the operational taxonomic unit (OTU) in the stool.
Time Frame
2 years
Title
Efficiency of FMT engraftment
Description
Evaluate the acquired similarity of the recipient microbiota to the donor microbiota by measuring the Euclidian distance between donor microbial composition and every available time point of the corresponding recipients, starting from the pre-FMT sample.
Time Frame
2 years
Title
Changes in concentration of peripheral blood mononuclear cells
Description
Compare composition and content of peripheral blood mononuclear cells (CD8+T-cells, NK cells and myelin-sourced inhibitory cells) between pre-FMT and post-FMT samples. The composition and content of CD8+T-cells, NK cells and myelin-sourced inhibitory cells were analyzed by flow cytometry.
Time Frame
2 years
Title
Changes in concentration of tumor immune related cytokines
Description
Compare the contents of tumor immune related cytokines (IFNγ、TNF、Granzyme A/B、Perforin and et al) between pre-FMT and post-FMT samples. The contents of tumor immune related cytokines were analyzed by enzyme-linked immunosorbent assay.
Time Frame
2 years
Title
Objective response rate (ORR)
Description
Number of patients with objective responses divided by the total number of evaluable patients, according to imaging studies (RECIST 1.1) and iRECIST
Time Frame
2 years

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
75 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: 1.Volunteer to participate in this trial, fully understand this trial, and sign the Informed Consent Form (ICF). 2.18-75 years old on the day of signing the ICF. 3.Locally advanced/metastatic non-small cell lung cancer diagnosed by histology or cytology. no epidermal growth factor receptor (EGFR) sensitive mutations, anaplastic lymphoma kinase (ALK) gene rearrangement, ROS Proto-oncogene 1 (ROS1) gene fusion. 4.Have stable disease (SD) defined by Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1 after receive at least 2 doses of anti-PD-1/PD-L1 for first-line treatment. 5.Have not received systemic treatment for locally advanced/metastatic NSCLC before immunotherapy. 6.Have measurable target lesions judged by the investigator according to Response Evaluation Criteria In Solid Tumors (RECIST V1.1). 7.0~1 ECOG score. 8.Life expectancy ≥ 12 weeks. 9.Have sufficient organ function, evaluated based on blood routine, renal function, liver function, and coagulation laboratory test results (and have not received blood transfusion or infusion of apheresis components within 14 days before the study drug administration , Erythropoietin, granulocyte colony stimulating factor and other medical support treatments). 10.Women of Childbearing Potential (WOBCP) must undergo a serum pregnancy test within 7 days before the first medication, and the result is negative; WOBCP or men and their WOBCP partners should agree from signing the ICF to the last one. Take effective contraceptive measures within 6 months after taking the study drug. Exclusion Criteria: Before the first administration of the anti-PD-1/PD-L1 reatment: a) have received previous systemic cytotoxic chemotherapy for metastatic disease; b) have received other targeted or biological anti-tumor therapy for metastatic disease ; c) received major surgery (<3 weeks before the first dose); d) received lung radiotherapy >30 Gy within 6 months before the first dose of the trial treatment; e) the first trial treatment Palliative radiotherapy was completed within 7 days before administration. Any other form of anti-tumor therapy is expected during the study period. Have progressive disease (PD) or response(CR or PR) defined by RECIST v1.1 after receive at least 2 doses of anti-PD-1/PD-L1 for first-line treatment. Unable to tolerate anti-PD-1/PD-L1 treatment due to adverse events or other reasons. Unable to swallow FMT capsules. Received antibiotic treatment within 30 days before the planned FMT started. Fecal occult blood test or calprotectin positive; have ulcerative colitis, Crohn's disease, ischemic enteritis, infectious enteritis, etc not suitable to take intestinal bacteria capsules, but not include anti-PD-1/PD-L1-related colitis. Live virus vaccines have been vaccinated within 30 days before the planned treatment. Seasonal influenza vaccine without live virus is allowed. A history of past malignant disease is known, unless the subject receives potentially curative treatment and there is no evidence of disease recurrence within 5 years after starting treatment. Accompanying known active central nervous system (CNS) metastasis and/or cancerous meningitis. According to the standard of Common Adverse Event Terminology (CTCAE) 4th edition, peripheral neuropathy has been ≥2 grade. Severe hypersensitivity reactions to other monoclonal antibody treatments have occurred in the past. Accompanied by active autoimmune diseases, systemic treatment (ie, use of disease modifiers, corticosteroids or immunosuppressive drugs) is required within the past 2 years. Are receiving long-term systemic steroid therapy. Subjects with asthma who require intermittent use of bronchodilators, inhaled steroids, or topical steroid injections are not excluded. Have received any other anti-PD-1 or PD-L1 or PD-L2 drugs or antibodies in the past, or small molecule therapy that targets other immunomodulatory receptors or mechanisms. Participated in any other anti-PD-1/PD-L1 trials and received anti-PD-1/PD-L1 treatment. Such antibodies include (but are not limited to) antibodies against IDO, PD-L1, IL-2R and GITR. Active infections requiring treatment. Known human immunodeficiency virus (HIV) history (known HIV1/2 antibody positive). Accompanied by known active hepatitis B or C. Being pregnant or breastfeeding, or expecting to conceive or conceive during the period of study drug treatment and within the required contraceptive period after the last administration of the study drug. The researcher believes that there are any circumstances that are not suitable for selection.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Qi Chen, MD
Phone
86-17811921405
Email
chenqimd@163.com
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Xizhong Shen, MD, PhD
Organizational Affiliation
Fudan University
Official's Role
Principal Investigator
Facility Information:
Facility Name
Zhongshan Hospital, Fudan University
City
Shanghai
State/Province
Shanghai
ZIP/Postal Code
200032
Country
China

12. IPD Sharing Statement

Plan to Share IPD
Yes
IPD Sharing Plan Description
Yes Individual participant data that underlie the results reported in this article, after deidentification (text, tables, figures, and appendices) will be available from the principal investigator Taotao Liu at shen.xizhong@zs-hospital.sh.cn, beginning 6 months and ending 5 years after the trial results were published. The study protocol and statistical analysis plan are available online from https://clinicaltrials.gov/. All proposals requesting data access will need to specify how it is planned to use the data, and all proposals will need approval of all investigators before data release.
IPD Sharing Time Frame
Beginning 6 months and ending 5 years after the trial results were published.
IPD Sharing Access Criteria
All proposals requesting data access will need to specify how it is planned to use the data, and all proposals will need approval of all investigators before data release.
IPD Sharing URL
http://clinicaltrials.gov/

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Gut Microbiota Reconstruction for NSCLC Immunotherapy

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