Fecal Microbiota Transplantation With Immune Checkpoint Inhibitors in Lung Cancer
Primary Purpose
Metastatic Lung Cancer
Status
Recruiting
Phase
Phase 2
Locations
Israel
Study Type
Interventional
Intervention
Antibiotics
FMT (Fecal Microbiota Transplantation)
Sponsored by
About this trial
This is an interventional treatment trial for Metastatic Lung Cancer focused on measuring Fecal microbiome transplant, Metastatic lung cancer
Eligibility Criteria
Patient (Recipient) Inclusion Criteria:
- A histologically confirmed diagnosis of malignancy.
- Patients over the age of 18.
- Patients planning to be treated with chemotherapy, immune checkpoint inhibitors and/or targeted therapy.
- Eastern Cooperative Oncology Group (ECOG) Performance Status 0-2
- Able to provide written informed consent.
Patient (Recipient) Exclusion Criteria:
- Severe or life-threatening food allergy (e.g. nuts, seafood)
- Allergy or other contraindication to omeprazole, investigational medicinal product, or placebo ingredients
- Treatment with pre- or probiotics in the four weeks prior to randomization.
Severe immunodeficiency:
- Systemic chemotherapy <30 days from baseline
- Known neutropenia with absolute neutrophils <1.0x109 cells/µL
- Prolonged treatment with corticosteroids (equivalent to prednisone >60mg daily for >30 days) within 8 weeks of randomization
- Swallowing disorder, oral-motor discoordination, inability to swallow capsules
- Pregnant or breastfeeding or expecting to conceive or father children within the trial's projected duration, starting from the pre-screening or screening visit through to 120 days after the last dose of trial treatment.
Donor Inclusion Criteria:
- A histologically confirmed diagnosis of malignancy.
- Over the age of 18.
- Treated with immune checkpoint inhibitors and with a full response.
- Currently attending medical follow-ups
Donor Exclusion Criteria:
- Has not consumed any antimicrobials within the past 3 months
- No prior exposure to HIV or viral hepatitis or suffering from tuberculosis/latent tuberculosis
- No risk factors for blood-borne viruses, including high-risk sexual behavior, use of illicit drugs, any tattoo/body piercing/needlestick injury/blood transfusion/acupuncture, all within the past 6 months
- No signs or symptoms consistent with Coronavirus disease 19 (COVID-19) or a nose/throat and/or stool sample with detectable Coronavirus disease 2 (CoV-2)
- Has not received a live attenuated vaccine within the past 6 months
- No underlying gastrointestinal conditions/symptoms (e.g., history of IBD, irritable bowel syndrome (IBS), chronic diarrhea, chronic constipation, coeliac disease, bowel resection or bariatric surgery)
- No acute diarrhea/gastrointestinal symptoms within the 2 weeks prior to donating
- No family history of any significant gastrointestinal conditions (e.g., family history of inflammatory bowel disease (IBD) or colorectal cancer)
- No history of atopy (e.g., asthma, eosinophilic disorders)
- Does not suffer from any systemic autoimmune conditions
- Does not start any new treatment regimens within 2 weeks of fecal collection
- No neurological or psychiatric conditions or known risk for prion disease
- No history of chronic pain syndromes, including chronic fatigue syndrome and fibromyalgia
- No history of receiving growth hormone, insulin from cows or clotting factor concentrates
- Has not received an experimental drug or vaccine within the past 6 months
- No history of travel to tropical countries within the past 6 months
Sites / Locations
- Soroka Medical CenterRecruiting
- Rabin Medical Center
Arms of the Study
Arm 1
Arm 2
Arm Type
Experimental
No Intervention
Arm Label
standard of care (SoC) (IO±CTX) + FMT
standard-of-care treatment
Arm Description
Subjects assigned to Arm 1 will be required to swallow FMT capsules in a regimen of ten capsules in the morning and ten capsules in the afternoon on day 1 of the first (chemo-)immunotherapy cycle, and then every three weeks. abbreviation: Immuno-Oncology (IO) Chemotherapy (CTX)
Subjects will receive standard-of-care treatment only.
Outcomes
Primary Outcome Measures
Progression-free Survival (PFS)
PFS is defined as the time passed from screening until the date of progressive disease (PD) or death from any cause. Imaging will be performed using computed tomography (CT) and/or Positron emission tomography (PET).
Secondary Outcome Measures
Overall Survival (OS)
OS is defined as the time passed from randomization until death from any cause.
Objective response rate (ORR)
ORR is defined as the percentage of subjects who had a complete response (CR) or partial response (PR), as defined by ir-RECIST v1.1, and is based on the best response obtained.
Rate of Disease Control
Rate of Disease Control is defined as the percentage of subjects who had a complete response (CR), partial response (PR), or stable disease (SD), as defined by ir-RECIST v1.1.
Microbiome analysis
Microbiome analysis of the stool of donors and recipients (before and after FMT) to reveal the optimum microbiome-based components to significantly increase cancer immunotherapy efficacy
Serum antibody levels and lymphocyte subpopulation distribution
Analysis of serum antibodies and blood lymphocyte repertoires to be correlated to gut microbes and yeasts via blood samples of donors and recipients at several timepoints prior and post FMT induction
Safety and feasibility
Number of adverse events and serious adverse events related definitely to fecal microbiota transplantation (FMT).
Full Information
NCT ID
NCT05502913
First Posted
August 8, 2022
Last Updated
September 27, 2023
Sponsor
Soroka University Medical Center
Collaborators
Biotax Labs LTD, Israel Cancer Association
1. Study Identification
Unique Protocol Identification Number
NCT05502913
Brief Title
Fecal Microbiota Transplantation With Immune Checkpoint Inhibitors in Lung Cancer
Official Title
Fecal Microbiota Transplantation to Improve Efficacy of Immune Checkpoint Inhibitors in Metastatic Lung Cancer
Study Type
Interventional
2. Study Status
Record Verification Date
September 2023
Overall Recruitment Status
Recruiting
Study Start Date
September 1, 2023 (Actual)
Primary Completion Date
June 30, 2025 (Anticipated)
Study Completion Date
June 30, 2028 (Anticipated)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Soroka University Medical Center
Collaborators
Biotax Labs LTD, Israel Cancer Association
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
Immunotherapy has recently become a main-stream treatment option in cancer care, with improved clinical outcomes in many malignancies, especially that of lung cancer. The long-term benefits of this treatment however are limited. There is therefore a critical need to distinguish predictive biomarkers of response from those of resistance, and to develop synergistic strategies for improved therapeutic response. Strong emerging evidence indicates that the gut microbiome has the ability to influence response to immunotherapy. Unlike tumor genomics, the gut microbiome is modifiable, and thus its modulation to enhance response to immunotherapy is an attractive therapeutic strategy.
Working hypothesis: Fecal Microbiota Transplant (FMT) treatment in conjunction with standard (chemo-)immunotherapy as a first-line treatment for metastatic lung cancer enhances disease control rate.
The main objective of this study is to evaluate the safety and efficacy of Fecal Microbiota Transplant (FMT) in altering response to immunotherapy in patients with metastatic lung cancer. The overall goal is to determine microbiome compositional and gene-content changes in patients who respond more efficiently to immunotherapy subsequent to FMT. This understanding may lead to future microbiome-based treatments in combination with immunotherapy to significantly increase lung cancer treatment efficacy. In this prospective clinical and molecular study, we will perform an in-depth analysis of the potential role of FMT in the context of immunotherapy.
Detailed Description
Only a small subset of tumor types benefit from immune checkpoint inhibitor therapy, where most responders eventually develop resistance. Oral administration of Fecal Microbiota Transplantation (FMT) from treatment-responsive patients has been found to considerably improve Programmed death-ligand 1 (PD-L1)-based immunotherapy outcomes as well as inhibit tumor growth through augmented dendritic cell and T cell responses.
This study aims to investigate the safety and efficacy of FMT treatment combined with first-line (chemo-)immunotherapy in metastatic lung cancer. The study will include a thorough microbiome composition analysis of FMT donors and recipients to be correlated to clinical outcomes. In addition, blood samples will be analyzed using a novel commensal antigen microarray for rapid serum profiling.
Patients with metastatic malignancy who completely respond to immunotherapy will serve as the fecal implant donors. Dr. Arik Segal's Lab will produce capsules with one donor/capsule. In an open-label approach, patients will receive FMT on the first day of (chemo-)immunotherapy cycle one and every 3-4 weeks based on the specific (chemo-)immunotherapy protocol. Before FMT treatment, participants will receive active antibiotics. The second arm will receive standard-of-care treatment only. Study participants will be evaluated throughout the study using imaging, laboratory, vital signs, and disease status assessments until the end of the study.
Stool samples from study participants will be collected before the start of treatment during the (chemo-)immunotherapy cycle and at the end of treatment for sequencing and bioinformatics analysis of the microbiome. Blood samples will be collected from all donors at the study start and from all recipients at recruitment, on the day of each FMT administration, and at the end of treatment.
Statistics:
A one-sided test for differences in proportions and type I error of 0.05 will have a power of 88% to detect a 30% difference in response between the FMT and placebo group, for a total of 80 randomized patients, 40 in each treatment group stratified by PD-L1 status.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Metastatic Lung Cancer
Keywords
Fecal microbiome transplant, Metastatic lung cancer
7. Study Design
Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
80 (Anticipated)
8. Arms, Groups, and Interventions
Arm Title
standard of care (SoC) (IO±CTX) + FMT
Arm Type
Experimental
Arm Description
Subjects assigned to Arm 1 will be required to swallow FMT capsules in a regimen of ten capsules in the morning and ten capsules in the afternoon on day 1 of the first (chemo-)immunotherapy cycle, and then every three weeks.
abbreviation: Immuno-Oncology (IO) Chemotherapy (CTX)
Arm Title
standard-of-care treatment
Arm Type
No Intervention
Arm Description
Subjects will receive standard-of-care treatment only.
Intervention Type
Drug
Intervention Name(s)
Antibiotics
Other Intervention Name(s)
Rifaximin
Intervention Description
Recipients will undergo bowel preconditioning with antibiotics (Rifaximin) following randomization.
Intervention Type
Other
Intervention Name(s)
FMT (Fecal Microbiota Transplantation)
Intervention Description
FMT involves the transplantation of fecal bacteria from a screened donor to a recipient. This will be achieved per os in the form of a capsule containing freeze-dried stool obtained from the donor.
Primary Outcome Measure Information:
Title
Progression-free Survival (PFS)
Description
PFS is defined as the time passed from screening until the date of progressive disease (PD) or death from any cause. Imaging will be performed using computed tomography (CT) and/or Positron emission tomography (PET).
Time Frame
up to 2 years
Secondary Outcome Measure Information:
Title
Overall Survival (OS)
Description
OS is defined as the time passed from randomization until death from any cause.
Time Frame
up to 4 years
Title
Objective response rate (ORR)
Description
ORR is defined as the percentage of subjects who had a complete response (CR) or partial response (PR), as defined by ir-RECIST v1.1, and is based on the best response obtained.
Time Frame
From randomization (Day 0) until end of study
Title
Rate of Disease Control
Description
Rate of Disease Control is defined as the percentage of subjects who had a complete response (CR), partial response (PR), or stable disease (SD), as defined by ir-RECIST v1.1.
Time Frame
up to 2 years
Title
Microbiome analysis
Description
Microbiome analysis of the stool of donors and recipients (before and after FMT) to reveal the optimum microbiome-based components to significantly increase cancer immunotherapy efficacy
Time Frame
up to 2 years
Title
Serum antibody levels and lymphocyte subpopulation distribution
Description
Analysis of serum antibodies and blood lymphocyte repertoires to be correlated to gut microbes and yeasts via blood samples of donors and recipients at several timepoints prior and post FMT induction
Time Frame
up to 2 years
Title
Safety and feasibility
Description
Number of adverse events and serious adverse events related definitely to fecal microbiota transplantation (FMT).
Time Frame
up to 2 years
10. Eligibility
Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Patient (Recipient) Inclusion Criteria:
A histologically confirmed diagnosis of malignancy.
Patients over the age of 18.
Patients planning to be treated with chemotherapy, immune checkpoint inhibitors and/or targeted therapy.
Eastern Cooperative Oncology Group (ECOG) Performance Status 0-2
Able to provide written informed consent.
Patient (Recipient) Exclusion Criteria:
Severe or life-threatening food allergy (e.g. nuts, seafood)
Allergy or other contraindication to omeprazole, investigational medicinal product.
Treatment with pre- or probiotics in the four weeks prior to randomization.
Severe immunodeficiency:
Systemic chemotherapy <30 days from baseline
Known neutropenia with absolute neutrophils <1.0x109 cells/µL
Prolonged treatment with corticosteroids (equivalent to prednisone >60mg daily for >30 days) within 8 weeks of randomization
Swallowing disorder, oral-motor discoordination, inability to swallow capsules
Pregnant or breastfeeding or expecting to conceive or father children within the trial's projected duration, starting from the pre-screening or screening visit through to 120 days after the last dose of trial treatment.
Donor Inclusion Criteria:
A histologically confirmed diagnosis of malignancy.
Over the age of 18.
Treated with immune checkpoint inhibitors and with a full response.
Currently attending medical follow-ups
Donor Exclusion Criteria:
Has not consumed any antimicrobials within the past 3 months
No prior exposure to HIV or viral hepatitis or suffering from tuberculosis/latent tuberculosis
No risk factors for blood-borne viruses, including high-risk sexual behavior, use of illicit drugs, any tattoo/body piercing/needlestick injury/blood transfusion/acupuncture, all within the past 6 months
No signs or symptoms consistent with Coronavirus disease 19 (COVID-19) or a nose/throat and/or stool sample with detectable Coronavirus disease 2 (CoV-2)
Has not received a live attenuated vaccine within the past 6 months
No underlying gastrointestinal conditions/symptoms (e.g., history of IBD, irritable bowel syndrome (IBS), chronic diarrhea, chronic constipation, coeliac disease, bowel resection or bariatric surgery)
No acute diarrhea/gastrointestinal symptoms within the 2 weeks prior to donating
No family history of any significant gastrointestinal conditions (e.g., family history of inflammatory bowel disease (IBD) or colorectal cancer)
No history of atopy (e.g., asthma, eosinophilic disorders)
Does not suffer from any systemic autoimmune conditions
Does not start any new treatment regimens within 2 weeks of fecal collection
No neurological or psychiatric conditions or known risk for prion disease
No history of chronic pain syndromes, including chronic fatigue syndrome and fibromyalgia
No history of receiving growth hormone, insulin from cows or clotting factor concentrates
Has not received an experimental drug or vaccine within the past 6 months
No history of travel to tropical countries within the past 6 months
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Ismaell Massalha, M.D.
Phone
+972526995934
Email
ismaell@post.bgu.ac.il
First Name & Middle Initial & Last Name or Official Title & Degree
Amichay Meirovitz, Prof.
Phone
+972528805922
Email
amichaym@gmail.com
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Ismaell Massalha, MD
Organizational Affiliation
Soroka University Medical Center
Official's Role
Principal Investigator
Facility Information:
Facility Name
Soroka Medical Center
City
Beer sheva
Country
Israel
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Ismaell Massalha, M.D.
Facility Name
Rabin Medical Center
City
Petah Tikva
Country
Israel
Individual Site Status
Not yet recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Mor Moskovitz, MD
12. IPD Sharing Statement
Plan to Share IPD
No
Citations:
PubMed Identifier
32732879
Citation
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Results Reference
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Results Reference
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Fecal Microbiota Transplantation With Immune Checkpoint Inhibitors in Lung Cancer
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