Stool Transplant to Control Treatment-related Diarrhea
Fecal Microbiota Transplantation (FMT)
About this trial
This is an interventional treatment trial for Fecal Microbiota Transplantation (FMT) focused on measuring Immune Checkpoint Inhibitor (ICI)-Related Diarrhea, 20-242
Eligibility Criteria
Inclusion Criteria:
- ≥ 18 years old
- Patient has been treated with immune checkpoint inhibitors (ICI), including anti-CTLA-4, anti-PD-1 and anti-PDL-1 therapy for any malignant indication
- Patient has developed diarrhea ≥ Grade 2 attributed to ICI
- Patient has diarrhea ≥ Grade 2 attributed to ICI, that persists despite treatment with corticosteroids for at least 72 hours and/or at least one dose of a biologic medication, such as infliximab or vedolizumab, with symptoms that persist or recur at least 72 hours post-infusion ° If no to the above, patient has a contraindictation to immunosuppressive treatment
Exclusion Criteria:
- Active GI infection, including untreated viral, bacterial or fungal or alternative identified cause(s) of diarrhea.
- Antibiotic exposure within 48 hours prior to FMT
Expected prolonged compromised immunity indicated by at least one of the below:
- Known HIV infection with CD4 count <240
- ANC <1000/mm3 (use of growth factors to raise ANC is acceptable)
- Seronegative for EBV or CMV (i.e. EBV IgG negative or CMV IgG negative)
Contraindications to anesthesia for procedure indicated by at least one of the below:
- Serious cardiopulmonary comorbidities
- Inability to tolerate anesthesia
Pregnancy
- Patient is pregnant
- Women of childbearing potential should not have plans to became pregnant or breastfeed an infant and must agree to use a highly effective method of birth control until 2 months after treatment with FMT (e.g. barrier method, oral or parenteral contraceptives, a vasectomized partner, or abstinence from sexual intercourse)
- Severe food allergies
Sites / Locations
- Memorial Sloan Kettering Cancer Center
Arms of the Study
Arm 1
Experimental
Fecal Microbiota Transplantation (FMT)
Study subjects will undergo standard bowel preparation and diagnostic colonoscopy with routine biopsies for pathologic assessment. FMT will be performed at the proximal extent of the colon reached, according to the same protocol used in prior randomized studies. FMT will use healthy donor stool provided by OpenBiome, a nonprofit 501(c)(3) organization that provides clinicians and hospitals with screened, filtered and frozen stool to be used for FMT. Routine clinical and research biopsies will be collected during the FMT colonoscopy procedure.