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Stool Transplant to Control Treatment-related Diarrhea

Primary Purpose

Fecal Microbiota Transplantation (FMT)

Status
Active
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
Fecal Microbiota Transplantation (FMT)
Sponsored by
Memorial Sloan Kettering Cancer Center
About
Eligibility
Locations
Arms
Outcomes
Full info

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

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

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

Arm Type

Experimental

Arm Label

Fecal Microbiota Transplantation (FMT)

Arm Description

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.

Outcomes

Primary Outcome Measures

Incidence of fecal microbiota transplantation (FMT)-related adverse events
will be grading according to CTCAE 5.0.1

Secondary Outcome Measures

Full Information

First Posted
May 10, 2021
Last Updated
October 3, 2023
Sponsor
Memorial Sloan Kettering Cancer Center
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1. Study Identification

Unique Protocol Identification Number
NCT04883762
Brief Title
Stool Transplant to Control Treatment-related Diarrhea
Official Title
Fecal Microbiota Transplantation (FMT) for Immune Checkpoint Inhibitor (ICI)-Related Diarrhea: A Pilot Study
Study Type
Interventional

2. Study Status

Record Verification Date
October 2023
Overall Recruitment Status
Active, not recruiting
Study Start Date
May 10, 2021 (Actual)
Primary Completion Date
May 2026 (Anticipated)
Study Completion Date
May 2026 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Memorial Sloan Kettering Cancer Center

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No

5. Study Description

Brief Summary
This study will test the safety, effectiveness, and feasibility of a treatment called fecal microbiota transplantation (FMT) to reduce the symptoms of ICI-related diarrhea. FMT uses a liquid preparation of stool collected from a healthy donor with normal (healthy) bacteria; this liquid is infused into the small or large intestine of a recipient during a colonoscopy procedure. The study researchers think that the healthy bacteria in the transplanted stool will grow and replace the unhealthy bacteria and return the intestines and colon of the recipient to a healthy state.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Fecal Microbiota Transplantation (FMT)
Keywords
Immune Checkpoint Inhibitor (ICI)-Related Diarrhea, 20-242

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1
Interventional Study Model
Single Group Assignment
Model Description
This is an open-label, non-randomized pilot trial.
Masking
None (Open Label)
Allocation
N/A
Enrollment
4 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Fecal Microbiota Transplantation (FMT)
Arm Type
Experimental
Arm Description
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.
Intervention Type
Biological
Intervention Name(s)
Fecal Microbiota Transplantation (FMT)
Intervention Description
Undergo FMT via colonoscopy.
Primary Outcome Measure Information:
Title
Incidence of fecal microbiota transplantation (FMT)-related adverse events
Description
will be grading according to CTCAE 5.0.1
Time Frame
for 7 days after each FMT

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
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
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
David Faleck, MD
Organizational Affiliation
Memorial Sloan Kettering Cancer Center
Official's Role
Principal Investigator
Facility Information:
Facility Name
Memorial Sloan Kettering Cancer Center
City
New York
State/Province
New York
ZIP/Postal Code
10065
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
Yes
IPD Sharing Plan Description
Memorial Sloan Kettering Cancer Center supports the international committee of medical journal editors (ICMJE) and the ethical obligation of responsible sharing of data from clinical trials. The protocol summary, a statistical summary, and informed consent form will be made available on clinicaltrials.gov when required as a condition of Federal awards, other agreements supporting the research and/or as otherwise required. Requests for deidentified individual participant data can be made beginning 12 months after publication and for up to 36 months post publication. Deidentified individual participant data reported in the manuscript will be shared under the terms of a Data Use Agreement and may only be used for approved proposals. Requests may be made to: crdatashare@mskcc.org.
Links:
URL
http://www.mskcc.org/mskcc/html/44.cfm
Description
Memorial Sloan Kettering Cancer Center

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Stool Transplant to Control Treatment-related Diarrhea

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