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NCT03819296 | RECRUITING | Clinical Stage 0 Cutaneous Melanoma AJCC v8

Role of Gut Microbiome and Fecal Transplant on Medication-Induced GI Complications in Patients With Cancer
Sponsor:

M.D. Anderson Cancer Center

Brief Summary:

This trial studies the role of the gut microbiome and effectiveness of a fecal transplant on medication-induced gastrointestinal (GI) complications in patients with melanoma or genitourinary cancer. The gut microbiome (the bacteria and microorganisms that live in the digestive system) may affect whether or not someone develops colitis (inflammation of the intestines) during cancer treatment with immune-checkpoint inhibitor drugs. Studying samples of stool, blood, and tissue from patients with melanoma or genitourinary cancer may help doctors learn more about the effects of treatment on cells, and help doctors understand how well patients respond to treatment. Treatment with fecal transplantation may help to improve diarrhea and colitis symptoms.

Condition or disease

Clinical Stage 0 Cutaneous Melanoma AJCC v8

Clinical Stage I Cutaneous Melanoma AJCC v8

Clinical Stage IA Cutaneous Melanoma AJCC v8

Clinical Stage IB Cutaneous Melanoma AJCC v8

Clinical Stage II Cutaneous Melanoma AJCC v8

Clinical Stage IIA Cutaneous Melanoma AJCC v8

Clinical Stage IIB Cutaneous Melanoma AJCC v8

Clinical Stage IIC Cutaneous Melanoma AJCC v8

Clinical Stage III Cutaneous Melanoma AJCC v8

Clinical Stage IV Cutaneous Melanoma AJCC v8

Colitis

Lung Non-Small Cell Carcinoma

Malignant Genitourinary System Neoplasm

Malignant Solid Neoplasm

Pathologic Stage 0 Cutaneous Melanoma AJCC v8

Pathologic Stage I Cutaneous Melanoma AJCC v8

Pathologic Stage IA Cutaneous Melanoma AJCC v8

Pathologic Stage IB Cutaneous Melanoma AJCC v8

Pathologic Stage II Cutaneous Melanoma AJCC v8

Pathologic Stage IIA Cutaneous Melanoma AJCC v8

Pathologic Stage IIB Cutaneous Melanoma AJCC v8

Pathologic Stage IIC Cutaneous Melanoma AJCC v8

Pathologic Stage III Cutaneous Melanoma AJCC v8

Pathologic Stage IIIA Cutaneous Melanoma AJCC v8

Pathologic Stage IIIB Cutaneous Melanoma AJCC v8

Pathologic Stage IIIC Cutaneous Melanoma AJCC v8

Pathologic Stage IIID Cutaneous Melanoma AJCC v8

Pathologic Stage IV Cutaneous Melanoma AJCC v8

Stage 0 Lung Cancer Ajc V8

Stage I Lung Cancer Ajc V8

Stage Ia1 Lung Cancer Ajcc v8

Stage Ia2 Lung Cancer Ajc V8

Stage Ia3 Lung Cancer Ajcc v8

Stage IB Lung Cancer Ajc V8

Stage II Lung Cancer Ajc V8

Stage Iia Lung Cancer Ajcc v8

Stage Iib Lung Cancer Ajcc v8

Stage III Lung Cancer Ajcc v8

Stage IIIA Lung Cancer Ajc V8

Stage IIIB Lung Cancer Ajcc V8

Stage IIic Lung Cancer Ajc V8

Stage IV Lung Cancer Ajcc v8

Stage IVA Lung Cancer Ajcc v8

Stage Ivb Lung Cancer Ajcc v8

Intervention/treatment

Best Practice

Biospecimen Collection

Endoscopic Procedure

Fecal Microbiota Transplantation

Infliximab

Laboratory Biomarker Analysis

Prednisone

Vedolizumab

Phase

PHASE1

Detailed Description:

PRIMARY OBJECTIVES: I. To compare the difference in stool microbiome pattern between patients who develop immune-checkpoint inhibitor (ICPI)-related colitis and patients who don't develop ICPI-related colitis. II. To compare the difference in stool microbiome pattern in patients who developed ICPI-related colitis before and after colitis medical treatment. III. To assess the safety and tolerability and efficacy of fecal microbiota transplantation (FMT). SECONDARY OBJECTIVES: I. To identify and characterize immune profile and genetic factors associated with onset of ICPI-related colitis in blood and colon tissue. II. To identify and characterize immune profile and genetic factors in blood and colon tissue that are associated with quick response of ICPI-related colitis to medical treatment. III. To characterize the endoscopic and histologic features of ICPI-related colitis before and after medical treatment. IV. To document the changes of ICPI-related symptoms and the impact on functioning and quality of life (QoL) from fecal microbiota transplantation by patient-reported outcomes (PRO). V. To assess stool microbiome and cytokine features that are associated with good response to fecal microbiota transplantation. VI. To assess the factors in genetic/immune profile obtained from blood and colon tissue that are associated with good response to fecal microbiota transplantation. VII. To characterize the endoscopic and histologic features of ICPI-related colitis before and after fecal microbiota transplantation. EXPLORATORY OBJECTIVES: I. To identify and characterize immune profile and genetic factors associated with onset of ICPI-related colitis in inflamed colonic mucosa and its matched normal mucosa. II. To characterize the immune profile and genetic factors from the colon tissue in these colitis patients among different histological subtypes. III. To assess the pattern of stool microbiome that is associated with good tumor response to ICPI treatment. IV. To assess the association between stool inflammatory markers (i.e. lactoferrin and calprotectin) and the severity of endoscopic/histologic inflammation. V. To assess the sensitivity and specificity of stool inflammatory markers (i.e. lactoferrin and calprotectin) as an indicators of ICPI-relate colitis response to treatment. VI. To assess the microbiome pattern that triggers the infections on immunosuppressant treatment for ICPI colitis. OUTLINE: PROJECT 1: Patients receive standard of care and undergo collection of stool and blood samples. PROJECT 2: Patients receive prednisone, infliximab, or vedolizumab per standard of care and undergo standard of care endoscopy 2 months after treatment. Patients also undergo collection of stool, blood, and tissue samples. PROJECT 3: Patients undergo fecal microbiota transplant (FMT). After completion of study, patients are followed up periodically.

Study Type : INTERVENTIONAL
Estimated Enrollment : 800 participants
Masking : NONE
Primary Purpose : TREATMENT
Official Title : Role of Microbiome in the Realm of Immune-Checkpoint Inhibitor Induced GI Complications In Cancer Population
Actual Study Start Date : 2021-02-21
Estimated Primary Completion Date : 2025-10-31
Estimated Study Completion Date : 2025-10-31

Information not available for Arms and Intervention/treatment

Ages Eligible for Study: 18 Years
Sexes Eligible for Study: ALL
Accepts Healthy Volunteers:
Criteria
Inclusion Criteria
  • 1. Diagnosis of any stage melanoma, Non-Small Cell Lung Cancer or genitourinary (GU) malignancies (Project 1).
  • 2. Diagnosis of any cancer type (Projects 2 and 3)
  • 3. Treatment with any ICPI agent
  • 4. Ability to understand and willingness to sign an informed consent form and rate surveys
  • 5. Life expectancy \> 4 months (Project 3)
  • 6. ICPI-related diarrhea and/or colitis of any grade with or without concurrent non- GI toxicity as the toxicity group (project 1)
  • 7. Patients with no organ toxicity as the control group (project 1)
  • 8. ICPI-related colitis and/or diarrhea of grade ≥ 2 as GI toxicity (initial episode or recurrence) receiving standard treatment of immunosuppressive agents (steroid, infliximab, vedolizumab, or ustekinumab) any time during the colitis disease course until sustained resolution of GI toxicity, or one- year time point after enrollment (Project 2)
  • 9. ICPI-related colitis and/or diarrhea of grade ≥ 2 as GI toxicity without involvement of non- GI toxicity within 45 days prior to FMT (Project 3)
  • 10. ICPI-related colitis and/or diarrhea of grade ≥ 2 within 45 days prior to FMT with ANY of the following characteristics (project 3)
    • (i) refractory to treatment of steroid and two doses of non-steroidal immunosuppressants e.g. infliximab, vedolizumab or ustekinumab,
    • (ii) contraindication for immunosuppressive treatment,
    • (iii) recurrence after successful initial treatment,
    • (iv) recurrent symptoms once steroid is tapered down/off or diarrhea/colitis symptoms are steroid dependent, or
    • (v) patients with a history of refractory ICPI-related colitis and/or diarrhea to medical treatment, even if they have improved symptoms from supportive care within 45 days prior to FMT
    • 11. No concern for active concomitant GI infection for the ICPI diarrhea/colitis work up at the time of protocol therapy initiation as confirmed by stool tests or as per the treating physician based on clinical presentation (project 3)
    • 12. Patient who has been cleared for enrollment by Infectious Diseases consultant or treating physician if positive infection workup or screening tests (e.g. lifelong positive T-spot due to BCG inoculation, chronic colonization) prior to initiation of diarrhea/colitis treatment (project 3)
    Exclusion Criteria
    • 1. Age younger than 18 years
    • 2. History of inflammatory bowel disease, and/or radiation enteritis or colitis with active disease status at the time of study treatment initiation
    • 3. Pregnant and breastfeeding women
    • 4. Women of child-bearing potential who have positive urine or serum pregnancy test or refuse to do pregnancy test unless last menstrual cycle was \> 1 year prior to consent and/ or clear documentation states that patient is peri- or post-menopausal or there was recent supporting objective evidence of 'no pregnancy' status (e.g. blood or imaging) within 30 days prior to date of study treatment
    • 5. Patients who develop concurrent non- GI toxicity at the time of FMT treatment (project 3)
    • 6. Patients with active bacterial or fungal infection (Project 3)
    • 7. Donors at risk for monkeypox infection and/ or exposure as determined by a questionnaire (Project 3)
    • Withdrawal Criteria
    • 1. Patients may withdraw from the trial at any time
    • 2. Patients who develop GI perforation or toxic colitis that require surgery from ICPI colitis
    • 3. In project 3, if the first 30% of cases fail the fecal transplant treatment, then project 3 will be terminated
Role of Gut Microbiome and Fecal Transplant on Medication-Induced GI Complications in Patients With Cancer

Location Details

NCT03819296

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Locations

RECRUITING

United States, Texas

M D Anderson Cancer Center

Houston, Texas, United States, 77030