MITRIC: Microbiota Transplant to Cancer Patients Who Have Failed Immunotherapy Using Faeces From Clinical Responders

Sponsor

Oslo University Hospital (Other)

Overall Status

Recruiting

CT.gov ID

NCT05286294

Collaborator

(none)

Enrollment

Location

Arm

153

Anticipated Duration (Months)

0.1

Patients Per Site Per Month

Study Details

Study Description

Brief Summary

This is a single-arm, single-center, open-label, phase IIa study evaluating the safety, feasibility and efficacy of Faecal Microbiota Transplant (FMT) to cancer patients not responding to ICI therapy, using ICI-responders as donors.

Condition or Disease	Intervention/Treatment	Phase
Melanoma Stage IV Head and Neck Squamous Cell Carcinoma Cutaneous Squamous Cell Carcinoma MSI-High Clear Cell Renal Cell Carcinoma	Biological: Fecal Microbiota Transplant (FMT)	Phase 2

Detailed Description

Immunotherapy with immune checkpoint inhibitors (ICI) has shown remarkable clinical efficacy against several cancer forms. This includes durable responses in patients with metastatic cancers and no other effective treatment options. However, many patients do not respond. This leaves a major challenge; how to turn non-responders into responders. Herein, this challenge is addressed, by attempting to modulate patients' intestinal microbiota through Faecal Microbiota Transplant (FMT). Data from several preclinical and translational studies have indicated that the microbiota composition is important for the effect of ICIs. Moreover, two recent trials exploring FMT for melanoma patients have suggested acceptable safety and a potential clinical benefit.

Study Design

Study Type:

Interventional

Anticipated Enrollment :

20 participants

Allocation:

N/A

Intervention Model:

Single Group Assignment

Masking:

None (Open Label)

Primary Purpose:

Treatment

Official Title:

MITRIC: Microbiota Transplant to Cancer Patients Who Have Failed Immunotherapy Using Faeces From Clincal Responders

Anticipated Study Start Date :

Mar 1, 2022

Anticipated Primary Completion Date :

Mar 1, 2034

Anticipated Study Completion Date :

Dec 1, 2034

Arms and Interventions

Arm	Intervention/Treatment
Experimental: Treatment Fecal Microbiota Transplant (FMT)	Biological: Fecal Microbiota Transplant (FMT) Fecal Microbiota Transplant (FMT)

Arm

Intervention/Treatment

Experimental: Treatment

Fecal Microbiota Transplant (FMT)

Biological: Fecal Microbiota Transplant (FMT)

Fecal Microbiota Transplant (FMT)

Outcome Measures

Primary Outcome Measures

Safety evaluation of Fecal Microbiota Transplant (FMT) in advanced cancer patients [10 years]
Safety of the intervention (FMT) as assessed by the incidence, nature, and severity of Adverse Events (AE) according to NCI CTCAE, version 5.0
Tumor response evaluation [10 years]
Objective Tumor Response Rate (ORR) as assessed by iRECIST in PP population

Secondary Outcome Measures

Feasibility evaluation of FMT for advanced cancer patients [10 years]
The percentage of included patients that receive i) at least two FMT, ii) the scheduled number of FMT until End of Intervention (EOI)
Overall survival (OS) [10 years]
Clinical response estimation
Objective Tumor Response Rate (ORR) [10 years]
Clinical response estimation
Progression Free Survival (PFS) [10 years]
Clinical response estimation
Durable response rate (DRR) [10 years]
Clinical response estimation
Clinical benefit range (CBR) [10 years]
Clinical response estimation
Duration of objective response (DOR) [10 years]
Clinical response estimation
Implant engraftment estimation, and the effect of repeated FMT [10 years]
Comparison of the patients' gut bacterial composition before and after FMT and in relation to their donors
Evaluation of the effect of therapy on quality of life [10 years]
Patient reported outcomes (PRO) as assessed by EORTC quality of life questionnaire (QLQ-C30)
Evaluation of the effect of therapy on fatigue [10 years]
Patient reported outcomes (PRO) as assessed by Chalder Fatigue Questionnaire (FQ)
Evaluation of the effect of therapy on pain [10 years]
Patient reported outcomes (PRO) as assessed by an 11-point Numerical Rating Scale (NRS) for pain intensity

Other Outcome Measures

Immunological response evaluation [10 years]
Immunological changes in blood (PBMC, serum/plasma), gut and tumor tissue
Explorative assessment of biomarkers or clinical responses and toxicity [10 years]
Microbial gut composition, tumor tissue, blood and gut will be characterized and correlated with treatment outcome. Assessment will include baseline profile and changes after FMT
Investigation of T cell reactivity to neoantigens and microbial antigens [10 years]
T cell receptor binding and T cell reactivity to selected peptides
Characterization of tumor evolution and changes in immunological milieu induced by the FMT and continued ICI therapy [10 years]
Comparison of tumor biopsies at baseline and later time points, by gene and protein profiling

Eligibility Criteria

Criteria

Ages Eligible for Study:

18 Years and Older

Sexes Eligible for Study:

All

Accepts Healthy Volunteers:

Inclusion Criteria:

Participant must be 18 years of age, at the time of signing the informed consent
Histologically confirmed malignant melanoma, CSCC, HNSCC, renal clear cell carcinoma or MSI+ solid cancer
Metastatic disease or local recurrence not curable by standard therapy
PD-L1 positivity (>20% combined positive score) is required for subjects with HNSCC
Measurable disease according to iRECIST
Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1
Progressive disease, as considered by the treating physician, on therapy with PD1/PD-L1 blockers and/or CTLA4-blockers. Indication for further treatment with ICI.
No response to ICI at any time point, during the history of the cancer
Mandatory pre-FMT biopsy and lesion accessible for further biopsies
Life expectancy >3 months
Adequate organ function as defined below:
Hemoglobin > 9 g/dL
Absolute neutrophil count (ANC) ≥ 1.0 x 109/L
Platelet count ≥80 x 109/L
INR≤1.2
Serum bilirubin ≤1.5 x institutional upper limit of normal (ULN).
AST and ALT ≤2.5 x ULN unless liver metastases are present, in which case it must be ≤5x ULN
Albumin >25 g/L
Serum creatinine ≤1.5 X ULN OR measured creatinine clearance (CL) >40 mL/min or Calculated creatinine CL>40 mL/min by the Cockcroft-Gault formula (Cockcroft and Gault 1976) or by 24-hour urine collection for determination of creatinine clearance.
Capable of giving signed informed consent

Exclusion Criteria:

Other cancer within 3 years prior to study entry, with the exception of those with a negligible risk of metastasis or death and treated with expected curative outcome (such as adequately treated carcinoma in situ of the cervix or basal or squamous cell skin cancer)
Spinal cord compression not definitively treated with surgery and/or radiation, or previously diagnosed and treated spinal cord compression without evidence that disease has been clinically stable for > 2 weeks prior to first FMT
Uncontrolled pleural effusion, pericardial effusion, or ascites. Patients with indwelling catheters are allowed
Uncontrolled tumor-related pain. Patients requiring narcotic pain medication must be on a stable regimen at study entry. Symptomatic lesions (e.g., bone metastases or metastases causing nerve impingement) amenable to palliative radiotherapy should be treated prior to enrolment. Asymptomatic metastatic lesions whose further growth would likely cause functional deficits or intractable pain (e.g., epidural metastasis that is not presently associated with spinal cord compression) should be considered for loco-regional therapy if appropriate prior to enrolment.
Significant cardiovascular disease, such as New York Heart Association (NYHA) cardiac disease (Class II or greater), myocardial infarction within 3 months prior to study entry, unstable arrhythmias, or unstable angina. Patients with a known left ventricular ejection fraction (LVEF) < 40% will be excluded. Patients with known coronary artery disease, congestive heart failure not meeting the above criteria, or LVEF < 50% must be on a stable medical regimen that is optimized in the opinion of the treating physician, in consultation with a cardiologist if appropriate
Undergone allogeneic stem cell or solid organ transplantation
A positive test for HIV
Active hepatitis B (defined as having a positive hepatitis B surface antigen [HBsAg] test at screening) or hepatitis C. Patients with past hepatitis B virus (HBV) infection or resolved HBV infection (defined as having a negative HbsAg test and a positive antibody to hepatitis B core antigen [anti-HBc] antibody test) are eligible. Patients positive for hepatitis C virus (HCV) antibody are eligible only if polymerase chain reaction (PCR) is negative for HCV RNA.
Active tuberculosis
Ongoing immune-related adverse effects from immunotherapy treatments that are of Grade ≥2, excluding endocrine adverse effects. An ongoing grade 2 cutaneous reaction is allowed.
Severe infection within 14 days prior to first FMT, requiring hospitalization.
Any condition that significantly increases the risk of perforation during endoscopy for FMT.
A history or current evidence of any condition, therapy, or laboratory abnormality that might confound the results of the trial, interfere with the subject's participation for the full duration of the trial, or is not in the best interest of the subject to participate, in the opinion of the treating Investigator.
Known psychiatric or substance abuse disorders that would interfere with cooperation and the requirements of the trial
A requirement of systemic antibiotics at the time of study entry.
Received oral or IV antibiotics within 5 days prior to first FMT.
Currently receiving other study therapy that may interfere with the interpretation of data in this study.
Received treatment with systemic corticosteroids or other systemic immunosuppressive medications (including but not limited to prednisone, dexamethasone, cyclophosphamide, azathioprine, methotrexate, thalidomide, and anti-tumor necrosis factor [TNF] agents) within 10 days prior to first FMT, or anticipated requirement for systemic immunosuppressive medications during the trial. A daily dose equivalent to ≤10mg prednisolone is allowed.
Patients who have received acute, low-dose, systemic immunosuppressant medications (e.g., a one-time dose of dexamethasone for nausea) may be enrolled in the study.
Patients with a history of allergic reaction to IV contrast requiring steroid pre-treatment should have baseline and subsequent tumor assessments performed using MRI.
The use of inhaled corticosteroids for chronic obstructive pulmonary disease, mineralocorticoids (e.g., fludrocortisone) for patients with orthostatic hypotension, and low-dose supplemental corticosteroids for adrenocortical insufficiency are allowed.
Pregnant or breastfeeding
Any reason why, in the opinion of the investigator, the patient should not participate