To determine whether the fecal microbiota transplant (FMT) capsule can help reverse the resistance of anti-PD-(L)1 treatment in Gastrointestinal (GI) cancer patients.
This study is designed to improve the response rate of anti-PD-(L)1 among patients with anti-PD-(L)1 resistant/refractory digestive (including gullet, stomach and intestine) system cancers through the intervention on their gut microbiota. Healthy people who have the gut microbiota profile similar to the responders of anti-PD-(L)1 therapy will be identified. The gut microbiota of these healthy people will be extracted to product FMT capsule. Gastrointestinal (GI) cancer patients who failed anti-PD-(L)1 treatment will be administrated with anti-PD-1 immunotherapy combined with FMT. The enrolled subjects will firstly receive 1-week of FMT therapy. Subsequently, each anti-PD-1 treatment will be combined with the maintenance dose of FMT capsules to ensure the efficiency of gut microbiota colonization. Each subject will receive anti-PD-1 therapy for 6 cycles. After the completion of both 3 and 6 cycles of therapy, safety and efficacy assessments will be conducted. The subjects who complete 3 cycles of treatment but are clinically evaluated as disease progression will not continue to the following 3 cycles of treatment.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
10
FMT capsules administration starts in the first week of enrollment. Capsules are taken for three consecutive days in the first week. From week 2, anti-PD-1 therapy will be administrated in combination with the maintenance dose of FMT treatment once every two weeks for up to 6 times.
Beijing Cancer Hospital
Beijing, Beijing Municipality, China
Objective Response Rate (ORR)
Number of subjects with objective responses (Complete Response (CR) + Partial Response (PR)) divided by total number of subjects, per iRECIST.
Time frame: 14 weeks
The number of adverse events
The number of adverse events that is related to FMT prior to the first anti-PD-1 immunotherapy treatment.
Time frame: 1 week
Rate of abnormal vital signs and laboratory test results
Rate of abnormal vital signs and laboratory test results that are determined to be clinically significant prior to the first anti-PD-1 immunotherapy treatment.
Time frame: 1 week
Change in T-cells Composition
Compare the changes in CD8+PD-1+T cells, Ki67+CD8+ T cells before and after treatment between response subjects and non-response subjects (evaluated by iRECIST).
Time frame: 14 weeks
Function of T-cells
Compare the changes in cells expressing IFN-γ before and after treatment between response subjects and non-response subjects (per iRECIST).
Time frame: 14 weeks
Association of anti-PD-1 response with gut microbiota
Compare the changes in bacterial abundance and bacterial diversity before and after treatment between response subjects and non-response subjects (per iRECIST).
Time frame: 14 weeks
Rate of abnormal vital signs, physical examination results, 12-lead electrocardiogram and laboratory test results
Rate of abnormal vital signs, physical examination results, 12-lead electrocardiogram and laboratory test results that are determined to be clinically significant from the beginning of the first anti-PD-1 immunotherapy treatment to the end of study.
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Time frame: 14 weeks
Change in subsets of specific and non-specific immune system
Compare the changes in T-cell receptor diversity (quantified by immune repertoire sequencing analyses), CD8+CCR7+CD45RA+T cells, CD4+CCR7+CD45RA+ T cells ,CD4 + Foxp3 + T cells,CD56+NK cells and CD68+ cells before and after treatment between response subjects and non-response subjects (evaluated by iRECIST).
Time frame: 14 weeks
The number of adverse events
The number of adverse events from the beginning of the first anti-PD-1 immunotherapy treatment to the end of study
Time frame: 14 weeks