Fecal Microbiota Transplantation for Kidney Cancer (PERFORM Trial)

Palo Alto (17 mi)

Overseen byRicardo Fernandes, MD

Age: 18+

Sex: Any

Travel: May be covered

Time Reimbursement: Varies

Trial Phase: Phase 1

Waitlist Available

Sponsor: London Health Sciences Centre Research Institute and Lawson Research Institute of St. Joseph's

No Placebo Group

Breakthrough Therapy

Approved in 3 jurisdictions

Trial Summary

What is the purpose of this trial?Cancer immunotherapy has been largely adopted in oncology patient management in the last decade. The deep and long responses to immunotherapy have accelerated the approval of these drugs across multiple disease sites. However, these agents can also be toxic to patients, meaning, the patient will have to discontinue treatment and outcomes could be negatively affected. Recently, a combination of two immunotherapy drugs, ipilimumab and nivolumab (ipi/nivo), has been approved for the treatment of intermediate and poor-risk renal cell carcinoma (RCC) patients. This powerful combination provides survival benefit, however, it can also be highly toxic leading to discontinuation of this treatment. There has been some evidence that these otherwise toxic drugs can be better tolerated by altering the composition of the patients gut bacteria to create a more diverse and healthy microbiome. The current study will involve Fecal Microbiota Transplantation (FMT) before the start of the immunotherapy combination, and during the first two cycles of ipilimumab treatment (the more toxic agent) as supportive therapy to prevent toxicity associated with the ipi/nivo combination. The goal of this project is to study the safety of such FMT combination treatment and reduce occurrence of immune-related toxicities in patients, allowing them to continue their cancer treatments in the hopes of a better outcome. The investigators will also be looking at changes in the immune populations, microbiome profile of patients, response to treatment, and patient survival as secondary objectives.

Eligibility Criteria

This trial is for adults with advanced or metastatic renal cell carcinoma, specifically those at intermediate or poor risk. Participants must be in good physical condition (KPS ≥70%), able to swallow capsules, and have not had certain prior treatments including systemic therapy for RCC. Pregnant individuals, those with immunodeficiency, chronic intestinal diseases, active infections requiring systemic therapy, or a history of serious autoimmune disease are excluded.

Inclusion Criteria

I am able to care for myself but may not be able to do active work.

I can swallow pills.

My kidney cancer has spread and this was confirmed through tissue testing.

My kidney cancer is classified as intermediate or poor risk.

My blood tests show my organs and bone marrow are working well.

Exclusion Criteria

I haven't had radiation for bone metastasis in the last 2 weeks or any radiation in the last 4 weeks.

I have an autoimmune disease that needs steroids or other immune-suppressing drugs.

I cannot receive FMT due to specific health reasons.

I have had lung inflammation treated with steroids or have it now.

I have had treatment for advanced kidney cancer that couldn't be surgically removed.

I have a long-term bowel disease.

I am currently being treated for an infection.

I have been diagnosed with an immune system disorder.

I am not on high-dose steroids or any immunosuppressive drugs.

I am currently using antibiotics or have used them in the last two weeks.

Treatment Details

The study tests if Fecal Microbiota Transplantation (FMT) can reduce the side effects of ipilimumab/nivolumab immunotherapy in kidney cancer patients. The goal is to allow patients to tolerate their cancer treatment better by altering gut bacteria before and during the first two cycles of this powerful but potentially toxic drug combination.

1Treatment groups

Experimental Treatment

Group I: Fecal Microbiota TransplantationExperimental Treatment1 Intervention

Fecal microbiota transplantation combined with approved standard of care treatment with nivolumab and ipilimumab.