Combining chemotherapy with stool transplant for advanced pancreatic cancer
An Open-label, Single-arm, Phase 1 Study of the Combination of FMT and Gemcitabine with Nab-paclitaxel As First-line Therapy in Patients with Advanced Pancreatic Ductal Adenocarcinoma.
This study is testing if combining a stool transplant with standard chemotherapy can help people with advanced pancreatic cancer feel better and improve their treatment outcomes.
Quick facts
| Phase | Phase 1 |
|---|---|
| Study type | Interventional |
| Enrollment | 20 (estimated) |
| Ages | 18 Years and up |
| Sex | All |
| Sponsor | London Health Sciences Centre Research Institute OR Lawson Research Institute of St. Joseph's Academic / other |
| Drugs / interventions | chemotherapy, radiation |
| Locations | 1 site (London, Ontario) |
| Trial ID | NCT06393400 on ClinicalTrials.gov |
What this trial studies
This phase 1 trial investigates the safety of combining oral fecal microbiota transplantation (FMT) with standard chemotherapy using gemcitabine and nab-paclitaxel in patients with unresectable or metastatic pancreatic ductal adenocarcinoma (PDAC). The study aims to treat 20 eligible patients and assess clinical outcomes, gut microbiome changes, and systemic immune responses. Participants will receive the combined treatment as first-line therapy, and the trial will be conducted at the Verspeeten Family Cancer Centre in London, Ontario.
Who should consider this trial
Good fit: Ideal candidates are adults aged 18 and older with a confirmed diagnosis of unresectable or metastatic pancreatic ductal adenocarcinoma.
Not a fit: Patients with resectable pancreatic cancer or those who cannot tolerate chemotherapy may not benefit from this study.
Why it matters
Potential benefit: If successful, this approach could enhance the effectiveness of chemotherapy in treating advanced pancreatic cancer.
How similar studies have performed: While the combination of FMT and chemotherapy is a novel approach, similar studies have shown promising results in other cancer types, suggesting potential for success.
Eligibility criteria
Show full inclusion / exclusion criteria
Inclusion Criteria: * Patients must be 18-years old or older * Patients must have a confirmed diagnosis of unresectable or metastatic pancreatic ductal adenocarcinoma. Diagnosis confirmation may include pathologic assessment or radiographic/biomarker determination of PDAC when obtaining a tumour sample is not feasible/successful. The latter case requires review at the Pancreas Multi-disciplinary Case Conference (MCC) * Patients with ECOG performance of 0-2 * Patients who have consented to treatment with first-line gemcitabine with nab-paclitaxel at the discretion of their primary oncologist. Patients must receive at least one dose of both chemotherapy agents to be considered eligible for evaluation. * Patients must be able to provide written informed consent and understand the infectious risks associated with FMT administration * Patients must understand that there are non-infectious risks associated with FMT administration * Ability to ingest capsules * Understand that data regarding the long-term safety risk of FMT are lacking * Have evaluable disease as per RECIST version 1.1 Patients may receive other localized therapies with palliative intent while on therapy to include external beam radiation to areas of metastatic disease. Stratification of outcomes will include identifying patients that receive palliative radiation to the primary tumour itself. Exclusion Criteria: * Previously received cytotoxic chemotherapy with curative or non-curative intent for PDAC * Pregnant or breastfeeding, or expecting to conceive or father children within the projected duration of the trial, starting with the pre-screening or screening visit * Has a diagnosis of immunodeficiency (e.g. HIV, organ transplantation) * Ongoing use of antibiotics or previous use of antibiotics within 7 days prior to the FMT procedure * Probiotic supplements and food products labeled as containing probiotics must be discontinued a minimum of 72 hours before FMT administration and are not permitted during the first 3 months of chemotherapy treatment * Presence of a chronic intestinal disease (e.g. Celiac, malabsorption, primary colonic tumor) * Presence of absolute contra-indications to FMT administration * Toxic megacolon * Severe dietary allergies (e.g. shellfish, nuts, seafood) * Inflammatory bowel disease * Has serious concomitant illnesses, such as: cardiovascular disease (uncontrolled congestive heart failure, uncontrolled hypertension, cardiac ischemia, myocardial infarction, and severe cardiac arrhythmia), bleeding disorders, autoimmune diseases, severe obstructive or restrictive pulmonary diseases, active systemic infections, and inflammatory bowel disorders * This includes HIV or AIDS-related illness, or active HBV and HCV * Has an active infection requiring systemic therapy * Patient has received a live vaccine within 4 weeks prior to the first dose of treatment * Note: Seasonal influenza vaccines for injection are generally inactivated flu vaccines and are allowed; however intranasal influenza vaccines (e.g., Flu-Mist®) are live attenuated vaccines, and are not allowed. * Has known psychiatric or substance abuse disorders that would interfere with cooperation with the requirements of the trial Special considerations include patients who are unable to tolerate the combination of gemcitabine with nab-paclitaxel, and subsequently after starting chemotherapy are transitioned to gemcitabine alone at the discretion of their treating oncologist. Such patients will not be removed or disqualified from continuing in the study but their clinical outcomes will be stratified between those who received nab-paclitaxel with gemcitabine and those who transitioned to gemcitabine alone. In general, this scenario is not expected to commonly occur in this trial.
Where this trial is running
London, Ontario
- Verspeeten Family Cancer Centre (formerly known as the London Regional Cancer Program) London Health Sciences Centre — London, Ontario, Canada (Recruiting)
Study contacts
- Study coordinator: John G Lenehan, MD
- Email: John.Lenehan@lhsc.on.ca
- Phone: 519-685-8640
How to participate
- Review the eligibility criteria above with your treating physician.
- Visit the official trial page on ClinicalTrials.gov for the most current contact information and recruitment status.
- Contact the listed study coordinator or principal investigator to request pre-screening. Pre-screening is free and never obligates you to enroll.