Probiotics Combined With Chemotherapy for Patients With Advanced NSCLC

A Prospective Multicenter Double-blind Randomized Clinical Trial of Probiotics Combined With Chemotherapy in the Treatment of Patients With Advanced Non-small Cell Lung Cancer

Based on the theory of intestinal lung axis, the effect of new therapy on patients with advanced NSCLC was observed by adjusting the intestinal micro-ecology and combining existing platinum-based doublet chemotherapy.

Study Overview

• Status: Not yet recruiting
• Conditions: Probiotics Plus Chemotherapy
• Intervention / Treatment: Drug: bifico; Drug: placebo

Detailed Description

OBJECTIVES:

Primary outcomes To compare progression free survival (PFS) and objective response rate (ORR) in patients with stage IIIB or IV non-small cell lung cancer receiving Bifico versus placebo plus platinum-based doublet chemotherapy for first-line treatment.

Secondary outcomes To compare overall survival (OS) between the two arms； To evaluate the nature, severity, and frequency of toxicities between arms； To correlate the blood markers and fecal microbiome (at diagnosis) with outcomes and response.

OUTLINE:

This is a randomized, double-blind, placebo-controlled clinical trial. Patients are stratified according to center, performance status (0 or 1), tobacco use (never vs past or present), weight loss (< 5% vs ≥ 5% or unknown). Patients are randomized to 1 of 2 treatment arms.

BIFICO Group: Patients receive Bifico (420mg, 3 times a day, p.o) plus platinum-based doublet chemotherapy. Chemotherapy repeats every 3 weeks in the absence of disease progression or unacceptable toxicity.

Placebo Group: Patients receive placebo (420mg, 3 times a day, p.o) plus platinum-based doublet chemotherapy. Chemotherapy repeats every 3 weeks in the absence of disease progression or unacceptable toxicity.

Blood, tissue and fecal samples are collected and examined for biomarkers, gene mutations and fecal microbiome, and may be banked for future studies.

• Study Type: Interventional
• Enrollment (Anticipated): 180
• Phase: Phase 3

Contacts and Locations

• Study Contact: Name: Lihong Fan, Doctor; Phone Number: +86 18001763288; Email: fanlih@aliyun.com

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 75 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

1. Patients have voluntarily to join the study and give written informed consent for the study.
2. Histologically documented, unresectable, inoperable, locally advanced, recurrent or metastatic stage IIIB or IV Non-Small Cell Lung Cancer (NSCLC).
3. A cytologic diagnosis is acceptable (i.e., FNA or pleural fluid cytology).
4. Received platinum-based doublet chemotherapy for first-line treatment.
5. At least 1 unidimensionally measurable lesion meeting Response Evaluation Criteria in Solid Tumours (RECIST) criteria.
6. Patients did not receive systemic anti-cancer therapy previously, including traditional Chinese medicine.
7. Able to comply with study and follow-up procedures.
8. Aged 18 to 75 years, ECOG PS: 0~1, estimated survival duration more than 3 months.
9. Major organ function (1) For regular test results (no blood transfusion within 14 days): Hemoglobin（HB）≥90g/L; Absolute neutrophils count（ANC）≥1.5×10^9/L; Blood platelets（PLT）≥80×10^9/L; (2) Biochemical tests results defined as follows: Total bilirubin（TBIL）≤1.5 times the upper limit of normal (ULN); Alanine aminotransferase（ALT）and aspartate amniotransferase AST≤2.5ULNliver metastases if anyALT和AST≤5ULN; Creatinine (Cr)≤1.5ULN or Creatinine Clearance rate (CCr)≥60 ml/min; (3) Patients voluntarily joined the study, signed informed consent, and good compliance.

Exclusion Criteria:

1. Small cell lung cancer (including lung cancer mixed with small cell carcinoma and non-small cell carcinoma).
2. Previously received anti-tumor treatment of any other organs, including radiotherapy, chemotherapy, immunotherapy and Chinese medicine treatment (except for previous radical treatment and no recurrence (treatment of malignant tumor with metastasis time ≥ 5 years).
3. having a variety of factors affecting oral medication (such as inability to swallow, postoperative gastrointestinal resection, chronic diarrhea, intestinal obstruction, etc.).

4. Patients with any severe and/or uncontrolled diseases, such as:

   Unstable angina pectoris, symptomatic congestive heart failure, myocardial infarction within months prior to randomization, severe uncontrolled arrhythmia; active or uncontrolled serious infections; liver diseases such as cirrhosis, decompensated liver disease, acute or chronic active hepatitis; Active tuberculosis, etc.; uncontrolled hypercalcemia (greater than 1.5 mmol/L calcium or calcium greater than 12 mg/dL or corrected serum calcium greater than ULN), or symptomatic hypercalcemia requiring continued bisphosphonate therapy; Long-term unhealed wounds or fractures.

5. Those who have a history of psychotropic substance abuse and are unable to quit or have a mental disorder.
6. Participated in other clinical trials within four weeks.
7. A history of immunodeficiency, including HIV positive or other acquired, congenital immunodeficiency disease, or a history of organ transplantation.
8. It is known that there are severe allergic reactions (≥3 grade) to the active ingredients and or any excipients of other test drugs such as pemetrexed, gemcitabine, carboplatin, cisplatin.
9. Use of immunosuppressive drugs within 4 weeks prior to enrollment, excluding nasal glucocorticoids or other routes of topical glucocorticoids or physiological doses of systemic glucocorticoids.
10. known or suspected active autoimmune diseases (congenital or acquired), such as interstitial pneumonia, uveitis, enteritis, hepatitis, pituititis, vasculitis, nephritis, thyroiditis, etc. (Vitiligo or Childhood asthma has been completely relieved, and patients who do not need any intervention after adulthood can be enrolled; patients with well-controlled insulin type I can also be enrolled).
11. Allogeneic organ transplantation (except corneal transplantation) or allogeneic hematopoietic stem cell transplantation is known.
12. The history of non-infectious pneumonia requiring glucocorticoid therapy or the current presence of interstitial lung disease in the first year prior to enrollment.
13. Accompanied by other malignant tumors (except for radical treatment, such as cervical carcinoma in situ, non-melanoma skin cancer, etc.); According to the investigator's judgment, there are serious concomitant diseases that endanger the safety of the patient or affect the patient's completion of the study.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Quadruple

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: BIFICO Group; The intervention group patients receive platinum-based doublet chemotherapy plus BIFICO (Dose: 420mg, 3 times a day, p.o)	Drug: bifico; Patients in BIFICO group receive platinum-based doublet chemotherapy for first-line treatment chemotherapy plus Bifico.
Placebo Comparator: Control Gruop; The control group patients receive platinum-based doublet chemotherapy plus Placebo (Dose: 420mg, 3 times a day, p.o)	Drug: placebo; Patients in control group receive platinum-based doublet chemotherapy for first-line treatment chemotherapy plus Placebo.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Objective Response Rate (ORR)	Response were evaluated in this study using the revised international criteria (1.1) proposed by the RECIST (Response Evaluation Criteria in Solid Tumours) committee. BEST RESPONSE from the start of study treatment until the end of treatment were reported. Objective response rate is the sum of CR + PR divided by the total number of patients in each group.	14 months
Progression Free Survival (PFS)	progression were evaluated using the revised international criteria (1.1) proposed by the RECIST (Response Evaluation Criteria in Solid Tumours) committee	6 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Overall Survival (OS)	Randomization to Date of Death from Any Cause.	5 years
Number of Participants With Toxicity	Incidence of Toxicities Measured by NCI CTCAE Version 4.0	up to 12 weeks

Collaborators and Investigators

• Sponsor: Shanghai 10th People's Hospital
• Collaborators: Shanghai Chest Hospital; Shanghai Pulmonary Hospital, Shanghai, China

Publications and helpful links

General Publications

• Xia Q, Chen G, Ren Y, Zheng T, Shen C, Li M, Chen X, Zhai H, Li Z, Xu J, Gu A, Jin M, Fan L. Investigating efficacy of "microbiota modulation of the gut-lung Axis" combined with chemotherapy in patients with advanced NSCLC: study protocol for a multicenter, prospective, double blind, placebo controlled, randomized trial. BMC Cancer. 2021 Jun 22;21(1):721. doi: 10.1186/s12885-021-08448-6.

Study record dates

Study Major Dates

• Study Start (Anticipated): February 21, 2019
• Primary Completion (Anticipated): March 1, 2024
• Study Completion (Anticipated): March 1, 2024

Study Registration Dates

• First Submitted: August 16, 2018
• First Submitted That Met QC Criteria: August 21, 2018
• First Posted (Actual): August 22, 2018

Study Record Updates

• Last Update Posted (Actual): February 25, 2019
• Last Update Submitted That Met QC Criteria: February 21, 2019
• Last Verified: February 1, 2019

More Information

Terms related to this study

• Keywords: NSCLC; gut-lung axis; Bifico
• Other Study ID Numbers: PCCAN

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No