Dietary Fiber to Induce Gut Microbiota-mediated Response to Immunotherapy in Melanoma. (FIGURE-IM)

June 29, 2026 updated by: Radboud University Medical Center
Previous research has shown that a higher fiber intake may have a beneficial effect on the intestinal health and improve the effectiveness of immunotherapy, but this is not certain. The objective of this double-blinded randomized clinical trial is to analyze, whether increased dietary fiber intake by patients with metastatic melanoma will increase the relative amount of Bifidobacterium, which in turn stimulates immune cell activity and improves the response to immunotherapy.

Study Overview

Status

Not yet recruiting

Conditions

Intervention / Treatment

Study Type

Interventional

Enrollment (Estimated)

70

Phase

  • Phase 2

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Contact Backup

Study Locations

  • Netherlands
    • Gelderland
      • Nijmegen, Gelderland, Netherlands, 6525GA
    • Provincie Groningen
      • Groningen, Provincie Groningen, Netherlands, 9713GZ
        • Universitair Medisch Centrum Groningen
        • Contact:
        • Principal Investigator:
          • Kalijn Bol, dr.
        • Sub-Investigator:
          • Isabel Ossekoppele, MS.
        • Contact:
        • Principal Investigator:
          • Sjoukje Lubberts, dr.

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Adult
  • Older Adult

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  • Histologically confirmed cutaneous melanoma classified as irresectable stage III or stage IV disease
  • Measurable disease according to RECIST 1.1 criteria
  • Age ≥ 18 years
  • Starting standard-of-care treatment with ICI in first line
  • Written informed consent must be given
  • Able to read and understand Dutch or English
  • Able to comply with study procedures (e.g. willing to provide fecal samples)

Exclusion Criteria:

  • Symptomatic brain metastases
  • Received prior immunotherapy; previous (neo)adjuvant treatment is allowed if the last administration is at least 6 months ago
  • Use of systemic immunosuppressive medications
  • Use of laxatives up to 1 week prior to start of ICI
  • Use of supplements that alter bowel function or gut microbiota such as fibers/prebiotics, probiotics, synbiotics, or postbiotics up to 1 month prior to start of ICI
  • Use of antibiotics up to 1 months prior to start of ICI
  • Use of proton pumps inhibitors (PPI's) up to 3 months prior to start of ICI
  • Pregnant or lactating
  • Current participation in another clinical trial requiring the use of study medication
  • Has a known allergy to plants such as lettuce, sage, tarragon, chicory, artichoke, chamomile, daisy, or sunflower.
  • Has a medical history of gastrointestinal resection (appendectomy is allowed)
  • Has active inflammatory bowel disease

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

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

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Fiber intervention arm
Dried chicory roots
Dietary supplement: Dried chicory roots
The dried chicory roots are implemented using a dosage of 22.5 gram/day resulting in 18.5 gram additional fibers a day.
Other Names:
  • Dietary fibers
  • fiber
  • Vezel
Placebo Comparator: Placebo arm
iso-caloric placebo (rice-puffs)
Dietary supplement: Placebo
The control arm will receive 12.4 grams of placebo a day, isocaloric to the intervention.
Other Names:
  • Control
  • Placebo control

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
An increase in the relative abundance of Bifidobacterium in fecal samples.
Time Frame: From baseline (T0) to 3-4 weeks (T1) after start ICI
The primary endpoint of this study is defined as a ≥5% (e.g. from 3% to 8%) increase in the relative abundance of Bifidobacterium in fecal samples between baseline (T0) and follow-up (T1) and significant differences between the experimental arm and the control arm.
From baseline (T0) to 3-4 weeks (T1) after start ICI

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Fecal microbiota composition
Time Frame: Measurement at baseline (T0), 3-4 weeks (T1), 3-4 months (T2), and 6-7 months (T3) after start ICI
Study the baseline and on-treatment gut microbiota composition of patients with melanoma treated with ICI +/- additional dietary fiber.
Measurement at baseline (T0), 3-4 weeks (T1), 3-4 months (T2), and 6-7 months (T3) after start ICI
Radiological response rate to ICI
Time Frame: From baseline (T0) to the first date of documented progression or date of death from any cause, wichever came first, assesed up to 5 year.
Evaluate radiological response rates to ICI +/- additional dietary fiber, assessed by CT/PET scan per RECIST 1.1 defined as; the date of randomization to the date of disease progression or death, respectively.
From baseline (T0) to the first date of documented progression or date of death from any cause, wichever came first, assesed up to 5 year.
Progression free survival (PFS)
Time Frame: From baseline (T0) to the first date of documented progression or date of death from any cause, wichever came first, assesed up to 5 year.
Evaluate progression-free survival defined as; the date of randomization to the date of disease progression or death, respectively.
From baseline (T0) to the first date of documented progression or date of death from any cause, wichever came first, assesed up to 5 year.
Overall survival (OS)
Time Frame: From baseline (T0) on, survival follow-up will be continued after study completion for a maximal of 5 years in accordance with standard-of-care follow-up.
Evaluate overall survival to ICI +/- additional dietary fiber defined as; the date from randomization to date of death, respectively.
From baseline (T0) on, survival follow-up will be continued after study completion for a maximal of 5 years in accordance with standard-of-care follow-up.
Evaluate the gastro-intestinal side effects of additional dietary fiber intake
Time Frame: From start intervention at baseline (T0) until the end of wash-out period at 6-7 months (T3) after start ICI.
Evaluate the gastro-intestinal side effects of additional dietary fiber intake, according to CTCAE common criteria v 5.0.
From start intervention at baseline (T0) until the end of wash-out period at 6-7 months (T3) after start ICI.

Other Outcome Measures

Outcome Measure
Measure Description
Time Frame
Habitual dietary intake (Food Frequency Questionnaire)
Time Frame: At baseline (T0) and at 3-4 months (T2)
Nutritional intake is measured using a semi-quantitative Food Frequency Questionnaire (FFQ). Scores are calculated using the Dutch National Food Consumption tables. The FFQ will be used to evaluate habitual diet and fiber intake.
At baseline (T0) and at 3-4 months (T2)
Physical activity level (Short QUestionnaire to ASsess Health-enhancing physical activity)
Time Frame: At baseline (T0) and at 3-4 months (T2)
Physical activity is measured using the Short QUestionnaire to ASsess Health-enhancing physical activity (SQUASH). The questions in the SQUASH are pre-structured in commuting, leisure time, household and work/school activities. Scores will be assigned to the different reported activities base on intensities in MET and translated to minutes of physical activity.
At baseline (T0) and at 3-4 months (T2)
Sleep quality and duration (Pittsburgh Sleep Quality Index)
Time Frame: At baseline (T0) and at 3-4 months (T2)
Sleep quality is measured with the Pittsburgh Sleep Quality Index (PSQI), a 19-item questionnaire with scores ranging from 0-21. A score above 5 indicates bad sleep quality.
At baseline (T0) and at 3-4 months (T2)
Bristol Stool Scale (BSS)
Time Frame: Measurement at baseline (T0), 3-4 weeks (T1), 3-4 months (T2), and 6-7 months (T3) after start ICI
Stool consistency is measured using the Bristol Stool Scale (BSS)
Measurement at baseline (T0), 3-4 weeks (T1), 3-4 months (T2), and 6-7 months (T3) after start ICI
Circulating tumor DNA (ctDNA)
Time Frame: Measurement at baseline (T0), 3-4 weeks (T1), 3-4 months (T2), and 6-7 months (T3) after start ICI
ctDNA levels will be analysed to evaluate circulating tumor DNA.
Measurement at baseline (T0), 3-4 weeks (T1), 3-4 months (T2), and 6-7 months (T3) after start ICI
Short-Chain Fatty Acids
Time Frame: Measurement at baseline (T0), 3-4 weeks (T1), 3-4 months (T2), and 6-7 months (T3) after start ICI
Fecal and Plasma SCFA's levels will be evaluated.
Measurement at baseline (T0), 3-4 weeks (T1), 3-4 months (T2), and 6-7 months (T3) after start ICI
Sequencing mRNA in circulating immune cells
Time Frame: Measurement at baseline (T0), 3-4 weeks (T1), 3-4 months (T2), and 6-7 months (T3) after start ICI
(m)RNA will be sequenced to evaluate the transcription/gene expression in circulating immune cells.
Measurement at baseline (T0), 3-4 weeks (T1), 3-4 months (T2), and 6-7 months (T3) after start ICI
Tumor infiltration
Time Frame: Pretreatment

Archived tumor tissue, previous to baseline (T0):

Pre-interventional tumor tissue will be requested for immune cell analyses using multiplex immunohistochemistry.
Pretreatment

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Radboud University Medical Center

Collaborators

Wageningen University and Research

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Estimated)

June 15, 2026

Primary Completion (Estimated)

May 1, 2028

Study Completion (Estimated)

April 30, 2029

Study Registration Dates

First Submitted

June 4, 2026

First Submitted That Met QC Criteria

June 29, 2026

First Posted (Actual)

July 7, 2026

Study Record Updates

Last Update Posted (Actual)

July 7, 2026

Last Update Submitted That Met QC Criteria

June 29, 2026

Last Verified

June 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • R0007807A

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

UNDECIDED

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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