Patients With Hepatocellular Carcinoma (HCC) (FORCE)

July 20, 2026 updated by: Fondazione Policlinico Universitario Agostino Gemelli IRCCS

Fecal Microbiota Transplantation as a Response Booster in Patients With Hepatocellular Carcinoma Undergoing Immune Checkpoint Inhibitor Therapy

Hepatocellular carcinoma (HCC) is one of the leading causes of cancer-related mortality worldwide and is frequently diagnosed at an advanced stage, resulting in limited therapeutic options. Despite the advances in immunotherapy, a substantial proportion of patients fail to respond adequately due to mechanisms of immune resistance. The gut microbiota plays a crucial role in modulating the response to immune checkpoint inhibitors (ICIs), and fecal microbiota transplantation (FMT) has demonstrated the ability to enhance their efficacy in other tumors, such as melanoma. In patients with HCC and cirrhosis, intestinal dysbiosis, characterized by a reduction in beneficial bacteria (e.g., Bifidobacterium, Akkermansia) and increased inflammation, is associated with an immunosuppressive profile. Furthermore, a dysbiosis index has been correlated with response to ICIs. In this context, FMT represents a promising strategy to enhance the efficacy of immunotherapy in HCC, although data regarding its efficacy and safety are still limited.

Study Overview

Status

Not yet recruiting

Conditions

Intervention / Treatment

Detailed Description

The study includes an initial screening phase aimed at assessing patient eligibility and obtaining written informed consent. Subsequently, participants will undergo centralized randomization through dedicated software, according to a procedure designed to maintain blinding for both patients and clinical staff involved in the study, with the exception of the technical personnel responsible for the preparation of fecal microbiota transplantation (FMT).

Throughout the study, both procedures included in standard clinical practice and procedures specifically required by the study protocol will be performed. Routine clinical activities will include the collection of clinical, laboratory, and instrumental data already planned within the standard patient care pathway. Laboratory monitoring will be carried out every 2-3 weeks and will include complete blood count, liver and renal function tests, C-reactive protein, urinalysis, and alpha-fetoprotein measurement. Radiological follow-up will be performed by CT scan every three months.

Regarding study-specific procedures, patients assigned to the experimental arm will receive fecal microbiota transplantation according to procedures designed to ensure maintenance of study blinding. Scheduled follow-up visits will take place at baseline and subsequently at 1, 6, and 12 months.

In addition to blood samples already collected as part of routine clinical practice, an extra 10 mL blood sample and two fecal samples will be collected from each patient at the predefined study timepoints, namely at enrollment and at months 1, 6, and 12. The analysis of biological samples, with particular focus on gut microbiota characterization and bile acid profiling, represents an important scientific investigational tool. These analyses may contribute to a better understanding of systemic inflammatory status and the pathophysiology of the gut-liver axis, potentially providing clinically relevant information for a more comprehensive and personalized long-term management of the disease.

Biological samples and patient data will be collected exclusively after obtaining written informed consent and in full compliance with the approval of the competent Territorial Ethics Committee.

Finally, the study includes prospective collection of clinical outcomes, including disease progression, radiological response according to RECIST 1.1/mRECIST criteria, and survival. Treatment efficacy will primarily be assessed in terms of progression-free survival (PFS), complemented by secondary endpoints including objective response rate (ORR), disease control rate (DCR), time to progression (TTP), and overall survival (OS).

Study Type

Interventional

Enrollment (Estimated)

52

Phase

  • Not Applicable

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

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:

  • Age >18 years;
  • Diagnosis of advanced or unresectable HCC;
  • Patients undergoing standard therapy with immune checkpoint inhibitors (ICIs);
  • Signed informed consent for study participation.

Exclusion Criteria:

  • Presence of chronic intestinal diseases (e.g., inflammatory bowel disease, celiac disease);
  • Recent use of systemic antibiotics (within the previous 4-6 weeks);
  • Child-Pugh class > B8, ECOG performance status >1;
  • Any contraindication to colonoscopy.

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: Double

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: FMT arm
Fecal microbiota transplantation (FMT) will be administered by colonoscopy at the initiation of standard therapy, as part of routine clinical practice, followed by oral capsule administration in combination with standard treatment.
Procedure: Fecal microbiota transplantation performed via colonoscopy.
Patients randomized to the intervention group will receive fecal microbiota transplantation (FMT) via colonoscopy.
Placebo Comparator: control arm
Patients assigned to the control arm will undergo a sham colonoscopy procedure, followed by administration of placebo capsules according to the same schedule, in combination with standard therapy.
Procedure: Simulated Colonoscopy With Placebo Capsules in Addition to Standard Treatment
Patients assigned to the control group will undergo a simulated (sham) colonoscopy and will subsequently follow the same therapeutic regimen with placebo capsules, in addition to standard therapy.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Progression-Free Survival (PFS)
Time Frame: 6-24 month
Time from randomization to documented disease progression or death from any cause.
6-24 month

Collaborators and Investigators

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

Sponsor

Fondazione Policlinico Universitario Agostino Gemelli IRCCS

Investigators

  • Principal Investigator: Francesca Romana Ponziani, Fondazione Policlinico A. Gemelli IRCCS

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)

September 1, 2026

Primary Completion (Estimated)

September 1, 2028

Study Completion (Estimated)

September 1, 2029

Study Registration Dates

First Submitted

July 1, 2026

First Submitted That Met QC Criteria

July 1, 2026

First Posted (Actual)

July 8, 2026

Study Record Updates

Last Update Posted (Actual)

July 21, 2026

Last Update Submitted That Met QC Criteria

July 20, 2026

Last Verified

June 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • 27533

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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