Fecal Microbiota Transfer in Liver Cancer to Overcome Resistance to Atezolizumab/Bevacizumab (FLORA)
Michael Dill
48 participants
Jul 16, 2025
INTERVENTIONAL
Conditions
Summary
The interventional, randomized, placebo-controlled, double-blind phase II-trial FLORA will assess safety and immunogenicity of fecal microbiota transfer in combination with standard of care immunotherapy in advanced hepatocellular carcinoma (HCC) in a parallel group design. Subjects will be randomized 2:1 into either the FMT or placebo group.
Eligibility
Inclusion Criteria7
- Age 18 years or older
- Confirmed radiologic or histological diagnosis of HCC
- Disease not amenable to resection, liver transplantation or loco-regionary therapy
- Eligible for therapy with Atezolizumab / Bevacizumab according to standard of care
- Measurable disease per RECIST 1.1
- Preserved liver function with a Child-Pugh score A or B (maximally 7 points)
- Performance status ECOG 0-1
Exclusion Criteria20
- Use of immunosuppressive medication within 6 months prior to the first dose of Atezolizumab / Bevacizumab.
- Active or prior documented autoimmune or inflammatory disorders
- Prior exposure to immune-mediated therapy including, but not limited to, other anti-CTLA-4, anti-PD-1, anti-PD-L1, and anti-VEGF antibodies.
- Known to have tested positive for human immunodeficiency virus (HIV) infection.
- Co-infection of HBV and HCV. Subjects with a history of HCV infection but who are negative for HCV RNA by PCR will be considered non-infected with HCV.
- Evidence by investigator assessment of varices at risk of bleeding on upper endoscopy undertaken within 12 months of randomization.
- Refractory nausea and vomiting, chronic gastrointestinal disease, inability to swallow a formulated product, or previous significant bowel resection that would preclude adequate absorption, distribution, metabolism or excretion of investigational product.
- Uncontrolled arterial hypertension defined by a systolic pressure \> 150 mm Hg or diastolic pressure \> 90 mm Hg or other hypertensive cardiovascular complications despite standard medical treatment.
- Any history of nephrotic or nephritic syndrome.
- Usage of systemic antibiotic therapy within 2 weeks prior to the first dose of Atezolizumab/Bevacizumab.
- Usage of probiotic products/supplements within 1 week prior to the first dose of Atezolizumab/Bevacizumab.
- Known fibrolamellar HCC, sarcomatoid HCC, infiltrative-type HCC, or mixed cholangiocarcinoma and HCC.
- History of another primary malignancy.
- Receipt of live attenuated vaccine within 30 days prior to the first dose of study intervention.
- Pregnancy or lactation.
- History of hypersensitivity to the investigational medicinal product or to any drug with similar chemical structure or to any excipient present in the pharmaceutical form of the investigational medicinal product.
- Participation in other interventional clinical trials or observation period of competing clinical trials, respectively.
- Held in an institution by legal or official order.
- Legally incapacitated.
- Known hypersensitivity to any component of the vancomycin, atezolizumab or bevacizumab formulation.
Interventions
FMT via capsule (50 g of fecal matter) on day 0 and day 21.
Vancomycin orally (250 mg 4xd, day -3 to 0).
Atezolizumab 1200mg i.v. \& Bevacizumab 15mg/kg body weight i.v. (A/B) as standard of care (SOC).
Placebo Vancomycin orally (4xd, day -3 to 0).
Placebo Fecal microbiota transfer (FMT) via capsule on day 0 and day 21.
Locations(7)
View Full Details on ClinicalTrials.gov
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NCT05690048