RecruitingPhase 2NCT05690048

Fecal Microbiota Transfer in Liver Cancer to Overcome Resistance to Atezolizumab/Bevacizumab (FLORA)


Sponsor

Michael Dill

Enrollment

48 participants

Start Date

Jul 16, 2025

Study Type

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

Min Age: 18 Years

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

DRUGFecal microbiota transfer

FMT via capsule (50 g of fecal matter) on day 0 and day 21.

DRUGVancomycin Oral Capsule

Vancomycin orally (250 mg 4xd, day -3 to 0).

DRUGAtezolizumab + Bevacizumab

Atezolizumab 1200mg i.v. \& Bevacizumab 15mg/kg body weight i.v. (A/B) as standard of care (SOC).

DRUGPlacebo Vancomycin Oral Capsule

Placebo Vancomycin orally (4xd, day -3 to 0).

DRUGPlacebo Fecal microbiota transfer

Placebo Fecal microbiota transfer (FMT) via capsule on day 0 and day 21.


Locations(7)

University Hospital Heidelberg

Heidelberg, Baden-Wurttemberg, Germany

University Hospital Augsburg

Augsburg, Germany

University Hospital Essen

Essen, Germany

University Hospital Mannheim

Mannheim, Germany

University Hospital Regensburg

Regensburg, Germany

University Hospital Tübingen

Tübingen, Germany

University Hospital Ulm

Ulm, Germany

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NCT05690048


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