The Effect of Diet and Exercise on ImmuNotherapy and the Microbiome (EDEN)

  • STATUS
    Recruiting
  • End date
    Oct 31, 2024
  • participants needed
    80
  • sponsor
    National Cancer Institute (NCI)
Updated on 26 September 2021
cancer
systemic therapy
measurable disease
unresectable melanoma

Summary

Background

The human gut microbiome is a topic of growing research interest because it modulates many systems, including immune function; and, alterations of the microbiome have been associated with the development of many diseases, including cancer.

Optimization of the gut microbiome can increase the probability of responding to immune checkpoint inhibitor therapy with responders exhibiting a higher level of gut microbial diversity than non-responders. Therefore, efforts are underway to investigate the effects of modulating the microbiome on response to immune checkpoint inhibitor therapy.

Diet is a major modulator of the gut microbiome. In particular, a high-fiber, plant-based diet promotes greater gut microbial diversity while diets high in animal fats and protein are associated with lower gut microbial diversity.

Exercise has been shown to increase gut microbial diversity independent of diet in both mice and humans. In addition, exercise has long been known to lower cancer risk and improve outcomes in cancer patients, possibly through its ability to enhance immune function.

Although diet and exercise prescriptions are cost-effective and implementable on a large scale, poor compliance is a major issue. Acceptance and Commitment Training (ACT) can help improve participant engagement and compliance with lifestyle change recommendations.

In previously untreated, unresectable melanoma participants, we hypothesize that the combination of a high-fiber, plant-based diet and exercise will increase gut microbial diversity and potentially increase the probability of responding to immune checkpoint inhibitor therapy.

Objectives

To determine the feasibility of conducting a decentralized clinical trial involving diet and exercise prescriptions with stool sample collections in previously untreated, unresectable melanoma participants who will be undergoing anti-PD1/PDL1 monotherapy

Eligibility

Adults with previously untreated and unresectable melanoma who will be undergoing anti-PD1/PDL1 monotherapy.

Adequate organ function as defined by the liver, kidney, and hematologic laboratory testing.

Participants who have recently used antibiotics, probiotics, fiber supplements, or any other products/medications that can significantly alter the gut microbiome will be excluded.

Design

Feasibility trial wherein participants will be randomized in a 1-to-1 fashion to the following arms:

Intervention Arm: 30 participants will be instructed to adopt a high-fiber, plant-based diet and to engage in at least 150 minutes of moderate or 75 minutes of vigorous intensity exercise per week.

Control Arm: 30 participants will be educated on general healthy eating and exercise guidelines, but they will not be instructed to change their behavior.

All participants will be asked to periodically record dietary intake (in the MyFitnessPal app or other logs, if needed), to wear a Garmin (trademark) physical activity tracker, and to collect stool samples periodically. Feasibility will be determined by assessing whether greater than or equal to 60% of participants in each arm adhere to their respective protocols....

Description

Background

The human gut microbiome is a topic of growing research interest because it modulates many systems, including immune function; and, alterations of the microbiome have been associated with the development of many diseases, including cancer.

Optimization of the gut microbiome can increase the probability of responding to immune checkpoint inhibitor therapy with responders exhibiting a higher level of gut microbial diversity than non-responders. Therefore, efforts are underway to investigate the effects of modulating the microbiome on response to immune checkpoint inhibitor therapy.

Diet is a major modulator of the gut microbiome. In particular, a high-fiber, plant-based diet promotes greater gut microbial diversity while diets high in animal fats and protein are associated with lower gut microbial diversity.

Exercise has been shown to increase gut microbial diversity independent of diet in both mice and humans. In addition, exercise has long been known to lower cancer risk and improve outcomes in cancer patients, possibly through its ability to enhance immune function.

Although diet and exercise prescriptions are cost-effective and implementable on a large scale, poor compliance is a major issue. Acceptance and Commitment Training (ACT) can help improve participant engagement and compliance with lifestyle change recommendations.

In previously untreated, unresectable melanoma participants, we hypothesize that the combination of a high-fiber, plant-based diet and exercise will increase gut microbial diversity and potentially increase the probability of responding to immune checkpoint inhibitor therapy.

Objectives

To determine the feasibility of conducting a decentralized clinical trial involving diet and exercise prescriptions with stool sample collections in previously untreated, unresectable melanoma participants who will be undergoing anti-PD1/PDL1 monotherapy

Eligibility

Adults with previously untreated and unresectable melanoma who will be undergoing anti-PD1/PDL1 monotherapy.

Adequate organ function as defined by the liver, kidney, and hematologic laboratory testing.

Participants who have recently used antibiotics, probiotics, fiber supplements, or any other products/medications that can significantly alter the gut microbiome will be excluded.

Design

Feasibility trial wherein participants will be randomized in a 1-to-1 fashion to the following arms:

Intervention Arm: 30 participants will be instructed to adopt a high-fiber, plant-based diet and to engage in at least 150 minutes of moderate or 75 minutes of vigorous intensity exercise per week.

Control Arm: 30 participants will be educated on general healthy eating and exercise guidelines, but they will not be instructed to change their behavior.

All participants will be asked to periodically record dietary intake (in the MyFitnessPal app or other logs, if needed), to wear a Garmin (trademark) physical activity tracker, and to collect stool samples periodically. Feasibility will be determined by assessing whether greater than or equal to 60% of participants in each arm adhere to their respective protocols.

Details
Condition melanoma, skin cancer
Treatment Control, Intervention Arm
Clinical Study IdentifierNCT04866810
SponsorNational Cancer Institute (NCI)
Last Modified on26 September 2021

Eligibility

Yes No Not Sure

Inclusion Criteria

Participants must have histologically or cytologically confirmed unresectable melanoma that has not been treated with any systemic therapy
Participants must be planning to undergo treatment with anti-PD1/PDL1 monotherapy
Note: This anti-PD1/PDL1 monotherapy is permissible to have started up to 14
days prior to completion of baseline assessments on this study to still be
eligible for enrollment
Participants must have measurable disease, per RECIST 1.1
Age greater than or equal to 18 years and English speaking. English-language ability is required because a portion of the study involves reading and responding to English-language questionnaires, along with creating a free response spoken answer to a question, where the information will be transcribed and analyzed
Willingness and capability to comply with diet and exercise prescriptions, use the MyFitnessPal app, wear the Garmin (trademark) device, complete surveys, and provide stool samples. Participants must own a smartphone capable of running the MyFitnessPal and
Garmin Connect (trademark) apps
ECOG performance status <2 (Karnofsky >60%,)
BMI 18.5 -35 kg/m2
The ability of the subject to understand and the willingness to sign a written informed consent document

Exclusion Criteria

Participants who are receiving any other investigational agents
Any concurrent malignancy that requires active systemic therapy
Any health condition that requires treatment with cytotoxic chemotherapy or targeted therapy
Medical contraindications to the study diet and/or exercise prescriptions as determined by a physician
Self-reported dietary and/or exercise restrictions that would preclude adherence to the study diet and exercise prescriptions
Systemic antibiotic use within the past 30 days
Use of probiotic supplements (probiotic foods such as yogurt, kefir, sauerkraut, etc., are permissible), fiber supplements, bile acid sequestrants, weight loss supplements, or appetite suppressants within the last 30 days
Women known to be pregnant or lactating are excluded from the study because it is unknown if the study diet and exercise prescriptions may have deleterious effects on the child and/or mother in the context of pregnancy/breastfeeding
Current smoker or < 8 weeks since smoking cessation. There is evidence that smoking may alter the microbiome
Heavy drinker defined as >14 alcoholic drinks per week
Current illicit drug use. There is evidence that illicit drug use may alter the microbiome
Diagnosis of diabetes mellitus type I or II that requires treatment
Uncontrolled intercurrent illness including, but not limited to, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements
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