A Randomized Trial of Microbiotic Product (NBT-NM108) to Promote Microbiome Health and Improve Chemotherapy Delivery

  • End date
    Sep 1, 2023
  • participants needed
  • sponsor
    Howard S. Hochster, MD
Updated on 23 October 2022


This phase II trial tests whether NBT-NM108 works in reducing chemotherapy-induced diarrhea in patients with colon cancer that has spread to other places in the body (metastatic). Irinotecan is one of the most used medicine for colon cancer, but it leads to diarrhea in most patients receiving it and among some of them, severe diarrhea can occur. NBT-NM108 is a high dietary fiber formula that is developed based on research findings that have shown that high fiber diets can help maintain healthy bacteria in the gut and improve gut function. Giving NBT-NM108 to patients with colon cancer receiving chemotherapy may help relieve or lessen diarrhea symptoms and lead to improved tolerance of the chemotherapy drug, irinotecan.



Dose Intensity of Irinotecan administered (mg/m2/week)


  1. Reduction in % Patients Needing Dose Modification for Diarrhea
  2. Toxicity Grade of diarrhea
  3. Response Rate
  4. Time to Progression-free survival


  1. 16S rRNA gene sequencing to reveal changes of the gut microbiota including institution of foundation guilds and restoration of healthy microbiome
  2. Short chain fatty acids analysis (promotion of acetic and butyric acid production)
  3. Markers for gut inflammation such as fecal lipocalin 2
  4. Gut barrier function test to see if the restoration of healthier gut microbiota would improve gut barrier function.

Condition Metastatic Colon Carcinoma, Stage IV Colon Cancer AJCC v8, Stage IVA Colon Cancer AJCC v8, Stage IVB Colon Cancer AJCC v8, Stage IVC Colon Cancer AJCC v8
Treatment NBT-NM108
Clinical Study IdentifierNCT05296681
SponsorHoward S. Hochster, MD
Last Modified on23 October 2022


Yes No Not Sure

Inclusion Criteria

Biopsy proven and metastatic colon cancer
Candidate for Second-line or later line therapy with irinotecan-based chemotherapy regimen with starting dose of irinotecan at 180 mg/m2 q2w
Participants who have had prior irinotecan will be eligible if they are off irinotecan for
at least three months and stools have returned to baseline consistency
Performance Status (PS) 0-1
Lab values as acceptable for trials: Absolute Neutrophil Count( ANC) >1500/uL
Creatinine < 1.5 x Upper Limit of Normal (ULN); Transaminases < 5x ULN; Bilirubin <
5 x ULN; Albumin > 3.0 g/dL
No known UGTA1A genotype

Exclusion Criteria

Grade two diarrhea or greater (4-6 movements per day over baseline)
Inability to take oral supplements
Current antibiotic therapy
Baseline grade 3-4 diarrhea Participants with grade two diarrhea should undergo stool
evaluation with stool test for bacteria (Salmonella, Shigella, Campylobacter, Yersinia
Mycobacterium), bacterial toxin (Clostridium difficile), ova and parasites (Giardia
Entamoeba, Isospora, Cyclospora, Cryptosporidium, Microsporidium), or viruses
(Cytomegalovirus), associated with an ongoing active infection and diarrhea. They will
be eligible if this evaluation shows no infection
History of the following infections and/or disease which could lead to diarrhea
History of prior positive gastrointestinal biopsy, gastrointestinal culture, or stool
test for bacteria (Salmonella, Shigella, Campylobacter, Yersinia, Mycobacterium)
bacterial toxin (Clostridium difficile), ova and parasites (Giardia, Entamoeba
Isospora, Cyclospora, Cryptosporidium, Microsporidium), or viruses (Cytomegalovirus)
associated with an ongoing active infection and diarrhea unless fully treated with at
least three months normal stool
History of ulcerative colitis, Crohn's disease, celiac sprue (gluten-enteropathy)
chronic pancreatitis, malabsorption, or any other gastrointestinal disease associated
with diarrhea
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