Overview
To learn about the possible effects of a prebiotic food-enriched diet (PreFED) targeting the gut microbiome in participants with melanoma who are starting immune checkpoint blockade (ICB) therapy.
Description
Primary Objectives
• Evaluate the effect of dietary intervention on the abundance of Faecalibacterium in stool samples from baseline to 12 weeks
Secondary Objectives
- Determine the best overall response rate (BORR) to PreFED + ICB regimens and landmark ORR at 12 weeks (intervention) and 24 weeks (maintenance)
- Determine progression-free survival (PFS) and overall survival (OS) with PreFED + ICB regimens
- Compliance and adherence to the dietary intervention at 12 weeks and maintenance at 24 weeks
- Determine the safety (diet-related AEs) and tolerability (GSRS-IBS) of the dietary intervention at 12 weeks and maintenance at 24 weeks
- Assess the rate of immune related adverse events in patients on ICB regimens receiving dietary intervention at 12 weeks and maintenance at 24 weeks
- Assess the effects of dietary intervention on systemic and tumor immunity
- Assess the effect of dietary intervention on overall gut microbiome composition and networks at 12 weeks and maintenance at 24 weeks
- Assess the effects of dietary intervention on gut metabolic output and systemic metabolism at 12 weeks and maintenance at 24 weeks
- Assess the effects of dietary interventions on quality of life and other patient reported outcomes (PROs) at 12 weeks and maintenance at 24 weeks
Eligibility
Inclusion Criteria:
- Age ≥18 years old
- Able to self-complete study assessments monitoring diet and gastrointestinal symptom burden
- Body mass index (BMI) 18.5-45 kg/m2
- ECOG performance status of 0 or 1
- Histologically confirmed stage III/IV, unresectable cutaneous, uveal, acral, or mucosal melanoma. Asymptomatic brain metastases are allowed.
- Planned initiation of 1st line standard-of-care approved immune checkpoint blockade (anti-PD1 +/- anti-CTLA4 or anti-LAG3 inhibitors) in the metastatic setting (prior ICB in adjuvant setting is allowed if last exposure ≥ 6 months prior). Prior targeted therapy is also allowed.
- Returning to MD Anderson for restaging and follow-up (ICB treatment may occur locally)
- WOCP must have negative UPT within 1 week of beginning dietary intervention.
- Self-reported willingness to eat the provided foods (with some tailoring to their food preferences)
- Self-reported willingness to comply with scheduled visits, undergo venipuncture, provide stool samples.
Exclusion Criteria:
- Previous ICB treatment in the metastatic setting
- History of inflammatory bowel disease, total colectomy, or bariatric surgery.
- Currently taking steroids > Prednisone 10 mg/day or equivalent
- Medical contraindications to the Intervention Diet as determined by the treating physician.
- Self-reported major dietary restrictions, including but not limited to relevant food allergies, celiac disease, or diets such as vegan, ketogenic, extended fasting.
- Insulin-dependent diabetes or condition requiring bile acid sequestrants
- Unable or unwilling to undergo study procedures.
- IV antibiotic use in the past month or oral antibiotic use in past 2 weeks.
- Regularly taking supplements containing prebiotics, fiber and/or probiotics, and unable/unwilling to discontinue for the purpose of the study.
- Current smoker or heavy drinker (defined as >14 drinks per week) or current illicit drug use.
- Currently pregnant, planning to become pregnant, or lactating.
- Concurrent malignancy requiring systemic therapy other than hormonal therapy.
- Cognitively impaired adults