Probiotic Yogurt Supplement in Reducing Diarrhea in Patients With Metastatic Kidney Cancer Being Treated With Vascular Endothelial Growth Factor-Tyrosine Kinase Inhibitor

Not Applicable

Completed

Conditions: Diarrhea
Metastatic Renal Cell Carcinoma
Stage IV Renal Cell Cancer

Interventions: Other: Laboratory Biomarker Analysis
Drug: VEGF-TKI
Dietary Supplement: Micronutrient-Fortified Probiotic Yogurt

Registration Number: NCT02944617

Lead Sponsor: City of Hope Medical Center

Brief Summary: This randomized clinical trial studies how well probiotic yogurt supplement works in reducing diarrhea in patients with kidney cancer that has spread from the primary site to other places in the body (metastatic) and that are being treated with vascular endothelial growth factor-tyrosine kinase inhibitor therapy. Studying samples of blood and stool from patients who eat probiotic yogurt and those who avoid probiotic yogurt may help doctors plan better treatment.

Detailed Description: PRIMARY OBJECTIVES:

I. To determine if adding Activia yogurt (containing Bifidobacterium lactis DN-173 010) to the diet of patients with metastatic renal cell carcinoma (mRCC) increases the level of Bifidobacterium spp in stool.

SECONDARY OBJECTIVES:

I. To determine if Activia reduces the incidence of diarrhea for mRCC patients treated with vascular endothelial growth factor - tyrosine kinase inhibitor (VEGF-TKI) therapy.

II. To compare pre-treatment levels of circulating T regulatory (Treg) cells and levels of peripheral signal transducers and activators of transcription 3 (STAT3) in patients with and without diarrhea with VEGF-TKI therapy, and correlate with Bifidobacterium, other bacteria, and Activia.

III. To determine if patients with the diarrhea in mRCC patients treated with VEGF-TKI therapy have a lower baseline of Bifidobacterium spp.

IV. To assess the change in global stool bacteriomic profile of patients receiving therapy with VEGF-TKI therapy with or without Activia.

V. To better assess the feasibility of stool collection and bacteriomic profiling.

VI. To explore association between psychosocial symptoms (anxiety and depression) and bacteriomic profile and gastrointestinal toxicity in mRCC patients receiving VEGF-TKI therapy therapy.

OUTLINE: Patients are randomized to 1 of 2 arms.

ARM I: Patients receive probiotic supplement Activia yogurt twice daily (QD) during weeks 2-13 of VEGF-TKI treatment.

ARM II: Patients avoid any intake of yogurt or yogurt-containing foods and refrain from taking/consuming other probiotic supplements for 3 months.

Recruitment & Eligibility

Status: COMPLETED

Sex: All

Target Recruitment: 21

Inclusion Criteria

Cytologically or pathologically verified diagnosis of renal cell carcinoma (RCC)
Diagnosis of RCC that is defined as metastatic by standard criteria (American Joint Committee on Cancer [AJCC] 7th edition, 2010)
Planned treatment with any VEGF-TKI, treatment has not yet begun
Ability to understand and the willingness to sign a written informed consent
Ability to read and write English
Documented consent to participation to include the following study specific procedures:
- Be able to provide up to six serial stool collections at home and deliver to FedEx location that day as per standard operating procedure
- Have three 10-ml blood samples taken during a routine clinic visit
- To not take probiotic supplements except as oriented
- If randomized to the probiotic-supplemented group (the yogurt-based supplement Activia), be willing to comply with daily intake and record this intake as a component of a dietary log; the patient will be asked not to take any yogurt or yogurt-containing foods beyond this
- If randomized to the probiotic-restricted group, agree not to consume yogurt or yogurt-containing foods
- Maintain a dietary log and stool frequency log

Exclusion Criteria

Patients with a known intolerance to lactose or other constituents of Activia
Patients with irritable bowel syndrome, Crohn's disease, or other clinically significant gastrointestinal (GI) related condition that might confound the VEGF-TKI-related-diarrhea endpoint
Patients taking antibiotics or who plan to begin taking antibiotics
Any other condition that would, in the investigator's judgment, contraindicate the patient's participation in the clinical study due to safety concerns or compliance with clinical study procedures (including compliance issues related to feasibility/logistics)

Study & Design

Study Type: INTERVENTIONAL

Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Arm II (no intervention)	Laboratory Biomarker Analysis	Patients avoid any intake of yogurt or yogurt-containing foods and refrain from taking/consuming other probiotic supplements for 3 months.
Arm II (no intervention)	VEGF-TKI	Patients avoid any intake of yogurt or yogurt-containing foods and refrain from taking/consuming other probiotic supplements for 3 months.
Arm I (probiotic yogurt supplement)	Laboratory Biomarker Analysis	Patients receive probiotic supplement Activia yogurt QD during weeks 2-13 of VEGF-TKI treatment.
Arm I (probiotic yogurt supplement)	Micronutrient-Fortified Probiotic Yogurt	Patients receive probiotic supplement Activia yogurt QD during weeks 2-13 of VEGF-TKI treatment.
Arm I (probiotic yogurt supplement)	VEGF-TKI	Patients receive probiotic supplement Activia yogurt QD during weeks 2-13 of VEGF-TKI treatment.

Primary Outcome Measures

Name	Time	Method
Number of Participants With Overall Response	Up to 3 years	Per Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.1) for target lesions and assessed by MRI: Complete Response (CR), Disappearance of all target lesions; Partial Response (PR), \>=30% decrease in the sum of the longest diameter of target lesions; Overall Response (OR) = CR + PR
Number of Participants With Diarrhea	Up to 13 weeks	The rate of all grade diarrhea as graded by the Common Terminology Criteria for Adverse Events version 4.0 will be compared in the patients who receive the dietary supplement and those who do not. A Fisher's exact test with a 0.050 one-sided significance level will be used.

Secondary Outcome Measures

Name	Time	Method
Clinical Benefit Rate	Up to 6 months	Per Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.1) for target lesions and assessed by MRI: Complete Response (CR), Disappearance of all target lesions; Partial response (PR): At least a 30% decrease in the sum of diameters of all target lesions, taking as reference the baseline sum of diameters, in the absence of CR; Stable disease (SD): Neither sufficient shrinkage to qualify for CR or PR nor sufficient increase to qualify for PD; Progressive disease (PD): At least a 20% increase in the sum of diameters of target lesions, taking as reference the smallest sum of diameters on study (including baseline). Clinical Benefit Rate (CBR) = CR + PR + SD at 6 months
Progression-free Survival (PFS)	Up to 36 months	Estimated using the product-limit method of Kaplan and Meier. Failure defined as disease progression or death from any cause. Progression is defined using Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.1), as a 20% increase in the sum of the longest diameter of target lesions, or a measurable increase in a non-target lesion, or the appearance of new lesions.