Poop pills could help cancer patients respond to immunotherapy while reducing toxic side effects

Fecal microbe transplants (FMT) can dramatically improve cancer treatment, suggest two groundbreaking studies published in the prestigious Nature Medicine newspaper. The first study shows that the toxic side effects of drugs to treat kidney cancer could be eliminated with FMT. The second study suggests that FMT is effective in improving the response to immunotherapy in patients with lung cancer and melanoma.

The findings represent a huge step forward in the use of FMT capsules – developed at the Lawson Research Institute (Lawson) in St. Joseph’s Health Care London and are used in clinical trials at the London Health Sciences Center Research Institute (LHSCRI) and the Center de recherche du Center hospitalier de l’Université de Montréal (CRCHUM) – for safe and effective cancer treatment.

A Phase I clinical trial was conducted by scientists at LHSCRI and Lawson to determine whether FMT is safe when combined with an immunotherapy drug to treat kidney cancer. The team found that tailored FMT can help reduce toxic side effects from immunotherapy. The clinical trial involved 20 patients at the Verspeeten Family Cancer Center at London Health Sciences Center (LHSC).

“Standard treatment for advanced kidney cancer often includes an immunotherapy drug that helps the patient’s immune system fight the cancer cells,” says Saman Maleki, PhD, Scientist at LHSCRI. “But unfortunately, treatment often results in colitis and diarrhea, sometimes so severe that a patient has to stop life-sustaining treatment early. If we can reduce toxic side effects and help patients complete their treatment, that will be a game changer.”

Separate Phase II studies in lung and skin cancer were conducted by researchers at CRCHUM in collaboration with Lawson and LHSCRI. Studies have found that 80 percent of lung cancer patients responded to immunotherapy after FMT, compared to only 39-45 percent who typically benefit from immunotherapy alone. Similarly, 75 percent of melanoma patients who received FMT showed a positive response to treatment, compared to only 50-58 percent of patients receiving immunotherapy alone. Twenty patients participated in the lung cancer clinical trial and 20 patients participated in the skin cancer clinical trial.

“Our clinical trial showed that transplanting fecal microbes could improve the effectiveness of immunotherapy in patients with lung cancer and melanoma,” he says. Dr. Arielle Elkrief, Co-Principal Investigator and Physician Scientist, University of Montreal Affiliated Hospital Research Center (CRCHUM). “The results also revealed a possible mechanism of action of faecal transplantation—through the elimination of harmful bacteria after transplantation. Our results open a new avenue for personalized microbiome therapies, and faecal transplantation is now being tested as part of the large pan-Canadian randomized controlled trial Canbiome2.”

“Faecal microbial transplantation in melanoma and lung cancer opens up a whole new therapeutic pathway, made possible by our patients’ extraordinary commitment and teamwork,” adds Dr. Rahima Jamal, Director of the Innovative Therapies Unit (UIT) at CRCHUM. “At CRCHUM’s Innovative Therapies Unit (UIT), we have been privileged to translate laboratory discoveries into early-phase clinical trials and witness their concrete impact on people living with cancer.”

Both studies use advanced, world-leading FMT capsules, also known as LND101, manufactured by Lawson in London, Ont. The research reinforces London’s position as a world leader in FMT innovation and treatment. The capsules are processed from healthy donor feces and ingested to help restore a patient’s healthy gut microbiome and treat different types of cancer.

“Using FMT to reduce drug toxicity and improve patients’ quality of life while potentially enhancing their clinical response to cancer therapy is tremendous and has never been done for kidney cancer treatment before,” says Dr. “And none of this would have been possible if not for this close collaboration: the innovation of FMT capsules in the Lawson labs and their introduction to LHSCRI and CHUM to advance vital research initiatives. Also, because LND101 is derived from healthy donors, production can be scaled up to ultimately help large numbers of cancer patients.”

The studies build on earlier Phase I research created by London and CHUM and show that FMT can safely augment treatment for people with melanoma. FMT is also being studied in people with pancreatic cancer and triple-negative breast cancer, and is already an established treatment for serious gut infections such as C. difficile, which can cause severe diarrhea.

“Our hope is that our research will one day help people with cancer live longer while reducing the harmful side effects of treatment,” adds Dr. Ricardo Fernandes, scientist at LHSCRI and Medical Oncologist at LHSC. “We are world leaders in FMT research and are excited about its potential.”

The lung and melanoma study was funded by the Canadian Cancer Society. The kidney cancer clinical trial was funded with support from the Ontario Institute of Cancer Research, Canadian Institutes of Health Research, AMOSO, Western University’s Division of Medical Oncology, London Health Sciences Foundation donors, and the St. Joseph’s Health Care Foundation, the Hesch Foundation and the Weston Family Foundation.