Vancomycin and Precision Radiation Therapy for the Treatment of Patients with Oligoprogressive Non-small Cell Lung Cancer

Inclusion Criteria

• RANDOMIZED PILOT: Patient is planned to receive stereotactic body radiotherapy (SBRT) to a biopsy-proven non-small cell lung cancer (NSCLC). Biopsy and PD-L1 testing is optional. If physician is willing to treat on clinical suspicion alone and biopsy is not advised or not feasible, then a biopsy is not required
• RANDOMIZED PILOT: Age 18 years old or older
• RANDOMIZED PILOT: Patient capable of giving informed consent
• SAFETY TRIAL: Patients planned to receive precision hypofractionated radiation (SBRT or an ablative dose of radiation is used if SBRT is not appropriate or if insurance does not approve – i.e. > 30 Gy in 10 fraction equivalent) to all sites of oligoprogressive NSCLC who progressed after 1st line systemic therapy which included immunotherapy
• SAFETY TRIAL: The number of sites of progression are < 5 sites
• SAFETY TRIAL: Age 18 years old or older
• SAFETY TRIAL: Patient capable of giving informed consent

Exclusion Criteria

• RANDOMIZED PILOT: Use of antibiotics, antifungal, antivirals or antiparasitics during the 4 weeks prior to registration
• RANDOMIZED PILOT: Active infection with oral temperature > 100 degrees Fahrenheit (F)
• RANDOMIZED PILOT: Use of corticosteroids, methotrexate or immunosuppressive drugs during the 4 weeks prior to registration
• RANDOMIZED PILOT: Use of chemotherapy during the 4 weeks prior to radiotherapy or during radiotherapy. Chemotherapy cannot begin before the collection of the 30-day post treatment sample (S4)
• RANDOMIZED PILOT: Documented human immunodeficiency virus (HIV), hepatitis B virus (HBV) or hepatitis C virus (HCV)
• RANDOMIZED PILOT: Chronic constipation (bowel movements less frequent than every other day)
• RANDOMIZED PILOT: Active uncontrolled gastrointestinal disorders such as inflammatory bowel disease, moderate/severe irritable bowel syndrome, persistent, infectious gastroenteritis, colitis or gastritis, persistent or chronic diarrhea of unknown etiology, Clostridium Difficile infection (within 2 years of lung cancer diagnosis) or Helicobacter Pylori infection (untreated)
• Major surgery of the gastrointestinal (GI) tract, with the exception of cholecystectomy and appendectomy, in the past five years. Any major bowel resection at any time
• RANDOMIZED PILOT: Patients on anti-diarrheal medications
• RANDOMIZED PILOT: Patients on probiotics
• SAFETY TRIAL: Presence of central nervous system (CNS) or leptomeningeal disease
• SAFETY TRIAL: Use of antibiotics, antifungal, antivirals or antiparasitics during the 4 weeks prior to registration
• SAFETY TRIAL: Active infection with oral temperature > 100°F
• SAFETY TRIAL: Use of corticosteroids, methotrexate or immunosuppressive drugs during the 4 weeks prior to registration
• SAFETY TRIAL: Use of chemotherapy during the 4 weeks prior to radiotherapy or during radiotherapy. Chemotherapy cannot begin before the collection of the 30-day post treatment sample
• SAFETY TRIAL: Documented history of HIV, HBV or HCV
• SAFETY TRIAL: Chronic constipation (bowel movements less frequent than every other day)
• SAFETY TRIAL: Active uncontrolled gastrointestinal disorders such as inflammatory bowel disease, moderate/severe irritable bowel syndrome, persistent, infectious gastroenteritis, colitis or gastritis, persistent or chronic diarrhea of unknown etiology, Clostridium Difficile infection (within 2 years of lung cancer diagnosis) or Helicobacter Pylori infection (untreated)
• SAFETY TRIAL: Major surgery of the GI tract, with the exception of cholecystectomy and appendectomy, in the past five years. Any major bowel resection at any time
• SAFETY TRIAL: Patients on anti-diarrheal medications
• SAFETY TRIAL: Use of probiotics during the 4 weeks prior to radiotherapy or during radiotherapy