The Negative Impact of Antibiotics on Outcomes in Cancer Patients Treated With Immunotherapy

A New Independent Prognostic Factor?

A. Elkrief; L. Derosa; G. Kroemer; L. Zitvogel; B. Routy

Disclosures

Ann Oncol. 2019;30(10):1572-1579. 

In This Article

Therapeutic Manipulation of the Microbiota

Novel therapeutic approaches are being designed to provide bacterial communities (for instance by patient-to-patient FMT) or individual bacterial species (for instance in the form of lyophilized encapsulated bacteria) to improve anticancer immunotherapies (Figure 2). Within this expanding area of clinical research, DeFillip et al. conducted a phase I study, administering FMT from third-party donors to an allo-HSCT population to show an increase in gut microbial diversity.[63] Taur et al. reported the results of a randomized clinical trial demonstrating that, within allo-HSCT patients, administration of an auto-FMT (from feces collected before antibiotherapy and chemotherapy) augmented microbial diversity.[34] Probiotics have also been hypothesized to correct ATB-induced dysbiosis. However, in both mice and humans, administration of over-the-shelf probiotics induced delayed and incomplete post-ATB microbiota reconstitution compared with FMT.[17] These studies indicate that FMT may be an effective way to reconstitute microbiota composition. Nonetheless, at this stage, it remains elusive whether FMT may translate into improved clinical responses to ICI. Randomized controlled trials are currently underway to evaluate the impact of FMT on melanoma patients (NCT03353402; NCT03341143), as are studies evaluating the effect of probiotics in RCC patients treated with ICI (NCT03829111).

Figure 2.

Summary of possible techniques to modify unfavorable gut microbiome into a favorable gut microbiome in order to improve clinical outcomes. ICI, immune-check point inhibition; ATB, antibiotics.

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