Monitoring and Modulating Diet and Gut Microbes to Enhance Response and Reduce Toxicity to Cancer Treatment

Abstract

The gut microbiome comprises a diverse array of microbial species that have been shown to dynamically modulate host immunity both locally and systemically, as well as contribute to tumorigenesis. In this review, we discuss the scientific evidence on the role that gut microbes and diet play in response and toxicity to cancer treatment. We highlight studies across multiple cancer cohorts that have shown an association between particular gut microbiome signatures and an improved response to immune checkpoint blockade, chemotherapy, and adoptive cell therapies, as well as the role of particular microbes in driving treatment-related toxicity and how the microbiome can be modulated through strategies, such as fecal transplant. We also summarize the current literature that implicate high fiber and ketogenic diets in improved response rates to immunotherapy and chemotherapy, respectively. Finally, we discuss the relevance of these findings in the context of patient care, advocate for a holistic approach to cancer treatment, and comment on the next frontier of targeted gut and tumor microbiome modulation through novel therapeutics, dietary intervention, and precision-medicine approaches.

Safety and efficacy of fecal microbiota transplantation for cytotoxic chemotherapy– induced diarrhea management in patients with colorectal cancer: a single-arm clinical trial

“…Furthermore, one of our patients who demonstrated diarrhea control after FMT was presumed to have CRC originating from the stomach-which highlighted the complexity of cancer pathogenesis and the potential of FMT in modulating gastrointestinal health. Overall, these ndings support the e cacy and safety of FMT in mitigating AEs of cancer treatments, warranting further research into relevant underlying mechanisms and broader applications [30]. Both experimental and clinical investigations have revealed substantial correlations among microbial taxa, intestinal dysbiosis, treatment-induced toxicity, and anticancer therapy effectiveness [31][32][33][34].…”

The Association between the Gut Microbiome and Development and Progression of Cancer Treatment Adverse Effects

“…Consequently, it was suggested that diet should be considered as a potential prevention or treatment for cancer treatment adverse effects [59]. Indeed, a recent review discussed the importance of targeting dietary intake around the production of key bacterial taxa, such as Bacteriodes and Firmicutes, in order to modulate adverse effects [71]. For example, it is understood that high fibre diets lead to an increased production of SCFA's [72,73], potentially reducing the prevalence and severity of adverse effects.…”