Modulating the microbiome to improve therapeutic response in cancer
Open accessAbstract
Although novel therapies, including immunotherapy, have dramatically improved outcomes for many patients with cancer, overall outcomes are heterogeneous and existing biomarkers do not reliably predict response. To date, predictors of response to cancer therapy have largely focused on tumour-intrinsic features; however, there is growing evidence that other host factors (eg, host genomics and the microbiome) can substantially affect therapeutic response. The microbiome, which refers to microbiota within a host and their collective genomes, is becoming increasingly recognised for its influence on host immunity, as well as therapeutic responses to cancer treatment. Importantly, microbiota can be modified via several different strategies, affording new angles in cancer treatment to improve outcomes. In this Review, we examine the evidence on the role of the microbiome in cancer and therapeutic response, factors that influence and shape host microbiota, strategies to modulate the microbiome, and present key unanswered questions to be addressed in ongoing and future research.
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Dysbiosis of the gut microbiome confers a predisposition to certain malignancies and influences the body's response to chemotherapy, radiotherapy, and immunotherapy.
“Studies have suggested that dysbiosis of the gut microbiome confers a predisposition to certain malignancies and influences the body’s response to a variety of cancer therapies, including chemotherapy, radiotherapy, and immunotherapy6,8–11.”
From Gut microbiome diversity is an independent predictor of survival in cervical cancer patients receiving chemoradiation (2021) · cites this paper as [9]
The composition of gut microbiota is mostly shaped by environmental factors, particularly diet and medications.
“Gut microbiota are largely determined by environmental exposure, especially what we ingest, i.e., diet and medications.12,18,131”
From Melanoma and microbiota: Current understanding and future directions (2024) · cites this paper as [131]
Many bacteria linked to ICI response have known dietary associations, and dietary patterns such as plant-based versus western diet correlate with higher or lower relative abundances of these candidate taxa.
“Many bacteria associated with ICI response have known dietary associations, such that specific dietary patterns (e.g., plant-based versus western diet) are associated with increased or decreased relative abundances of these candidate taxa.131–135”
From Melanoma and microbiota: Current understanding and future directions (2024) · cites this paper as [131]
The microbial response to dietary intervention differs among individuals, making straightforward prediction of results difficult.
“In addition, the microbial response to dietary intervention varies among individuals, complicating straightforward prediction of results.131,143”
From Melanoma and microbiota: Current understanding and future directions (2024) · cites this paper as [131]
After an individual returns to their habitual diet, diet-induced changes to the metabolome and microbiota are reversed.
“changes to the metabolome/microbiota are reversed after an individual reverts to their habitual diet.131,142”
From Melanoma and microbiota: Current understanding and future directions (2024) · cites this paper as [131]
The critical window for dietary modulation of microbiota may be only the priming phase before ICI initiation.
“However, the critical time for dietary microbiota modulation may only be at the priming phase prior to ICI initiation.131”
From Melanoma and microbiota: Current understanding and future directions (2024) · cites this paper as [131]
The intestinal microbiota has been shown to induce a response to immunotherapy in patients with melanoma.
“The intestinal microbiota has been shown to induce a response to immunotherapy in patients with melanoma, and can be modulated by dietary habits7–10.”
From Microbiota-derived 3-IAA influences chemotherapy efficacy in pancreatic cancer (2023) · cites this paper as [7]
The intestinal microbiota can be modulated by dietary habits.
“The intestinal microbiota has been shown to induce a response to immunotherapy in patients with melanoma, and can be modulated by dietary habits7–10.”
From Microbiota-derived 3-IAA influences chemotherapy efficacy in pancreatic cancer (2023) · cites this paper as [7]
A high-fiber diet and exercise are associated with greater gut microbiota diversity and short-chain fatty acid enrichment, both linked to improved survival after immune checkpoint blockade.
“A high-fiber diet and exercise are associated with increased diversity of the gut microbiota and enrichment of short chain fatty acids (SCFAs), both of which have been implicated in improved survival following treatment with ICB”
From Hallmarks of response, resistance, and toxicity to immune checkpoint blockade (2021) · cites this paper as McQuade et al., 2019
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- Authors
- McQuade, J. L., Daniel, C. R., Helmink, B. A., & Wargo, J. A.
- Affiliations
- The University of Texas MD Anderson Cancer Center (US)
- Corresponding author
- Wargo, Jennifer A
- Venue
- The Lancet Oncology
- Publisher
- Elsevier BV
- Published
- 2019-02
- Volume
- 20
- Issue
- 2
- Pages
- e77-e91
- ISSN
- 1470-2045 (ISSN-L)
- PMC
- PMC12908161
- OpenAlex
- W2911909218
- Cited by
- 376
- References
- 112
- Citations by year
- 2026: 34 · 2025: 44 · 2024: 49 · 2023: 52 · 2022: 64 · 2021: 53 · 2020: 54 · 2019: 26
- FWCI
- 4.35
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- The Lancet Oncology (acceptedVersion)
- PubMed (publishedVersion)
- PubMed Central (publishedVersion)
- Funders
- National Cancer Institute (P50CA221703, L30 CA162156, R01CA219896, R25CA203650, P30CA016672)
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Gut microbiota and health
- Health Sciences › Medicine › Oncology › Cancer Immunotherapy and Biomarkers
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Biotechnology › Cancer Research and Treatments
- Keywords
- gut microbiota, microbiota modulation, cancer immunotherapy, treatment response prediction, host factors, host genomics, host immunity, microbiome-targeted therapy
- MeSH terms
- Gastrointestinal Microbiome, Humans, Neoplasms, Treatment Outcome, Probiotics, Prebiotics, Carcinogenesis
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