Role of the gut microbiome for cancer patients receiving immunotherapy: Dietary and treatment implications

• Published in: European journal of cancer (1990) Vol. 138; pp. 149 - 155
• Main Authors: Lee, Karla A., Shaw, Heather M., Bataille, Veronique, Nathan, Paul, Spector, Tim D.
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.10.2020; Elsevier Science Ltd
• Subjects: Animals; Anti-Bacterial Agents - adverse effects; Antibiotics; Bacteria - drug effects; Bacteria - immunology; Clinical trials; Consortia; Diet; Diet - adverse effects; Dietary Supplements; Digestive system; Dysbiosis; Fecal Microbiota Transplantation; Fermented food; Food intake; Gastrointestinal Microbiome - drug effects; Gut microbiome; Histamine; Host-Pathogen Interactions; Humans; Immune checkpoint inhibitors; Immune Checkpoint Inhibitors - adverse effects; Immune Checkpoint Inhibitors - therapeutic use; Immunotherapy; Immunotherapy - adverse effects; Intestinal microflora; Meat; Microbiomes; Microbiota; Neoplasms - drug therapy; Neoplasms - immunology; Neoplasms - microbiology; Nutrition; Nutritional Status; Patients; Probiotics; Proton pump inhibitors; Proton Pump Inhibitors - adverse effects; Microbiota; Nutrition; Antibiotics; Gut microbiome; Immunotherapy
• ISSN: 0959-8049; 1879-0852
• DOI: 10.1016/j.ejca.2020.07.026

Immune-checkpoint inhibitors (ICIs) have revolutionised the therapeutic landscape for multiple malignancies and the health of the gut microbiome (GM) is strongly linked with therapeutic responses to ICI. This review explores the implications of diet and medication on the GM for patients receiving ICI. Clinical trials are underway to explore the impact of factors such as faecal microbiota transfer, probiotics, prebiotics, bacteria consortia and a number of dietary interventions on patients receiving ICI. Randomised controlled trials are lacking, and inferences are currently based on short-term clinical and observational studies. Antibiotics should be avoided before ICI initiation, and depending on prospective data, future consideration may be given to temporary delay of initiation of non-urgent ICI if patient has had broad spectrum antibiotics within 1 month of planned treatment initiation. Proton pump inhibitor use should be discontinued when not clearly indicated and potential switch to a histamine H2-receptor antagonist considered. Patients should be advised to minimise animal meat intake and maximise plants, aiming to consume ≥30 plant types weekly. A high fibre intake (>30 g/day) has been seen to be beneficial in increasing the chance of ICI response. Fermented foods may have a beneficial effect on the GM and should be introduced where possible. Ideally, all patients should be referred to a nutritionist or dietician with knowledge of GM before commencing ICI. •Therapeutic response to immune-checkpoint inhibitor (ICI) is linked to the gut microbiome.•Care needs to be given to protecting the microbiome, both by clinicians and patients.•Patients' diets should focus on diversity, variety, plentiful plants, protein and dietary fibres.•Antibiotics and many other common medications can adversely affect responses to ICI.•Before and during ICI patients should have access to nutritional support.