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Abstract The gut microbiome (GM) has emerged as a significant determinant of cancer biology, which influences carcinogenesis, therapeutic efficacy and toxicity associated with treatment. Dysbiosis contributes to the initiation and progress of tumors due to long-term inflammatory reaction, generation of genotoxins, and immune system evasion in tumors such as colorectal, gastric, pancreatic, hepatic cancers, and prostate tumors. Microbial diversity and the growth of specific taxa that include Faecalibacterium prausnitzii, Bifidobacterium longum, Akkermansia muciniphila, and others have been positively correlated with efficacy of immune checkpoint inhibitors (ICIs) in the GM. These effects are mediated by microbial metabolites, namely, short-chain fatty acids and menaquinone (vitamin K2) through immunomodulation and toxicity control. Conversely, bacterial dysbiosis and pathological taxa induced by antibiotics complicate the cure of infection and lead to immune-related adverse events (irAEs). Future interventions such as transplantation of fecal microbiota, next-generation probiotics and engineered biotherapeutics have the potential to restore the ICI responsiveness and decrease the toxicity. To implement microbiome-based biomarkers and therapeutics in precision oncology, the existing issues of standardization, causality, and clinical translation should be solved. The GM represents a new frontier in cancer treatment, combining immunology, metabolism and microbial ecology to further the personalized medicine. This narrative review synthesizes molecular and clinical findings regarding the influence of the GM on carcinogenesis, immunotherapy efficacy, resistance, and toxicity, while also delineating translational initiatives for the integration of microbiome-based biomarkers and therapies into precision oncology.
Sunny et al. (Wed,) studied this question.