A comprehensive new review reveals both the promise and challenges of using fecal microbiota transplantation (FMT) to enhance cancer immunotherapy effectiveness. The study, published in Gut Microbes , examines the controversial effects of transferring healthy gut bacteria to cancer patients receiving immune checkpoint inhibitors (ICIs).
"FMT's impact on immune checkpoint inhibitor efficacy varies dramatically across studies," explains lead researcher Dr. Peng Luo from Southern Medical University. "Some clinical trials show remarkable improvements in patient outcomes, while others demonstrate no benefit or even potential harm."
The research team analyzed multiple clinical trials involving melanoma, colorectal cancer, and other solid tumors. In some melanoma studies, 40% of patients who previously failed immunotherapy showed renewed responses after FMT. However, other trials found that certain bacterial formulations actually reduced treatment effectiveness compared to placebo.
"The gut microbiome acts like a complex ecosystem that can either support or hinder the immune system's ability to fight cancer," notes Dr. Luo. "We discovered that the success of FMT depends on multiple factors including donor selection, recipient characteristics, and the specific bacterial communities being transferred."
The review identifies key mechanisms by which gut bacteria influence cancer treatment. Beneficial bacteria can enhance immune cell function and alter the tumor microenvironment, while harmful bacteria may promote immunosuppressive cells that protect tumors from attack.
"What surprised us most was how the same bacterial species could have opposite effects in different patients," Dr. Luo explains. "This highlights the need for personalized approaches rather than one-size-fits-all treatments."
The researchers emphasize that large-scale clinical trials are urgently needed to clarify FMT's role in cancer therapy. They also call for standardized protocols and better methods to predict which patients will benefit from microbiome interventions.
This work represents a critical step toward harnessing the power of gut bacteria to improve cancer treatment outcomes while ensuring patient safety.
Gut Microbes
Literature review
Cells
From chaos to order: optimizing fecal microbiota transplantation for enhanced immune checkpoint inhibitors efficacy.
No potential conflict of interest was reported by the author(s).