Assessing the Impact of Probiotics on Immunotherapy and Antibiotic-Mediated Resistance in Cancer

Authors & Affiliations

• Authors: Shuya Zhao, Zian Lu, Fangmin Zhao, Shihuan Tang, Lishan Zhang, Cuiling Feng
• Affiliations: Dongzhimen Hospital, Beijing University of Chinese Medicine; Peking University People’s Hospital; Zhejiang Chinese Medical University; State Key Laboratory for Quality Assurance and Sustainable Use of Dao-di Herbs

Background

• Probiotics potentially enhance the effect of immune checkpoint inhibitors (ICIs) in cancer patients.
• Antibiotics have a detrimental impact on ICIs, with no recent studies directly addressing this.
• This study aims to update previous meta-analyses and evaluate if probiotics can mitigate the negative effects of antibiotics on ICIs.

Methods

• Literature search in English and Chinese databases up to August 11, 2024.
• Quality assessment using Newcastle-Ottawa Quality Assessment Scale (NOS) and Revised Cochrane risk-of-bias tool (RoB 2).
• Hazard ratios (HRs) and confidence intervals (CIs) were extracted using Engauge Digitizer.
• Meta-analysis conducted using Stata 14 software.

Results

• Study sample: 12 studies (8 retrospective, 4 prospective) with 3,142 participants.
• Probiotics significantly improved:
  • Overall survival (OS): HR=0.58, p < 0.001
  • Progression-free survival (PFS): HR=0.66, p < 0.001
  • Objective response rate (ORR): OR=1.75, p = 0.001
  • Disease control rate (DCR): OR=1.93, p = 0.002
• NSCLC patients on antibiotics showed better OS and PFS with probiotics.
• Subgroup differences noted in cancer type and ethnic backgrounds for OS.

Discussion

• Probiotics improve ICIs' efficacy, especially in antibiotic-exposed populations.
• Gut microbiome plays a crucial role in modulating response to cancer treatments.
• Probiotics might help counteract antibiotic-induced gut microbiota disruption.
• Further large-scale, high-quality trials are needed.

Study Limitations

• Heterogeneity in study designs and probiotic types.
• Predominantly based on retrospective data, which can introduce bias.

Conclusion

• Probiotics positively affect ICIs in cancer treatment, particularly in NSCLC.
• They may mitigate antibiotics' negative effects on ICIs.
• Calls for more comprehensive studies to validate findings.

References

• Various studies and meta-analyses reviewed, noting the role of microbiota in cancer therapy response.

Supplementary Material

• Available online for more detailed data and analysis.