The Role of Probiotics in Cancer Therapy
When cancer therapy fails
Immunotherapy, where drugs help a patient’s own immune system fight cancer, is curative for some cancer patients. For example, current immunotherapy treatments cure around 10-20 % of patients with melanoma . Sadly, for the remaining 80% of patients, immunotherapy is less effective. Most melanoma patients either do not respond to immunotherapy, or after an initial response their cancer returns .
An exciting new study provides hope for these patients in the form of a fecal microbiota transplant (FMT). Otherwise known as a poo transplant.
It’s all in the gut!
Researchers have known for some time that certain gut bacteria are essential for the development and proper function of your immune system. Pre-clinical cancer models suggest that gut bacteria are determine how well cancer patients respond to immunotherapy. For example, mice who received fecal bacteria transplants from melanoma patients who responded to immunotherapy have a better immune response to melanoma than mice who receive faecal bacteria from non-responsive melanoma patients .
These pre-clinical studies inspired Baruch and Colleagues to test whether transplanting bacteria improves immunotherapy in human melanoma patients .
What they did
The researchers identified ten patients with metastatic melanoma who were unresponsive to immunotherapy. These patients had their natural gut flora eradicated by three days of hard-core antibiotic therapy. They then received a fecal microbiota transplant (FMT) of bacteria samples derived from two melanoma patients who had curative responses to immunotherapy.
After FTM the test subjects were treated with six cycles of immunotherapy. They maintained their new gut bacteria populations by taking probiotic capsules of gut bacteria from the cured melanoma patient donors throughout the study.
What they found
Three of the ten non-responders responded positively to immuno-therapy after their FMT. Strikingly, one patient showing complete response and two showing partial response. Interestingly, all three of the patients who responded received their bacteria from the same donor.
The researchers compared the gut bacteria populations before and after FMT. They found that the patients gut biome changed after FMT to resemble that of the donors. Unfortunately there was no clear association between bacterial species and therapy response. Thus, identification of bacterial species responsible for augmenting the anti-cancer immune response will require clinical trials with larger patient numbers.
Why bacterial transplants work
Mouse tumour models show that microbiota transplants increase the infiltration of antigen presenting cells (APCs) into tumours. APCs are specialised immune cells that present foreign molecules (for mutated cancer proteins) to immune cells. The presentation of cancer proteins to immune cells is what allows the immune system to identify and kill cancer cells.
The same thing appears to happen in human cancer patients . Beneficial bacteria stimulate APCs in the gut. These active APCs then make their way to tumours where they help facilitate a robust anti-tumour immune response .
What this means for you
This study provides the first critical evidence that transfer of gut bacteria can improve the cure rate in cancer patients.
This is a breakthrough because microbiota transplantation is known to be extremely safe. This is true even for people with compromised immune systems. Thus, optimised bacterial therapies can be rapidly deployed to improve the survival of patients with non-responsive cancers.
These finding also have broader implications for cancer prevention. Most of the time, your immune system keeps cancer at bay. Once identified, bacterial strains that improve your immune response to cancer can be developed into probiotics that prevent cancer.
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