Interventions Targeting the Gut Microbiome to Improve Cancer Treatment Outcomes and Their Gastrointestinal Side Effects: A Systematic Review and Meta-analysis
Abstract
Background Improvements in cancer treatment are essential to reduce premature mortality. Emerging evidence highlights the role of the gut microbiome (GM) in influencing treatment responses and modulating gastrointestinal adverse events (GIAEs). Because cancer therapy disrupts GM composition, restoring gut health may help mitigate side effects and support gut-associated immunity. Objectives This study aimed to systematically evaluate and assess the effectiveness of GM interventions on the occurrence of GIAEs and clinical responses to cancer treatment. Methods Three databases (PubMed, Web of Science, and Cochrane Library) were systematically searched up to February 2025 for studies assessing GM interventions during cancer treatment. Risk of bias was evaluated using the Effective Public Healthcare Panacea Project Quality Assessment tool. Meta-analyses were conducted in Stata 18 using random-effects models to estimate the pooled relative risk of GM interventions on gut microbiome interventions, gastrointestinal adverse events (GIAEs) (primary outcome) and objective disease response rates (secondary outcome). Results Fifty-six studies were included in the systematic review, and 40 were meta-analyzed (n = 37 for GIAE outcomes, n = 8 for treatment response). GM interventions reduced the overall risk of GIAEs [relative risk (RR)]: 0.59; 95% CI: 0.53, 0.65; I2: 76.8%; 95% prediction interval (PI): 0.32, 1.08], including diarrhea, constipation, nausea, and vomiting, but with…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 37 participants or records.
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