Gut Microbiome Modulation and Outcomes of Immune Checkpoint Inhibitors in Solid Tumors: A Secondary Qualitative Review
Abstract
ICI has revolutionized the treatment of solid tumors, but durable response has only been observed in a minority
of patients, and traditional biomarkers are not sufficient to explain the heterogeneity. Indeed, an increasing body
of translational evidence suggests that the gastrointestinal tract microbiome is not merely correlational but a host
determinant that can be remodeled to influence immune tone, treatment response, and toxicity. Synthesizing
clinical evidence on gut microbiome modulation in clinical primaries and outcomes of immune checkpoint
inhibitors in solid tumors, this secondary qualitative analysis has a thematic focus on response, survival, and
mechanistic plausibility. Eligible English language studies based on citation chasing were searched through a
structured search of PubMed, Europe PMC, Crossref, and Google Scholar. The findings synthesis involved fifteen
primary studies, and theoretical framing and discussion were conducted by a separate review of the literature.
Three common patterns were found in the thematic analysis. First, responder phenotypes were repeatedly
associated with higher microbial diversity and microbial enrichment, including Akkermansia, Ruminococcaceae,
Faecalibacterium, and Bifidobacterium. Second, in certain environments, uncontrolled exposure to antibiotics
and, in others, uncontrolled exposure to probiotics seemed to undermine the integrity of the ecological response
and the effectiveness of checkpoints, even though confounding is…
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