Re­searchers study how gut mi­cro­biome af­fects can­cer treat­ment

The Progress-Index - - AMUSEMENTS - Dr. El­iz­a­beth Ko & Dr. Eve Glazier

Dear Doc­tor: I read that mi­crobes can af­fect how our body deals with im­munother­apy. A friend of mine is about to start im­munother­apy for lung can­cer. Is there any­thing she can do to in­crease the chances that her gut will help her body beat this can­cer?

Dear Reader: Your ques­tion sends us into the brave new world of pre­ci­sion medicine, which is rapidly trans­form­ing how we ap­proach can­cer treat­ment. Un­like chemo­ther­apy, which tar­gets all of the fast-di­vid­ing cells within the body no mat­ter their ori­gin, or ra­di­a­tion, which kills can­cer cells by dam­ag­ing the DNA in all of the cells in its path whether they are healthy or can­cer cells, im­munother­apy ap­proaches can­cer quite pre­cisely, and at the cel­lu­lar level. The point isn't so much to de­stroy can­cer cells as to dis­rupt them.

For in­stance (and very broadly -- it's far more com­plex than our space here al­lows), re­searchers have de­signed an­ti­bod­ies that dis­able can­cer cells by tar­get­ing spe­cific sites within those cells. They have also cre­ated chemo and ra­dio la­beled an­ti­bod­ies, which de­liver mi­cro­doses of pow­er­ful anti-can­cer drugs and ra­di­a­tion to can­cer at the cel­lu­lar level. In an ap­proach known as "adop­tive T cell trans­fer," a pa­tient's own im­mune cells are col­lected, mod­i­fied to en­hance can­cer­fight­ing prop­er­ties, and then re-in­fused.

Now, new re­search sug­gests that this tar­geted ap­proach can be bol­stered by beef­ing up a pa­tient's own gut mi­cro­biome, which is the vast and var­ied col­lec­tion of mi­cro­bial com­mu­ni­ties that live within each of us. This is im­por­tant be­cause, although im­munother­apy is bril­liant in the­ory, in prac­tice the re­sults thus far have been mixed.

That's be­cause the im­mune sys­tem is so alert to in­trud­ers of any kind that the pres­ence of the im­munother­apy drugs them­selves can set it off. Side ef­fects of im­munother­apy can in­clude rashes, fever, headache, weak­ness, el­e­vated liver en­zymes, low blood cell counts, breath­ing is­sues, di­ar­rhea and vom­it­ing. In some cases, ad­verse re­ac­tions to im­munother­apy can be se­vere enough to be lifethreat­en­ing. In ex­plor­ing av­enues to help a pa­tient's body tol­er­ate im­munother­apy, re­searchers looked to the gut mi­cro­biome.

Ac­cord­ing to a pair of stud­ies fea­tured in the jour­nal Sci­ence, the pa­tients who re­sponded best to treat­ment with a cer­tain class of im­munother­apy drugs were those with the more di­verse and ro­bust mi­cro­biomes.

One study, done by re­searchers in Texas, fo­cused on pa­tients with melanoma. The other, con­ducted in France, in­cluded pa­tients who had un­der­gone a course of an­tibi­otics to deal with lung, blad­der and kid­ney can­cer. The French re­searchers found that pa­tients who had un­der­gone a course of an­tibi­otics to deal with prob­lems like a uri­nary tract in­fec­tion had the poor­est re­sponse to im­munother­apy. The Texas re­searchers are now plan­ning to check their re­sults with a clin­i­cal trial. The re­search has re­port­edly caught the in­ter­est of sev­eral biotech com­pa­nies, which are also do­ing clin­i­cal re­search into the mat­ter.

Mean­while, your friend can take steps to im­prove her own mi­cro­biome. These in­clude adding fer­mented foods and bev­er­ages to her diet, eat­ing high-fiber fresh fruits and veg­eta­bles to pro­vide plenty of nu­tri­ents for her mi­cro­bial com­mu­nity, and steer­ing clear of ar­ti­fi­cial sweet­en­ers and pro­cessed foods. Fi­nally, we be­lieve it would be wise for her to en­list her health care team in this en­deavor.

Eve Glazier, M.D., MBA, is an in­ternist and as­so­ciate pro­fes­sor of medicine at UCLA Health. El­iz­a­beth Ko, M.D., is an in­ternist and as­sis­tant pro­fes­sor of medicine at UCLA Health. Send your ques­tions to ask­the­do­c­[email protected]­, or write: Ask the Doc­tors, c/o UCLA Health Sciences Me­dia Re­la­tions, 10880 Wil­shire Blvd., Suite 1450, Los An­ge­les, CA, 90024. Owing to the vol­ume of mail, per­sonal replies can­not be pro­vided.

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