Immunotherapy may work better after a fecal transplant

Immunotherapy may work better after a fecal transplant

Patients for whom immunotherapy drugs initially failed but then had a fecal transplant from a donor who had good results, saw the immunotherapy work, reduce tumours and prolong survival.

Two different studies in their early stages were presented at the 2020 American Association for Cancer Research. The early results suggest that some patients who initially did not benefit from certain immunotherapy drugs benefitted after receiving a stool sample from patients for whom the drugs had worked. Their tumours stopped growing and/or shrank.

The research involved patients on PD-1 immunotherapy drugs, where the drugs block a protein on immune system T-cells, stopping they from working fully. By the blocker reducing the block, the T-cell can recognise the cancer and do its job.

So far, immunotherapy drugs like Pembrolizumab (Keytruda) and Nivolumab (Opdivo) work well in a few people but most cancers just don’t respond.

Research has largely pointed in the direction of the microbiome for being a controlling factor:

  • People who take antibiotics before immunotherapy have very poor success rates
  • People who take probiotics with immunotherapy sometimes get a better response
  • People who consume high levels of soluble fibre, get a better response

Researchers have previously concluded that increasing the number of T-cells (through increasing good bacteria numbers (through probiotics or their favourite foods) aided the PD-1 drugs whereas decreasing T-cell numbers through antibiotics hindered the drugs, which anyway damage the gut microbiome.

Initial studies showed the benefits of Fecal Transplants with immunotherapy drugs in mice. Now a number of different centres are looking at giving fecal transplants to humans.

Go to: What is a Fecal Transplant?

For example, Gal Markel and Ben Boursi at Sheba Medical Center in Ramat Gan, Israel, collected stool samples from two patients with metastatic skin cancer whose tumours completely disappeared after they got the PD-1 drugs. Using colonoscopy, the researchers added bacteria from the successful patients to three others who had had poor results. The microbiome of each of the three moved closer to that of the successful patients and one man is still doing well after 7 months, with another seeing an immediate positive response lasting 2 months.

Researchers for the National Cancer Institute saw the same sort of result – a major breakthrough in one person, improved performance in another but no improvement in a third.

Early days yet, but already lessons can be learned. If you are about to have immunotherapy, do everything in your power to boost your microbiome. Although, just to confuse issues, after three studies from Chicago Medical School and Lille, France showing Probiotics had a positive benefit, MD Anderson researchers think they might not!

Go to: Your microbiome controls your immune response




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2020 Research
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