改善癌症免疫治疗,菌群调节从何入手?(综述)
创作:szx 审核:szx 2020年09月14日
  • 抗生素对非小细胞肺癌、肾细胞癌及黑色素瘤患者对ICI治疗的应答均有不利影响;
  • 多项临床试验正在探究调控菌群(粪菌移植、益生菌、饮食干预、特定活菌组合等)在多种癌症中对ICI疗效的影响;
  • 患者接受ICI治疗前应避免使用抗生素及质子泵抑制剂,近期使用过抗生素的患者可考虑延迟ICI治疗;
  • 患者应多样化饮食结构,多摄入膳食纤维,摄入尽量多种类的植物;
  • 目前不建议患者摄入商品化的益生菌补充剂,而建议摄入含有多种活菌的发酵食品。
主编推荐语
szx
肠道菌群与癌症患者对免疫检查点抑制剂(ICI)治疗的应答密切相关。European Journal of Cancer上发表的一篇综述文章,详细讨论了如何通过直接方式(粪菌移植、抗生素、益生菌、合生制剂、特定菌群组合、噬菌体)及间接方式(饮食干预、膳食纤维、发酵食品等)调控癌症患者的肠道菌群,以提高患者对ICI治疗的应答,同时对于开始ICI治疗前的患者及医生给出了一些广泛的建议。
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Role of the gut microbiome for cancer patients receiving immunotherapy: Dietary and treatment implications

肠道菌群在接受免疫治疗的癌症患者中的作用:饮食与治疗的影响

10.1016/j.ejca.2020.07.026

2020-09-01, Article

Abstract & Authors:展开

Abstract:收起
Immune-checkpoint inhibitors (ICIs) have revolutionised the therapeutic landscape for multiple malignancies and the health of the gut microbiome (GM) is strongly linked with therapeutic responses to ICI. This review explores the implications of diet and medication on the GM for patients receiving ICI. Clinical trials are underway to explore the impact of factors such as faecal microbiota transfer, probiotics, prebiotics, bacteria consortia and a number of dietary interventions on patients receiving ICI. Randomised controlled trials are lacking, and inferences are currently based on short-term clinical and observational studies. Antibiotics should be avoided before ICI initiation, and depending on prospective data, future consideration may be given to temporary delay of initiation of non-urgent ICI if patient has had broad spectrum antibiotics within 1 month of planned treatment initiation. Proton pump inhibitor use should be discontinued when not clearly indicated and potential switch to a histamine H2-receptor antagonist considered. Patients should be advised to minimise animal meat intake and maximise plants, aiming to consume ≥30 plant types weekly. A high fibre intake (>30 g/day) has been seen to be beneficial in increasing the chance of ICI response. Fermented foods may have a beneficial effect on the GM and should be introduced where possible. Ideally, all patients should be referred to a nutritionist or dietician with knowledge of GM before commencing ICI.

First Authors:
Karla A Lee

Correspondence Authors:
Karla A Lee

All Authors:
Karla A Lee,Heather M Shaw,Veronique Bataille,Paul Nathan,Tim D Spector

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