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Immunotherapy in Colorectal Cancer: Potential of Fecal Transplant and Microbiota-Augmented Clinical Trials

  • Basic Science Foundations in Colorectal Cancer (S Umar, Section Editor)
  • Published:
Current Colorectal Cancer Reports

Abstract

Purpose of Review

This review summarizes the role of the microbiome in colorectal cancer (CRC) in the setting of immunotherapy and emphasizes the potential of microbiota-influencing strategies with a focus on the use of fecal microbiota transplant (FMT).

Recent Findings

Observations from preclinical and clinical studies suggest that the human gut microbiome is implicated in the CRC carcinogenesis and is integral in determining the clinical response and toxicity to immunotherapy. Among the therapeutic methods devised to exploit the microbiome, FMT is the most direct method and is backed by the highest level of evidence of efficacy in nonneoplastic disease settings. Furthermore, a favorable microbiome has the potential to overcome immunotherapy resistance and ameliorate immune-related adverse events (irAEs). To this end, clinical trials are underway to evaluate the potential of FMT and microbiota-augmented methods in the setting of immunotherapy in CRC.

Summary

Evidence from animal studies, retrospective studies, and smaller-scale prospective human studies have led to initiation of a number of microbiota-augmented clinical trials in CRC. Given the intimate relationship between the gut microbiota and the immune system as well as antitumor immune responses, potentiating immunotherapy and managing its toxicity are major areas of research in microbiota-augmented therapies in cancer. Therefore, evaluation of the patient microbiome as a routine part of clinical outcome analysis is warranted in future clinical trials.

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Acknowledgements

The editors would like to thank Dr. Sakti Chakrabarti for taking the time to review this manuscript.

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Authors and Affiliations

  1. Department of Medicine, MetroWest Medical Center/Tufts University School of Medicine, Framingham, MA, USA

    Robin Park

  2. Department of Medicine, Division of Surgery, Kansas University Medical Center, Kansas City, KS, USA

    Shahid Umar

  3. Department of Medicine, Division of Medical Oncology, Kansas University Medical Center, 2650 Shawnee Mission Pkwy, Westwood, Kansas City, KS, 66205, USA

    Anup Kasi

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Correspondence to Anup Kasi.

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Robin Park and Shahid Umar each declare no potential conflicts of interest.

Anup Kasi has received financial support, paid to his institution, from TESARO, Halozyme, Geistlich Pharma, Astellas Pharma, and Rafael Pharmaceuticals, and honoraria from OncLive.

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This article is part of the Topical Collection on Basic Science Foundations in Colorectal Cancer

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Park, R., Umar, S. & Kasi, A. Immunotherapy in Colorectal Cancer: Potential of Fecal Transplant and Microbiota-Augmented Clinical Trials. Curr Colorectal Cancer Rep 16, 81–88 (2020). https://doi.org/10.1007/s11888-020-00456-1

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