{"entity":{"id":"dietary-fibre-microbiome-io","kind":"technology","name":"Dietary fibre and the gut microbiome for immunotherapy response","aka":[],"tldr":"Patients who eat plenty of fibre and avoid probiotic pills seem to respond better to immunotherapy for melanoma, probably because fibre feeds the right gut bacteria. A proper trial is under way.","summary":"In 128 melanoma patients on checkpoint inhibitors (Spencer et al., Science 2021), each 5 g/day of dietary fibre was associated with a 30% lower risk of progression or death, and the combination of sufficient fibre (at least 20 g/day) with no probiotic use had the best outcomes; in mice, low fibre or probiotics impaired the anti-PD-1 response. Gut taxa such as Faecalibacterium, Ruminococcaceae and Akkermansia repeatedly associate with response across cohorts, though the specific species differ by study and geography. This is observational in humans and confounded by overall health, so a fibre-intervention trial is the right next step; a randomised high-fibre diet trial in melanoma patients starting immunotherapy is recruiting at MD Anderson. The pragmatic message that is defensible today: eat more fibre, do not take over-the-counter probiotics, and avoid unnecessary antibiotics around immunotherapy.","status":"emerging","asOf":"2026-09-08","wikipedia":"https://en.wikipedia.org/wiki/Dietary_fiber","links":[{"label":"Spencer et al. (Science 2021)","url":"https://doi.org/10.1126/science.aaz7015"}],"tags":[],"related":["idea-bio2-fibre-diet-io-trial","polymorphic-microbiomes","idea-nl-diet-covariates-io-trials"],"cancers":["melanoma","nsclc","rcc"],"sections":["nutrition-lifestyle","immunotherapy"],"technologies":["checkpoint-inhibitor","microbiome-modulation-io","fmt-checkpoint-nonresponders"],"targets":[],"drugs":["pembrolizumab","nivolumab","ipilimumab"],"companies":[],"institutions":["md-anderson"],"pathways":["microbiome-tumour"],"terms":["gut-microbiome-diversity","cold-vs-hot"],"trials":[],"people":["laurence-zitvogel"],"bottlenecks":["b-immunotherapy-response"],"keyPapers":["paper-spencer-science"],"journals":[],"dependsOn":[],"notes":[],"principle":"Fermentable fibre yields short-chain fatty acids and sustains bacterial taxa that enhance dendritic-cell antigen presentation and systemic interferon tone, increasing CD8 T-cell infiltration into tumours.","strengths":["Consistent microbiome-response associations across independent cohorts","Fibre is safe and cheap","Mechanistic mouse data support causality"],"limitations":["Human data observational and mostly in melanoma","Taxa vary between cohorts; no validated microbiome test","Diet recall is noisy"]},"route":"/technologies/dietary-fibre-microbiome-io/","neighbours":{"idea":[{"id":"idea-nl-diet-covariates-io-trials","kind":"idea","name":"Capture diet, fibre and antibiotic exposure in every immunotherapy pivotal trial","route":"/ideas/idea-nl-diet-covariates-io-trials/"},{"id":"idea-nl-upf-controlled-feeding-trial","kind":"idea","name":"Controlled feeding trials to separate ultra-processing from calories","route":"/ideas/idea-nl-upf-controlled-feeding-trial/"},{"id":"idea-bio2-fibre-diet-io-trial","kind":"idea","name":"Test a high-fibre diet as an immunotherapy adjunct","route":"/ideas/idea-bio2-fibre-diet-io-trial/"}],"term":[{"id":"gut-microbiome-diversity","kind":"term","name":"Gut microbiome diversity and composition","route":"/terms/gut-microbiome-diversity/"},{"id":"polymorphic-microbiomes","kind":"term","name":"Hallmark (2022): polymorphic microbiomes","route":"/terms/polymorphic-microbiomes/"},{"id":"cold-vs-hot","kind":"term","name":"Hot vs cold tumours","route":"/terms/cold-vs-hot/"}],"cancer":[{"id":"melanoma","kind":"cancer","name":"Melanoma","route":"/cancers/melanoma/"},{"id":"nsclc","kind":"cancer","name":"Non-small-cell lung cancer","route":"/cancers/nsclc/"},{"id":"rcc","kind":"cancer","name":"Renal cell carcinoma","route":"/cancers/rcc/"}],"section":[{"id":"nutrition-lifestyle","kind":"section","name":"Diet, Exercise & Lifestyle","route":"/fronts/nutrition-lifestyle/"},{"id":"immunotherapy","kind":"section","name":"Immunotherapy","route":"/fronts/immunotherapy/"}],"technology":[{"id":"fmt-checkpoint-nonresponders","kind":"technology","name":"Faecal microbiota transplantation for PD-1 non-responders","route":"/technologies/fmt-checkpoint-nonresponders/"},{"id":"checkpoint-inhibitor","kind":"technology","name":"Immune checkpoint inhibitors","route":"/technologies/checkpoint-inhibitor/"},{"id":"mediterranean-plant-forward-diet","kind":"technology","name":"Mediterranean and plant-forward dietary patterns","route":"/technologies/mediterranean-plant-forward-diet/"},{"id":"microbiome-modulation-io","kind":"technology","name":"Microbiome modulation to unlock immunotherapy","route":"/technologies/microbiome-modulation-io/"},{"id":"probiotics-antibiotic-stewardship-io","kind":"technology","name":"Probiotics, antibiotics and stewardship around immunotherapy","route":"/technologies/probiotics-antibiotic-stewardship-io/"}],"drug":[{"id":"ipilimumab","kind":"drug","name":"Ipilimumab","route":"/drugs/ipilimumab/"},{"id":"nivolumab","kind":"drug","name":"Nivolumab","route":"/drugs/nivolumab/"},{"id":"pembrolizumab","kind":"drug","name":"Pembrolizumab","route":"/drugs/pembrolizumab/"}],"institution":[{"id":"md-anderson","kind":"institution","name":"MD Anderson Cancer Center","route":"/institutions/md-anderson/"}],"pathway":[{"id":"microbiome-tumour","kind":"pathway","name":"Microbiome-tumour interactions","route":"/pathways/microbiome-tumour/"}],"person":[{"id":"laurence-zitvogel","kind":"person","name":"Laurence Zitvogel","route":"/people/laurence-zitvogel/"}],"bottleneck":[{"id":"b-immunotherapy-response","kind":"bottleneck","name":"No one can predict who responds to immunotherapy","route":"/bottlenecks/b-immunotherapy-response/"}],"paper":[{"id":"paper-spencer-science","kind":"paper","name":"Dietary fiber and probiotics influence the gut microbiome and melanoma immunotherapy response","route":"/key-papers/paper-spencer-science/"}],"roadmap":[{"id":"nutrition-lifestyle-roadmap","kind":"roadmap","name":"Diet, exercise and lifestyle roadmap: causes established → interventions that disappointed → exercise proven as treatment","route":"/roadmaps/nutrition-lifestyle-roadmap/"}]}}