{"entity":{"id":"idea-bio2-fibre-diet-io-trial","kind":"idea","name":"Test a high-fibre diet as an immunotherapy adjunct","aka":[],"tldr":"People who eat more fibre appear to respond better to immunotherapy, while some probiotic supplements may do the opposite. A proper trial would settle it.","summary":"Observational data in melanoma associate higher dietary fibre intake with improved checkpoint response, and over-the-counter probiotic use with worse response, with supporting mouse experiments. Diet is a cheap, scalable and modifiable exposure but has never been tested randomly alongside checkpoint therapy with microbiome and immune endpoints. Adherence measurement, through stool short-chain fatty acids, makes a rigorous trial possible.","asOf":"2026-09-08","links":[{"label":"Bottleneck evidence (No one can predict who responds to immunotherapy): Haslam & Prasad (JAMA Network Open 2019)","url":"https://doi.org/10.1001/jamanetworkopen.2019.2535"}],"tags":[],"related":[],"cancers":["melanoma","nsclc"],"sections":[],"technologies":["checkpoint-inhibitor"],"targets":[],"drugs":[],"companies":[],"institutions":["md-anderson"],"pathways":[],"terms":[],"trials":[],"people":["laurence-zitvogel"],"bottlenecks":["b-immunotherapy-response","b-tme-immunosuppression","b-generic-repurposing"],"keyPapers":["paper-haslam-jama-netw-open"],"journals":[],"dependsOn":[],"notes":[],"hypothesis":"A supervised high-fibre dietary intervention during checkpoint therapy improves response rate compared with usual diet, with stool short-chain fatty acid levels mediating the effect.","rationale":"Fibre fermentation produces short-chain fatty acids that alter T-cell differentiation, giving a plausible mechanism, and the observational effect size reported in melanoma was large. The intervention has no toxicity and independent health benefits.","test":"A randomised trial of provided high-fibre meals versus usual diet in patients starting checkpoint blockade, with objective response as primary endpoint and stool metabolomics and metagenomics as mechanistic endpoints.","maturity":"early-clinical","actor":"research","cost":"medium","horizonYears":5},"route":"/ideas/idea-bio2-fibre-diet-io-trial/","neighbours":{"cancer":[{"id":"melanoma","kind":"cancer","name":"Melanoma","route":"/cancers/melanoma/"},{"id":"nsclc","kind":"cancer","name":"Non-small-cell lung cancer","route":"/cancers/nsclc/"}],"technology":[{"id":"dietary-fibre-microbiome-io","kind":"technology","name":"Dietary fibre and the gut microbiome for immunotherapy response","route":"/technologies/dietary-fibre-microbiome-io/"},{"id":"checkpoint-inhibitor","kind":"technology","name":"Immune checkpoint inhibitors","route":"/technologies/checkpoint-inhibitor/"}],"institution":[{"id":"md-anderson","kind":"institution","name":"MD Anderson Cancer Center","route":"/institutions/md-anderson/"}],"person":[{"id":"laurence-zitvogel","kind":"person","name":"Laurence Zitvogel","route":"/people/laurence-zitvogel/"}],"bottleneck":[{"id":"b-tme-immunosuppression","kind":"bottleneck","name":"Cold tumours and the immunosuppressive microenvironment","route":"/bottlenecks/b-tme-immunosuppression/"},{"id":"b-generic-repurposing","kind":"bottleneck","name":"No incentive to repurpose cheap drugs","route":"/bottlenecks/b-generic-repurposing/"},{"id":"b-immunotherapy-response","kind":"bottleneck","name":"No one can predict who responds to immunotherapy","route":"/bottlenecks/b-immunotherapy-response/"}],"paper":[{"id":"paper-haslam-jama-netw-open","kind":"paper","name":"Estimation of the Percentage of US Patients With Cancer Who Are Eligible for and Respond to Checkpoint Inhibitor Immunotherapy Drugs","route":"/key-papers/paper-haslam-jama-netw-open/"}],"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/"}]}}