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The bacteria in the gut, and even inside tumours, influence whether cancer starts and whether immunotherapy works. Transplanting stool from responders has made some non-responders respond.
Gut microbiota modulate systemic immunity (Bifidobacterium, Akkermansia, Faecalibacterium associated with PD-1 response; antibiotics associated with worse outcomes); faecal microbiota transplant from responders converted a fraction of refractory melanoma patients to responders (2021, and 2023-25 follow-ups). Intratumoural bacteria (Fusobacterium nucleatum in colorectal cancer, Gammaproteobacteria degrading gemcitabine in pancreatic cancer) affect chemoresistance and inflammation; colibactin-producing pks+ E. coli leaves a mutational signature in CRC. 'Polymorphic microbiomes' is a 2022 hallmark. Defined consortia (VE800, SER-155) and diet interventions are in trials; causality beyond melanoma is not settled.
Soil bacteria decide whether a garden thrives. Some feed the plants' defenders, some produce poisons, and some even eat the pesticide before it reaches the weeds.
If a childhood exposure to colibactin-producing Escherichia coli writes APC mutations into the colon decades before a tumour appears, then the rise in early-onset bowel cancer may be preventable by something done in childhood rather than by screening alone.
Cancer is now understood to change its identity and behaviour without new mutations, to be shaped by bacteria inside and around it, and to be helped along by ageing cells. This explains why some tumours escape targeted drugs by changing cell type and why gut bacteria affect immunotherapy response.
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