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Antibiotics in the weeks before immunotherapy are linked with worse outcomes, and shop-bought probiotics may not help and might hurt. Avoiding both where possible is a low-cost precaution.
Meta-analyses of more than 10,000 patients find that antibiotic exposure within about 30-60 days before starting checkpoint inhibitors is associated with roughly halved overall survival (pooled HR near 1.9), consistent across lung, kidney and melanoma cohorts, though confounding by indication (sicker patients get antibiotics) is unresolvable in observational data. Over-the-counter probiotics were associated with lower microbiome diversity and worse response in the Spencer melanoma cohort; by contrast, the specific strain Clostridium butyricum CBM588 improved PFS when added to nivolumab-ipilimumab in a small randomised trial in kidney cancer (Nature Medicine 2022, n=30). The distinction between 'probiotics' as a class and specific evidence-based strains matters. Practical stewardship: avoid prophylactic or empirical antibiotics around IO initiation where safe, narrow spectrum and shorten courses, and counsel against unselected probiotic supplements.
Broad-spectrum antibiotics deplete the commensal taxa and metabolites that support anti-tumour immunity; generic probiotics can reduce diversity by dominating the niche, whereas specific strains may restore favourable metabolite production.
Query for this technology: (TITLE:"Probiotics, antibiotics and stewardship around immunotherapy" OR ABSTRACT:"Probiotics, antibiotics and stewardship around immunotherapy") AND (cancer OR tumor OR tumour OR oncology OR carcinoma OR lymphoma OR leukemia OR leukaemia OR myeloma OR sarcoma OR melanoma OR glioma). Results are unfiltered search hits about Probiotics, antibiotics and stewardship around immunotherapy, not a curated reading list.
Shares Microbiome modulation to unlock immunotherapy, Gut microbiome diversity and composition, Dietary fibre and the gut microbiome for immunotherapy response, Microbiome-tumour interactions.
Shares Microbiome modulation to unlock immunotherapy, Gut microbiome diversity and composition, Microbiome-tumour interactions, Diet, exercise and lifestyle roadmap: causes established → interventions that disappointed → exercise proven as treatment.
Shares Microbiome modulation to unlock immunotherapy, Gut microbiome diversity and composition, Microbiome-tumour interactions, Diet, exercise and lifestyle roadmap: causes established → interventions that disappointed → exercise proven as treatment.
Shares Capture diet, fibre and antibiotic exposure in every immunotherapy pivotal trial, Dietary fibre and the gut microbiome for immunotherapy response, No one can predict who responds to immunotherapy, Melanoma.
Shares Ipilimumab, Renal cell carcinoma, Nivolumab, Bladder & urothelial cancer.
Shares Gut microbiome diversity and composition, Dietary fibre and the gut microbiome for immunotherapy response, Microbiome-tumour interactions.
Shares Ipilimumab, Renal cell carcinoma, Nivolumab, Melanoma.
Shares No one can predict who responds to immunotherapy, Nivolumab, Melanoma, Pembrolizumab.