Dual contribution of the gut microbiome to immunotherapy efficacy and toxicity: supportive care implications and recommendations

Hannah R. Wardill, Raymond J. Chan, Alexandre Chan, Dorothy Keefe, Samuel P. Costello, Nicolas H. Hart

Research output: Contribution to journalComment/debatepeer-review

7 Citations (Scopus)


The efficacy of immune checkpoint inhibitors (immunotherapy) is increasingly recognized to be linked to the composition the gut microbiome. Given the high rates of resistance, interventions targeting the gut microbiome are now being investigated for its ability to improve the efficacy of immunotherapy. In light of recently published data demonstrating a strong correlation between the efficacy and toxicity of immunotherapy, there is a risk that efforts to enhance immunotherapy efficacy may be undermined by increases in immune-related adverse events (IrAEs) This is particularly important for microbial interventions aimed at increasing immunotherapy efficacy, with many microbes implicated in tumour response also linked to IrAEs, especially colitis. IrAEs have a profound impact on patient quality of life, causing physical, psychosocial, and financial distress. Here, we outline strategies at the discovery, translational, and clinical research phases to ensure the impact of augmenting immunotherapy efficacy is approached in a manner that considers adverse implications. Adopting these strategies will ensure that our ongoing efforts to overcome immunotherapy resistance are not impacted by unacceptable toxicity.

Original languageEnglish
Pages (from-to)6369-6373
Number of pages5
JournalSupportive Care in Cancer
Issue number8
Publication statusPublished or Issued - Aug 2022


  • Adverse events
  • Efficacy
  • Gut microbiome
  • Immune checkpoint inhibitors
  • Immunotherapy
  • Supportive cancer care
  • Toxicity

ASJC Scopus subject areas

  • Oncology

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