Understanding how the microbes that live on and in the human body affect health is a promising new frontier in cancer treatment, and modifying them could boost the effectiveness of immunotherapy, according to Daniel Spakowicz, PhD, a research assistant professor in the OSUCCC – James Division of Medical Oncology. “We’re learning a tremendous amount about the microbiome and how it interacts with, and helps, the body’s immune system,” he says. The Microbiome Environment Everyone’s digestive system contains trillions of microbe cells, such as bacteria, fungi and viruses. They combine to create a unique microbiome environment in each individual. Spakowicz and other leading researchers in this new and rapidly growing field can analyze a patient’s fecal sample and determine the exact composition of these cells. “We think the answers are in your poop, and we’re learning that people who respond better to immunotherapy have a different set of microbiomes in their gut than those patients who don’t respond as well,” Spakowicz says. “We’re still trying to understand exactly why some people have more of a certain microbe than others, which ones are more beneficial and how this impacts the prevention and treatment of cancer.” Modifying Microbes The next step is to alter the microbiome environment to better resemble that of the patients who have responded well to immunotherapy. One way is a fecal microbiome transplant. “There have been some early studies with this method, and it has shown some promise,” Spakowicz says. A better way may be altering a patient’s diet. “We think this is the safest option, and it’s something patients are able to control. This enables them to take a more active role in their cancer treatment.” To study the strategy, Spakowicz and his lab have opened the Be Well clinical trial, in which cancer patients drink two juice boxes per day that contain black raspberry nectar. This juice is high in polyphenols, which they think will increase the amount of Akkermansia muciniphila, a microbe that is more abundant in the microbiomes of patients who respond well to immunotherapy. Timing Is Important Learning how and when to change a patient’s microbiomes is another challenge. “Getting the timing right and learning how to change the microbiomes quickly is important because we don’t want to delay the start of a patient’s treatment,” Spakowicz says. One way to speed up the process could be to give someone a large dose of antibiotics. “[That could] help clear out much of the old microbiomes, and then [we could] utilize a fecal transplant from a donor and combine it this with diet,” Spakowicz says, adding that this line of research is being tested in pre-clinical models. Altering the Diet Spakowicz and others are just beginning to learn how our diets determine our exact microbiome environments. “A lot of people have been studying how food relates to cancer prevention and treatment for a long time,” he says. “There hasn’t been a lot of strong links between certain foods and outcomes, and I think that’s because we didn’t understand the microbiome connection.” Finding the connections and creating a diet rich in the foods that create better, healthier microbiomes is the goal. The Next Steps “This research is very exciting and has a lot of potential,” Spakowicz says of the growing field of microbiome research. The research is still in the basic science stage — comparable to where immunotherapy was several years ago — but could soon become a more and more important tool in treating cancer. “We think it will support and improve the effectiveness of other types of treatment, and create better outcomes for patients.”