Can Consideration of the Microbiome Improve Antimicrobial Utilization and Treatment Outcomes in the Oncology Patient?

Abstract

The need to provide effective and timely antimicrobial treatment to cancer patients with infections is well-recognized, but tempered by preliminary, but accumulating, evidence that antibiotic-induced microbiome dysbiosis affects cancer therapy response, non-infectious toxicities, and infectious complications. Given only a minority of empirically treated cancer patients are proven to have a true bacterial infection, it is important to consider the potential negative consequences of extensive broad-spectrum antimicrobial use on the commensal microbiota. Herein, we review the literature substantiating the dilemma oncologists face when treating suspected or documented infections with respect to the interaction between the host microbiome, antibiotics, and cancer-related clinical outcomes. We propose microbiome-based explorations that could assist oncologists in optimizing treatment strategies for cancer-related infections as well as the cancer, itself. In addition, we discuss knowledge gaps and challenges in this nascent field that must be addressed in order to deliver medically relevant translational applications. We anticipate the emerging knowledge regarding the role of the microbiota in the health of cancer patients may cause a reappraisal of the manner in which antibiotics are used in the oncologic setting and how microorganisms are viewed by oncologists.

Antibiotic prophylaxis in veterinary cancer chemotherapy: A review and recommendations

“…Systemically administered antimicrobials have been reported to have a dramatic impact on the composition and function of the gastrointestinal microbiome, a key factor in increasing gastrointestinal colonization by pathogenic and resistant bacteria . There is also significant evidence in humans that disruption of the intestinal microbiome during chemotherapy because of prophylactic antimicrobials as well as immunosuppression and mucositis can predispose to infections with Clostridium difficile …”

“…Based on these studies it is suspected that the commensal microbiome (particularly in the small intestine) is essential for an optimal response to chemotherapy. This is likely to be because of the effects such as bacterial translocation and activation of helper T cells, induction of reactive oxygen species and modulation of cell functions in the tumour microenvironment …”

“…One study found that alterations in the intestinal microbiome of patients receiving fluoroquinolone prophylaxis after haematopoietic stem cell transplantation were predictive of pulmonary complications such as lung infiltration . A “catch 22” situation has been described in human medicine where chemotherapy induces mucosal injury and inflammatory response, antimicrobials are given prophylactically at this stage to try to prevent infection but induce microbial dysbiosis leading to potential pulmonary complications, reduced responses to chemotherapy, inflammatory colitis, C. difficile and resistant infections …”

Role of Tryptophan-Metabolizing Microbiota On Diarrhea Mice Caused by Folium sennae Extracts

“…The dramatic impact of the commensal microbiota on the digestive disorders including diarrhea is increasing in appreciation. Although reports have provided evidence that Folium sennae can result in intestinal microbiota diversity disorder, the specific mechanism is still unknown for the gap of gaining knowledge that regarding the factors that drive different microbiota trajectories [21]. Therefore, this study was based on animal experiment and the techniques of metagenomics sequencing, drug target protein bioinformatics and microbial VMH intestinal simulation were utilized to probed the molecular mechanism of the variety of intestinal bacterial characteristic caused by Folium sennae diarrhea (Figure 10).…”

The Microbiota: A New Variable Impacting Cancer Treatment Outcomes

“…The authors highlight the role that the microbiota plays in treatment efficacy and the overall health of the cancer patient (see Figure 1) (1). …”