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An adjunct microbiome therapy to enhance immunotherapy efficacy in melanoma patients

Genes & Immunity volume 25, pages 87–88 (2024)Cite this article

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In the clinic, the decision to use the combination of nivolumab and ipilimumab is based on the judgment as to whether the patient would likely tolerate the known grade 3/4 toxicities that occur in more than half of patients receiving it. Despite this, the combination remains the standard of care, and the goal is to use it preferentially, particularly in patients with intracranial disease. However, it is unclear as to which patients ultimately do not require the addition of anti-CTLA4 and could be spared the toxicity associated with it when combined with anti-PD1. The results from the MIMic trial suggest that an adjunct microbiome-based intervention can improve the response to anti-PD1 monotherapy with minimal additional toxicity.

Although not the primary objective of MIMic, this trial gained insight into the composition of the intestinal microbiota of patients with advanced melanoma both before and after FMT with stool from healthy donors. The stool microbial composition at the time of diagnosis is simple to assess and may reflect the gut microbiota profile of the patient and prove a valuable biomarker for selecting patients who would benefit most from FMT. Ultimately, the results of the MIMic trial highlight the potential that specific taxonomic deficiencies could be identified and targeted with a single dose of FMT from healthy donors prior to ICI treatment.

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Fig. 1: Healthy donor FMT to modify the gut microbiome in anti-PD1-naive melanoma patients.

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Acknowledgements

This work is supported by a grant from the Lotte and John Hecht Memorial Foundation and a grant from the Weston Family Foundation.

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Authors and Affiliations

  1. Department of Oncology, Western University, London, ON, Canada

    John G. Lenehan & Saman Maleki Vareki

  2. Lawson Health Research Institute, London, ON, Canada

    John G. Lenehan & Saman Maleki Vareki

  3. Department of Pathology and Laboratory Medicine, Western University, London, ON, Canada

    Saman Maleki Vareki

  4. Ontario Institute of Cancer Research, Toronto, ON, Canada

    Saman Maleki Vareki

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  1. John G. Lenehan
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  2. Saman Maleki Vareki
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SMV designed the project. JGL and SMV co-wrote the commantry and approved the final version.

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Correspondence to Saman Maleki Vareki.

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Lenehan, J.G., Maleki Vareki, S. An adjunct microbiome therapy to enhance immunotherapy efficacy in melanoma patients. Genes Immun 25, 87–88 (2024). https://doi.org/10.1038/s41435-023-00240-9

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