SynthesisThe oncologist2026
The use of antibiotic, probiotic, and fecal microbiota transplantation in modulating immunotherapy efficacy and survival: a systematic review and meta-analysis of clinical outcomes.
Synthesis in The oncologist, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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13 authors.
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Abstract
backgroundImmune checkpoint inhibitors (ICIs) have been one of the important therapeutic approaches for patients with advanced malignancies; nevertheless, their clinical efficacy remains limited in many patients. Recently, the contribution of intestinal microbiota to improved antitumor immune responses has gradually been recognized.
methodsA comprehensive literature search was conducted in PubMed, Embase, and the Cochrane Library to identify relevant studies published up to June 15, 2026. We evaluated the influence of microbiota interventions with respect to efficacy and survival in cancer patients receiving ICIs from 3 perspectives: antibiotics, probiotics, and fecal microbiota transplantation (FMT). The main endpoint was objective response rate (ORR), and secondary endpoints were overall survival (OS) and progression-free survival (PFS).
resultsThe final analysis comprised 106 studies, which were categorized into 3 groups: antibiotics (76 studies), probiotics (15 studies), and FMT (15 studies). Antibiotic use was correlated with compromised immunotherapy efficacy and unfavorable survival outcomes. In particular, antibiotic exposure was linked to a reduced ORR (odds ratio [OR] = 0.60, 95% CI, 0.46-0.77, P < .001), shorter OS (hazard ratio [HR] = 1.56, 95% CI, 1.44-1.69, P < .001), and shorter PFS (HR = 1.50, 95% CI, 1.32-1.70, P < .001). In contrast, probiotics showed a supportive and positive effect on immunotherapy outcomes, with improved ORR (OR = 1.95, 95% CI, 1.46-2.62, P < .001) and better OS (HR = 0.56, 95% CI, 0.41-0.78, P < .001) and PFS (HR = 0.53, 95% CI= 0.38-0.74, P < .001). FMT combined with immunotherapy achieved a favorable ORR of 0.30 (95% CI, 0.16-0.45, P < .001).
conclusionsThis meta-analysis synthesized evidence from studies on antibiotics, probiotics, and FMT use, suggesting gut microbiota offering potential approaches to enhance immunotherapy treatment effectiveness and clinical efficacy in individuals with advanced-stage solid cancers.
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