Dr Barata on the Relationship Between the Microbiome and Immunotherapy in RCC

Pedro Barata, MD, MSc, director, GU Medical Oncology Research Program, University Hospitals Seidman Cancer Center, associate professor of Medicine, Case Western Reserve University, Case Comprehensive Cancer Center, discusses the relationship between the gut microbiome and treatment with immunotherapy in patients with renal cell carcinoma (RCC).

Although significant strides have been made for the treatment of patients with advanced clear cell RCC, along with some progress for those with non–clear cell RCC, most patients continue to experience disease progression at some point and eventually succumb to their disease, Barata begins. Therefore, developing novel targets and approaches remains a key focus for improving outcomes for patients with advanced disease, he details. Ongoing research is centered around both optimizing the treatments currently available for these patients and bringing new therapies into the treatment paradigm, Barata explains.

Immunotherapy-based regimens have an established role in the treatment of patients with advanced RCC, and one current direction for research involves optimizing the gut microbiome to improve the efficacy of these immuno-oncology agents, Barata expands. Published data have detailed the interaction between antibiotics and the activity of immune checkpoint inhibitors, he says. Additionally, the presence of specific microorganisms in the gut could affect response to immune checkpoint inhibitors in patients with RCC or other tumor types, Barata empahasizes.

Some of this beneficial data was derived from a phase 1 trial (NCT03829111) that showed that the that addition of CBM588—a live probiotic comprised primarily of Clostridium butyricum—to the standard immunotherapy doublet of ipilimumab (Yervoy) and nivolumab (Opdivo) led to a significant improvement in progression-free survival vs ipilimumab and nivolumab alone.

By better understanding the gut microbiome and factors that could affect outcomes for patients with advanced RCC treated with immunotherapy, outcomes could potentially improve, Barata continues. Of note, there are 2 current ongoing trials exploring this approach, Barata concludes.