Published online Nov 14, 2021. doi: 10.3748/wjg.v27.i42.7340
Peer-review started: May 20, 2021
First decision: June 13, 2021
Revised: June 18, 2021
Accepted: November 3, 2021
Article in press: November 3, 2021
Published online: November 14, 2021
Processing time: 173 Days and 20.5 Hours
Immunotherapy has revolutionized the clinical outcomes of intractable cancer patients. Little is known about the intestinal nonpathogenic bacterial composition of hepatocellular carcinoma (HCC) patients treated by immunotherapy.
To determine whether there is a correlation between gut bacterial composition and prognosis in HCC patients.
From September 2019 to March 2020, we prospectively collected fecal samples and examined the gut microbiome of 8 advanced HCC patients treated with nivolumab as a second- or third-line systemic treatment. Fecal samples were collected before the start of immunotherapy. Fecal samples of patients with progression during treatment were collected at the time of progression, and fecal samples of patients who showed good response to nivolumab were collected after 5-7 mo as follow-up. Metagenomic data from 16S ribosomal RNA sequencing were analyzed using CLC Genomics Workbench. Microbiome data were analyzed according to therapeutic response.
All 8 patients were male, of which 6 had underlying chronic hepatitis B. A higher Shannon index was found in the responders than in the non-responders after nivolumab therapy (P = 0.036). The unweighted beta diversity analysis also showed that the overall bacterial community structure and phylogenetic diversity were clearly distinguished according to therapeutic response. There was no significant difference in the diversity or composition of the patient gut microbiome according to the immunotherapy used. Several taxa specific to therapeutic response were designated as follows: Dialister pneumosintes, Escherichia coli, Lactobacillus reteri, Streptococcus mutans, Enterococcus faecium, Streptococcus gordonii, Veillonella atypica, Granulicatella sp., and Trchuris trichiura for the non-responders; Citrobacter freundii, Azospirillum sp. and Enterococcus durans for the responders. Of note, a skewed Firmicutes/Bacteroidetes ratio and a low Prevotella/Bacteroides ratio can serve as predictive markers of non-response, whereas the presence of Akkermansia species predicts a good response.
The current presumptive study suggests a potential role for the gut microbiome as a prognostic marker for the response to nivolumab in treatment of HCC patients.
Core Tip: Immune check point inhibitors are known to be an effective treatment option for advanced hepatocellular carcinoma (HCC), not only for second-line, but also as a first-line treatment. However, there are few predictive or prognostic markers for which patient group will have a good treatment response to immunotherapy or systemic therapy for HCC until now. Our study shows that non-responders to nivolumab in HCC patients have dysbiotic fecal composition, whereas a high Prevotella/Bacteroides ratio can predict a better response to nivolumab, highlighting a potential role for the gut microbiome as a prognostic marker for the response to nivolumab therapy.