《JAMA·肿瘤学》:全方位参与癌症叙事 肠道微生物有望重塑癌症治疗范式！

目前正在进行多项临床试验，涵盖了我们前面介绍的各个方向，可能会彻底改变未来癌症治疗的范式。

然而，靶向肠道微生物疗法的应用仍存在许多局限和不足。

首先，研究结果的异质性可能是由于测定微生物组成时取样样品和分析方法的不一致造成的。

其次，即使在健康人群中，肠道微生物的组成也存在很大差异。此外，我们目前对许多肠道微生物的功能缺乏了解，无法定义理想的菌群。因此，癌症患者如果想用益生菌治疗，需要谨慎。

再次，人的肠道微生物组成更加复杂，从动物研究到临床研究的转化不稳定。例如，在临床试验中，补充鼠李糖乳杆菌GG未能显著改善HSCT后患者的肠道微生物组成，与对照组相比，发生移植物抗宿主病的比例更高[26]。

另外，就像我们之前对抗生素的关注一样，饮食作为一个对肠道微生物组成也有很大影响的因素，也需要给予更多的关注。因为肿瘤也需要来自饮食的营养，所以饮食辅助治疗也是研究方向之一，比如热量限制、生酮饮食，或者限制氨基酸含量的饮食等。饮食不仅影响肿瘤，还影响肠道微生物组成。这些影响是重叠的还是冲突的？如何更有效的调节肠道微生物和抗肿瘤效果？这些都是亟待解决的重要问题。

众所周知，癌症的治疗不是单一疗法就能成功的，而是需要多方面的综合治疗。因此，仍有许多可能性值得探索，例如，将手术、免疫治疗与饮食和益生菌/代谢物治疗结合起来，成为一种新的治疗范式，可以增强抗肿瘤效果，降低全身毒性，提高癌症的全程管理。

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