Faecal transplants can treat some cancers — but probably won’t ever be widely used (Jul 2024) Article

Michael Harrop · Jul 4, 2024

https://www.nature.com/articles/d41586-024-02212-z

"Won't ever be used" relies a lot on what the FDA decides next week.

FMT has provided a proof of concept that changing the gut microbiome of someone with cancer can save their life, and has set the benchmark against which these prospective treatments will be judged.

However, practical challenges — such as difficulties recruiting donors, demanding screening requirements and unease among physicians — have limited clinical uptake. Physicians also worry that human stool is an inconsistent medicine. “You don’t know if a donor has the right bacteria, and you don’t know which bacteria the recipient needs,” says Gajewski.

Thanks for ignoring the fact that a patient has solved most of those problems.

One problem is that the studies that found differences between the microbiomes of responders and non-responders in small cohorts failed to converge on a set of gut microbes that robustly predict immunotherapy responses across study sites. So, in 2022, gastroenterologist Laura Bolte at the University of Groningen in the Netherlands co-led a meta-analysis that combined data from several sources to examine the microbiomes and clinical outcomes of 165 people12. She hoped that the large sample size would bring clarity, but “it’s not that easy”, she says. “It’s more complex than just species differing between responders and non-responders.”

More limitations of current technological/testing capabilities.

Bolte and her colleague Johannes Björk, a microbiome researcher at the University of Groningen, think it might be necessary to go beyond the species level and also catalogue the subspecies and strains of bacteria present.

lol.. no shit.

a 2022 meta-analysis by Zarour and his colleagues was able to link some bacterial species to positive responses to checkpoint inhibitors. However, it uncovered a much stronger signature in non-responders, Zarour says — raising the possibility that removing unhelpful microbes might be more important than delivering ‘good’ ones14.

In Houston, Ajami says that, every few months, he welcomes to MD Anderson a woman who is currently in remission from colon cancer following checkpoint-inhibitor treatment three years ago. She has already donated stool for use in an ongoing FMT clinical trial, but is now providing samples to Ajami’s laboratory, too.

Fucking nuts. So much incompetence.

She hopes to uncover the mechanisms by which the gut microbiome influences cancer immunity, and design conventional drugs that use the same mechanisms to promote positive immunotherapy outcomes. “Let’s just completely circumvent the need to have the right microbiome,” she says.

Laughably incompetent and ignorant. Thinking the microbiome is so unimportant that ignoring it completely is a good idea.

These are the fools that laypeople blindly trust, and to whom their lives depend.

“There are going to be many mechanisms by which the microbiome can impact antitumour immunity, and this was one of them,” she adds. “We need to keep looking for others.”

Yes, including the cancer directly, not just the treatment.

Antibodies to PD-L2 and defined mixtures of live bacteria are likely to be more scalable and have a more consistent composition than FMT, and their developers are confident that they will succeed. If so, FMT might become nothing more than a footnote in the development of better therapies.

Presented with this view of the future, Routy and Elkrief both agree that using FMT for C. difficile infections has revealed many challenges. “There are a lot of logistical hurdles associated with such a programme,” Elkrief says. Most biotechnology companies are uninterested in FMT, she adds, and would prefer to develop more targeted treatments.

Eg. "drugs they can profit off of". FMT is not enough profit for them. They can't patent it. This is why a single disabled patient has been left to do the job of the medical research system on his own.

But Routy thinks that if trials of FMT for cancer keep yielding positive data, scientists and physicians will find ways to put it to clinical use.

If the FDA allows them to access high-quality donors.

This article is part of Nature Outlook: The human microbiome, a supplement produced with financial support from Yakult.

Interesting.

I think this article is a good demonstration of how much the scientific community lives in their own little bubble. That a "highly reputable" scientific source like Nature would be celebrating the use of cancer patients as stool donors, without covering the downsides of it, and listing issues hindering FMT while seemingly completely oblivious to the fact that a patient already solved those problems.

Faecal transplants can treat some cancers — but probably won’t ever be widely used (Jul 2024) Article

Michael Harrop

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