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Interventions Targeting the Gut Microbiome to Improve Cancer Treatment Outcomes and Their Gastrointestinal Side Effects: A Systematic Review and Meta-analysis.

  • 2026-02
  • The Journal of nutrition 156(2)
    • Cecilia Morel
    • Ruijie Li
    • Carmen Fiuza Luces
    • Mark Fh Brougham
    • Juan Francisco Pascual-Gazquez
    • Luciana Torquati
    • Raquel Revuelta Iniesta

Study Design

Type
Meta-Analysis
Sample size
n = 37
Population
studies assessing GM interventions during cancer treatment
Methods
Three databases (PubMed, Web of Science, and Cochrane Library) were systematically searched up to February 2025; risk of bias was evaluated using the Effective Public Healthcare Panacea Project Quality Assessment tool; meta-analyses were conducted in Stata 18 using random-effects models

Background

Improvements in cancer treatment are essential to reduce premature mortality. Emerging evidence highlights the role of the gut microbiome (GM) in influencing treatment responses and modulating gastrointestinal adverse events (GIAEs). Because cancer therapy disrupts GM composition, restoring gut health may help mitigate side effects and support gut-associated immunity.

Objectives

This study aimed to systematically evaluate and assess the effectiveness of GM interventions on the occurrence of GIAEs and clinical responses to cancer treatment.

Methods

Three databases (PubMed, Web of Science, and Cochrane Library) were systematically searched up to February 2025 for studies assessing GM interventions during cancer treatment. Risk of bias was evaluated using the Effective Public Healthcare Panacea Project Quality Assessment tool. Meta-analyses were conducted in Stata 18 using random-effects models to estimate the pooled relative risk of GM interventions on gut microbiome interventions, gastrointestinal adverse events (GIAEs) (primary outcome) and objective disease response rates (secondary outcome).

Results

Fifty-six studies were included in the systematic review, and 40 were meta-analyzed (n = 37 for GIAE outcomes, n = 8 for treatment response). GM interventions reduced the overall risk of GIAEs 95% CI: 0.53, 0.65; I2: 76.8%; 95% prediction interval (PI): 0.32, 1.08], including diarrhea, constipation, nausea, and vomiting, but with considerable heterogeneity between studies. There was insufficient evidence to suggest improvements in objective disease response rates (RR: 1.06; 95% CI: 0.93, 1.20; I2: 0%; 95% PI: 0.93, 1.20).

Conclusions

GM interventions show promise in improving cancer care by reducing GIAEs, although evidence for direct effects on-treatment response remains limited. Standardizing intervention protocols and outcome reporting in future RCTs is essential to strengthen the evidence base and guide clinical recommendations. This trial was registered at PROSPERO as CRD42023443332 (https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023443332).

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