Gut microbiome and nutritional strategies in gastrointestinal cancers: Clinical implications and therapeutic perspectives

Table 2 Recent findings on microbiome-targeted therapies for pancreatic ductal adenocarcinoma

Therapeutic approach	Description	Key findings
Antibiotic therapy	Targeting tumor-associated bacteria to reduce tumor burden and enhance immunotherapy	Pushalkar et al[211] found a 50% tumor burden reduction in PDAC mouse models after oral antibiotic treatment
		Tumor microenvironment reprogrammed, reducing myeloid-derived suppressor cells and increasing M1 macrophages[211]
		Antibiotics improved PD-1 checkpoint inhibitor response, enhancing T-cell activation and reducing tumor size[211]
		A clinical trial is evaluating antibiotic-pembrolizumab combination in locally advanced PDAC[189]
Probiotics and PDAC prevention	Investigating probiotics’ role in mitigating PDAC risk factors (e.g., pancreatitis, obesity, diabetes)	Lactobacillus plantarum 299 reduced pancreatic sepsis and surgical need in acute pancreatitis patients[212]
		Probiotics reduced fibrosis, inflammation, necrosis, ductal damage, and atypical cellular regeneration, potentially lowering PDAC risk
Microbiome and chemotherapy resistance	Examining bacterial interference with chemotherapy efficacy	Gammaproteobacteria enriched in 76% of PDAC samples, degrading gemcitabine into an inactive form[179]
		Microbiome-targeted approaches could enhance chemotherapy effectiveness

PDAC: Pancreatic ductal adenocarcinoma; PD-1: Programmed death 1.