Metagenomic Shotgun Sequencing and Unbiased Metabolomic Profiling Identify Specific Human Gut Microbiota and Metabolites Associated with Immune Checkpoint Therapy Efficacy in Melanoma Patients

• Published in: Neoplasia (New York, N.Y.) Vol. 19; no. 10; pp. 848 - 855
• Main Authors: Frankel, Arthur E., Coughlin, Laura A., Kim, Jiwoong, Froehlich, Thomas W., Xie, Yang, Frenkel, Eugene P., Koh, Andrew Y.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-10-2017; Elsevier Limited; Elsevier
• Subjects: Adult; Aged; Aged, 80 and over; Antineoplastic Agents, Immunological - pharmacology; Antineoplastic Agents, Immunological - therapeutic use; Bacteroides; Biomarkers, Tumor; Chromatography, High Pressure Liquid; Cluster Analysis; Female; Gastrointestinal Microbiome; High-Throughput Nucleotide Sequencing; Humans; Immune checkpoint inhibitors; Intestinal microflora; Male; Melanoma; Melanoma - drug therapy; Melanoma - etiology; Melanoma - metabolism; Melanoma - pathology; Metabolites; Metabolomics; Metabolomics - methods; Metagenome; Metagenomics - methods; Metastases; Metastasis; Microbiomes; Microbiota; Middle Aged; Molecular Targeted Therapy; Monoclonal antibodies; Neoplasm Metastasis; Neoplasm Staging; Prognosis; Solid tumors; Studies; Tandem Mass Spectrometry; Treatment Outcome
• ISSN: 1476-5586; 1522-8002; 1476-5586; 1522-8002
• DOI: 10.1016/j.neo.2017.08.004

This is the first prospective study of the effects of human gut microbiota and metabolites on immune checkpoint inhibitor (ICT) response in metastatic melanoma patients. Whereas many melanoma patients exhibit profound response to ICT, there are fewer options for patients failing ICT—particularly with BRAF-wild-type disease. In preclinical studies, specific gut microbiota promotes regression of melanoma in mice. We therefore conducted a study of the effects of pretreatment gut microbiota and metabolites on ICT Response Evaluation Criteria in Solid Tumors response in 39 metastatic melanoma patients treated with ipilimumab, nivolumab, ipilimumab plus nivolumab (IN), or pembrolizumab (P). IN yielded 67% responses and 8% stable disease; P achieved 23% responses and 23% stable disease. ICT responders for all types of therapies were enriched for Bacteroides caccae. Among IN responders, the gut microbiome was enriched for Faecalibacterium prausnitzii, Bacteroides thetaiotamicron, and Holdemania filiformis. Among P responders, the microbiome was enriched for Dorea formicogenerans. Unbiased shotgun metabolomics revealed high levels of anacardic acid in ICT responders. Based on these pilot studies, both additional confirmatory clinical studies and preclinical testing of these bacterial species and metabolites are warranted to confirm their ICT enhancing activity.