The use of antibiotic, probiotic, and FMT in modulating Immunotherapy Efficacy and Survival: a systematic review and meta-analysis of clinical outcomes.

Authors

Zijun Zhai, Shuling Ma, Shijie Shang, Xinyi Liang, Shan Yin, Haofeng Lin, Rui Ding, Aimin Jiang, Ran Zhang, Meng Wu, Jinming Yu, Qian Song, Dawei Chen

Published in

The oncologist. Jul 10, 2026. Epub Jul 10, 2026.

Abstract

Immune checkpoint inhibitors (ICIs) have been one of the important therapeutic approaches for patients with advanced malignancies; nevertheless, their clinical efficacy remains limited in many patients. Recently, the contribution of intestinal microbiota to improved antitumor immune responses has gradually been recognized.
A comprehensive literature search was conducted in PubMed, Embase, and the Cochrane Library to identify relevant studies published up to June 15, 2026. We evaluated the influence of microbiota interventions with respect to efficacy and survival in cancer patients receiving ICIs from three perspectives: antibiotics, probiotics, as well as fecal microbiota transplantation (FMT). The main endpoint was objective response rate (ORR), and secondary endpoints were overall survival (OS) and progression-free survival (PFS).
The final analysis comprised 106 studies and categorized them into three groups: antibiotics (76 studies), probiotics (15 studies), and FMT (15 studies). Antibiotic use was correlated with compromised immunotherapy efficacy and unfavorable survival outcomes. In particular, antibiotics exposure was linked to a reduced ORR (Odds Ratio, OR = 0.60, 95% Confidence Interval, CI = 0.46-0.77, p < 0.001), shorter OS (Hazard Ratio, HR = 1.56, 95% CI = 1.44-1.69, p < 0.001), and shorter PFS (HR = 1.50, 95% CI = 1.32-1.70, p < 0.001). In contrast, probiotics showed a supportive and positive effect on immunotherapy outcomes, with improved ORR (OR = 1.95, 95% CI = 1.46- 2.62, p < 0.001) and better OS (HR = 0.56, 95% CI = 0.41- 0.78, p < 0.001) and PFS (HR = 0.53, 95% CI = 0.38-0.74, p < 0.001). FMT combined with immunotherapy achieved a favorable ORR of 0.30 (95% CI = 0.16-0.45, p < 0.001).
This meta-analysis synthesized evidence from studies on antibiotics, probiotics, and FMT use, suggesting gut microbiota offering potential approaches to enhance immunotherapy treatment effectiveness and clinical efficacy in individuals with advanced-stage solid cancers.

PMID:
42434798
Bibliographic data and abstract were imported from PubMed on 11 Jul 2026.

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