Nazli Dizman, MD

Nazli Dizman, MD, internal medicine resident at Yale Department of Internal Medicine, discusses the role of the gut microbiome in cancers like renal cell carcinoma.

gut microbiome influences a patient's immune system

 in a variety of ways by including metabolites that go to circulation, stemming circulation, changing immune responses, modulating immune-risk cancers, and by having a strong presence of bacteria in tumor microenvironment.

Having microbial diversity also tends to be linked with better treatment outcomes which can be characterized by changes in microbial species over the course of treatment, especially in renal cell carcinoma. Still, more research is needed to fully understand how we can use gut microbiome to treat patients with cancer.

 In general gut microbiome affects the immune system in different ways, including its metabolites going to circulation, stemming circulation, changing immune responses, with the presence of bacteria in tumor microenvironment and this way modulating immune-risk cancers. In renal cell carcinoma, we have a lot of data that has been done in the United States and in Europe in large cohorts looking at response characteristics and it looks like its determinant of better outcomes in renal cell carcinoma as well, beyond that microbial diversity which is so important. This has been shown in renal cell carcinoma to be associated with better outcomes with immunotherapy patients.

 Also, our study that I mentioned where we attempted to modulate gut microbiome with live bacterial production obtained very interesting, impressive results in patients treated with this live bacterial product. In renal cell carcinoma where we have immunotherapies as the backbone of treatment, microbiome is going to play an important role and is playing an important role, and we investigators need to work a little bit more to understand how we can modulate and how we can use microbiome to help treat cancer.

Articles

Analyzing the Role of Gut Microbiome in Renal Cell Carcinoma

Nazli Dizman, MD, internal medicine resident at Yale Department of Internal Medicine, discusses what community oncologists should keep in mind about gut microbiome when treating their patients.

Gut microbiome impacts an individual's immune system in various ways, including metabolites going to circulation, stemming circulation, changing immune responses, modulating immune-risk cancers, and with there being a presence of bacteria in tumor microenvironment.

According to Dizman, there is currently research being done regarding how 

gut microbiome diversities work in modulating response to immunotherapy

 in patients with cancer. With there being limited yet impressive data obtained from previous studies, further understanding of gut microbiome diversities is needed to discover how they can be associated with better outcomes for patients, particularly with renal cell carcinoma.


 When we treat our patients, mindful use of antibiotics is a key point. At this point, we have a very big reliable meta-analysis showing the mental effects of antibiotics on response to immunotherapies. I assume that community oncologists are probably getting questions about provider cues and even the use of live bacterial production given those impressive results that we obtained. As an answer to those questions, we have limited data obtained from a small study, despite that it is very impressive.

 We are currently working on gut microbiome and trying to understand how we can modulate gut microbiome and perhaps get better outcomes in larger data sets. I think one thing to know is that research is still evolving, and there are a lot of unknown unknowns as well. Keeping track of what's happening in the field would be a recommendation from me to them as they might get questions from the patients about modulation. If they have a close-by center with clinical trials that evaluate gut microbiome or its modulation, referring interested patients into those places might be a recommendation as well.

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Nazli Dizman, MD, discusses what community oncologists should keep in mind about gut microbiome when treating their patients.

Association Between Gut Microbiome and Improved Outcomes in RCC

Nazli Dizman, MD, an Internal Medicine resident at Yale Department of Internal Medicine, discusses the role of gut microbiome diversities in cancer.

According to Dizman, gut microbiome diversities play a large role in modulating response to immunotherapy and the more diverse, the better. Within several cancer types, including renal cell carcinoma (RCC), microbial diversity is associated with better outcomes for patients.

Advancements in research have allowed investigators to better understand the microbiomes impact on clinical outcomes. In patients with RCC, better progression free survival and higher rates of response have been shown.

 Gut microbiome diversities are playing an important role in modulating one's response to immunotherapy as a diverse microbiome is a better microbiome. There are also a few other species that were shown to be associated with response immunotherapies and targeted therapies too such as akkermansia muciniphila which has shown to be associated with better outcomes with immunotherapies in several cancer types, including renal cell carcinoma. Bacterial species are associated with worse outcomes when they are abundant in one school.

 Overall, there's still inconsistencies across different studies in terms of the association between certain species and the outcomes, but what is consistent across studies is the microbiome diversity. In my presentation, I also mentioned that antibiotics may have detrimental roles in a patient's response to immunotherapies again, and even with targeted therapies, we have some evidence showing their role as a determinant of response. It doesn't mean that we should refrain from antibiotics, but we should be using them very mindfully. Beyond that, now we have techniques to modulate gut microbiome.

Nazli Dizman, MD, explains that gut microbiome diversities play a large role in modulating response to immunotherapy. 

Nazli Dizman, MD | Authors

Articles

Analyzing the Role of Gut Microbiome in Renal Cell Carcinoma

Association Between Gut Microbiome and Improved Outcomes in RCC

How Gut Microbiome Diversity Impacts Outcomes for Patients With RCC