Rishabh Jain, Medical Oncologist at AIIMS, shared a post on X:
“Gut microbiome may decide how dual immunotherapy works in advanced NSCLC. A prospective ESMO Open 2026 study links baseline gut diversity to outcomes with nivolumab + ipilimumab.
Study essentials.
- Advanced or recurrent NSCLC.
- Dual checkpoint blockade:
- Nivolumab + ipilimumab
- With or without chemotherapy.
Study population.
- N = 48 (Japan).
- Median age 71 years.
- ECOG PS ≤1 in 94%.
- First-line ICI (no prior chemo or IO)..
- Antibiotic exposure assessed within 1 month pre-ICI.
Key findings.
– High gut microbiome diversity:
- Better PFS with Ipi + Nivo alone.
- Higher CD8+ and PD-1+ CD8 TILs.
- Enrichment of SCFA-producing bacteria.
–Low microbiome diversity:
- Benefit from adding chemotherapy to dual ICI.
– Antibiotics before ICI:
- Shorter PFS and OS across regimens.
Clinical insight.
Gut microbiome may act as a treatment selector:
- High diversity – Ipi + Nivo alone may suffice.
- Low diversity – Add chemotherapy.
Practice takeaway.
Not all patients need chemo upfront. Baseline microbiome could help personalize ICI intensity.
Save this for IO decision-making.
Katayama Y et al. ESMO Open 2026. Gut microbiome-driven modulation of the tumor immune microenvironment optimizes dual checkpoint blockade in advanced NSCLC.”
Title: Gut microbiome-driven modulation of the tumor immune microenvironment optimizes dual checkpoint blockade in advanced non-small-cell lung cancer
Authors: Y. Katayama, A. Fukuda, R. Inoue, H. Kawachi, R. Sawada, T. Harada, A. Yoshimura, A. Okada, S. Shiotsu, Y. Chihara, Y. Takemura, T. Yamada, N. Nishioka, M. Iwasaku, S. Tokuda, T. Takagi, S. Kumagai, S. Koyama, K. Takayama, T. Yamada
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