Gut microbes as medical signature for the effectiveness of immunotherapy in patients with advanced non‐small cell lung cancer

Abstract Lung cancer (LC) is the most common cause of cancer‐related death worldwide and poses a severe threat to public health. Immunotherapy with checkpoint blockers has improved the outlook for advanced non‐small cell lung cancer (NSCLC) therapy. For the treatment of patients with advanced NSCLC, antibodies such as anti‐programmed death 1 (anti‐PD1), anti‐programmed death ligand 1 (anti‐PD‐L1), and anti‐cytotoxic T lymphocyte‐associated antigen 4 (anti‐CTLA‐4) are of paramount importance. Anti‐PD‐1 and anti‐PD‐L1 monoclonal antibody therapies are used to block the PD‐1/PD‐L1 pathway and identify cancerous cells to the body's defenses. Antibodies directed against CTLA‐4 (anti‐CTLA‐4) have also been shown to improve survival rates in patients with NSCLC. Currently, other immunotherapy approaches like neoadjuvant immune checkpoint inhibitors (NAICIs) and chimeric antigen receptor T‐cell (CAR‐T) therapies are applied in NSCLC patients. NAICIs are used for resectable and early stage NSCLC and CAR‐T is used to find more useful epitope sites for lung tumors and destroy cancer cells. A patient's gut microbiota might influence how their immune system reacts to NSCLC immunotherapy. The majority of intestinal microbes stimulate helper/cytotoxic T cells, induce natural killer (NK) cells, activate various toll‐like receptors (TLR), build up cluster of differentiation 8 (CD8), increase PD‐1 production, and attract chemokine receptors towards cancer cells. Thus, they serve as immune inducers in NSCLC immunotherapy. Nonetheless, certain bacteria can function as immune suppressors by inhibiting DC proliferation, stopping CD28 trafficking, restoring CD80/CD86, increasing immunological tolerance, and upsetting Th17 cells. Therefore, they are prevalent in non‐responders with NSCLC immunotherapy.