The Association between Prognosis and Oral Mycobiota in Lung Cancer Patients Receiving Chemo-Immune Therapy

Abstract

Background: Chemo-immune therapy is a common treatment for lung cancer (LC) which possesses serious adverse effects and provides only minimal survival gain. There is an urgent need to find novel biomarkers to refine the chemo-immune therapy application in LC treatment. This prospective study was designed to investigate the association of oral mycobiome features (prior or post treatment) with the prognosis of LC patients receiving chemo-immune therapy. Methods: The prognosis was based on the Response evaluation criteria in solid tumors (RECIST) 1.1 criteria, and progressive disease (PD), partial response (PR), and stable disease (SD) in 30 cases were confirmed before and after chemo-immune therapy. The oral mycobiome was characterized based on the Internal Transcribed Spacer (ITS) ribosomal RNA V3~V4 region with the Illumina™ platform. Results: There were no differences in α-diversity and β-diversity before or after treatment in LC patients with different prognoses. The fungal composition of the oral cavity changed at almost all levels before and after chemo-immune therapy. Especially at the genus level, the relative abundance of Malassezia was severely elevated within the PD group before treatment in comparison with the PD group after treatment (Pre-Treatment (Pre-Tr)-PD vs. Post-Treatment (Post-Tr)-PD), and in the PR group, the result of Malassezia was conversed (Pre-Tr-PR vs. Post-Tr-PR). Conclusions: The abundance of genus Malassezia over the course of chemo-immune therapy treatment was associated with prognosis in LC patients. The mechanisms and therapeutic implications of these findings need to be investigated in future studies.