Onkológia 5/2021

Microbiome and long-term toxicity of cancer treatment

Insufficient specificity of cancer therapy results in several side effects. Cancer treatment affects the nervous and immune system, damages the intestinal mucosa, and disrupts the gut ecosystem leading to dysbiosis. Long-term cancer survivors often suffer from depression, fatigue, fear and cognitive dysfunctions. “Chemobrain” represents the chemotherapy-related side effects affecting the central nervous system. Some chemoterapeutic agents cannot easily penetrate through the blood-brain barrier, suggesting an indirect mechanism to affect the cognitive functions. The “microbiota-gut-brain” axis forms a bidirectional communication system between the central and enteric nervous systems, in which the gut microbiota plays a key role. Endocrine and metabolic pathways are linked with emotional and cognitive centers in the brain. Production of cardiotoxic metabolites leading to atherosclerosis, thrombosis, and heart failure might be associated with the changes in gut microbiota composition. The neuroprotective and cardioprotective effects of probiotics as well as fecal microbiota transplantation suggest the possible role of microbiota modulation not only to improve the efficacy, but also to reduce the acute and late toxicity of cancer treatment.

Keywords: microbiome, cancer therapy, cognitive dysfunctions, cardiotoxicity, microbiota modulation, probiotics, fecal microbiota transplantation