# Strategic modulation of the gastrointestinal microbiome to enhance pancreatic cancer immunotherapy

## TL;DR

This review explores how manipulating gut microbes could improve immunotherapy for pancreatic cancer by influencing immune responses and treatment resistance.

## Contribution

The paper introduces microbiome-targeted strategies and advanced drug-delivery systems for modulating the gut microbiome to enhance pancreatic cancer immunotherapy.

## Key findings

- The gastrointestinal microbiome significantly influences immune regulation and treatment resistance in pancreatic cancer.
- Microbiome-targeted approaches like probiotics and fecal microbiota transplantation show potential in modulating tumor progression.
- Combining microbiome science with nanotechnology and epigenetic reprogramming could improve immunotherapy outcomes.

## Abstract

Pancreatic cancer (PC) remains one of the most lethal malignancies, characterized by aggressive progression, late detection, and limited response to current therapies. Recent research has revealed that the gastrointestinal and intratumoral microbiomes are key modulators of immune regulation, metabolism, and epigenetic pathways, influencing tumor progression and therapeutic efficacy. This review summarizes the complex microbiome–PC interplay, emphasizing microbial modulation of inflammation, immunity, and treatment resistance. We also highlight microbiome-targeted strategies, such as probiotics, prebiotics, postbiotics, and fecal microbiota transplantation, along with advanced drug-delivery platforms – including nanoparticles, engineered bacteria, and stimuli-responsive systems – for precise microbiome modulation. Integrating microbiome science with immunotherapy, nanotechnology, and epigenetic reprogramming offers promising opportunities to improve outcomes in PC.