Probiotics while on Immunotherapy. Good or bad?

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plastikos
Posts: 330
Joined: Wed Jan 14, 2015 6:09 am

Probiotics while on Immunotherapy. Good or bad?

Postby plastikos » Tue Jun 11, 2019 7:16 am

Hi all. Title explains it all. I have been seeing conflicting data (well not super hard evidence since they aren’t from trials). Any opinions on this? I used to take probiotic pills while on Keytruda but stopped them now. My response on Keytruda has been splendid. Now just loading up on “natural” probiotics like Kimchi, yogurt etc.
St. IV Colon CA @ 37, male, Kras wild, MSI-high (2014)
11/2014 Right Hemicolectomy + Liver Resection
12/2014 - 6/2015 FOLFOX + Cetuximab
10/2015 - Recurrence liver
Liver resection 10/2015
FOLFIRI 11/2015 - 5/2016
Recurrence liver, nodes 11/2016
Pembrolizumab started 12/2016 -> pseudoprogression(?) -> biliary obstruction -> biliary stenting
Chemo 4x: most mets inactive and smaller on PET-CT
March 2017 - Back on Pembrolizumab again
Sept 2017 - SIRT - > NED
2019 NED

Pyro
Posts: 238
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Location: Tucson, AZ

Re: Probiotics while on Immunotherapy. Good or bad?

Postby Pyro » Tue Jun 11, 2019 7:36 am

Do it. When I lived in Korea I couldn’t stand kimchi, now that I don’t, I can’t get enough of the stuff. Then again, Keytruda didn’t work for me.
Aug 2015- Diag Stage 4 CC with mets to liver (38/m)
Sep 2015- Avastin/Folfox/Iron
Dec 2015-Not a surgery candidate for liver
Jan 2016- Erbitux/Folfiri, 2nd opinion at MDA in TX
Feb 2016 -MDA liver surgery, Dr. Vauthey
Mar 2016 -30% of left lobe rem, PVE
May 2016 - 70% of liver rem
Jun 2016-Rad
Jan 2017-perm colost @MDA
Jul 2017-Erb/FOLFURI
Nov 2017 -Lung & Liver ablations@MDA
Jan 2018 -Xeloda & Avastin mx
Jul 2018-Avast/FOLFURI
Sep 2018-Rad
Mar 2019 - Keytruda, CEA @36, treatment failure

Pyro70
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Joined: Mon Jan 21, 2019 4:25 pm

Re: Probiotics while on Immunotherapy. Good or bad?

Postby Pyro70 » Thu Jun 13, 2019 12:28 am

There is limited data but here is my take:

Store bought commercial probiotics are likely almost entirely junk since they aren’t refrigerated, so they are mostly dead.

The data that does exist shows immunotherapy response is correlated with micobiome diversity. If you load up your biome with bugs that aren’t supposed to be there (eg lactobacillus). These bugs will crowd out a lot of other bugs and actually decrease your biome diversity. So I would be very cautious (and have have heard experts express the same concerns) regarding taking probiotics.

However, In theory taking “pre-biotics” (pretty much everything that gets eliminated in the FODMAP diet) will feed your gut bacteria and should encourage a more diverse flora. Fermented foods like kimchi should be full of pre-biopics and pro-biotics. I would eat them, simply because they are yummy.

The best way to increase your biome diversity is likely a fecal transplant - but these would need to be repeated too often to be practical. Maybe the best way to get a healthy biome is via the fecal-oral route the same way our ancestors maintained a healthy biome. You can figure out how one would do this, but no need to get into too much detail here.

Again, this is largely my opinion. There is very little data to support it.
Dx Jan 2017 stage IVB w/ PC age 35
FOLFOX
SEP 17 HIPEC 1, anastamosis leak
XELODA
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JUN 18, ileo reversal and 2nd anastamosis leak

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henry123
Posts: 186
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Re: Probiotics while on Immunotherapy. Good or bad?

Postby henry123 » Thu Jun 13, 2019 3:37 am

plastikos wrote:Hi all. Title explains it all. I have been seeing conflicting data (well not super hard evidence since they aren’t from trials). Any opinions on this? I used to take probiotic pills while on Keytruda but stopped them now. My response on Keytruda has been splendid. Now just loading up on “natural” probiotics like Kimchi, yogurt etc.


My oncologist stopped my probiotics once I started with nivolumab.
I only take aspirin and an occasional course of vitamin d.
Beside this I try to stick to a vegan diet.
46yo M msi-high Lynch +ve
5/16 lap AR 14/21 L nodes +ve
T4N2M1
7/16 Capox 9 cyc
9/16 cea 2
1/17 550
PET CT mets in lung & peri
iri+ avast fail
3/17 10577
4/17 regro fail
5/17 cea 28800
5/17 CT inc in size of mes nodes ,onset of multi nodules in liver.
6/17 Opdivo start
7/17 26754
8/17 5623
9/17 497
10/17 52
11/17 12
CT all clear exc a nodule in Lung. liver norm
1/18 3.6
4/18 2.0
Aspirin start
6/18 1.5 CT clear
12/18 1.1 CT Clear NED
4/19 1.1
6/19 .9 CT clear
Vegan yoga juicing
Still on opdivo

Jannine
Posts: 142
Joined: Wed Jun 20, 2018 7:46 am
Location: Maryland, USA

Re: Probiotics while on Immunotherapy. Good or bad?

Postby Jannine » Thu Jun 13, 2019 8:39 pm

Not immunotherapy-related, but I've been prescribed 14 days of Florastor probiotic (available over the counter in the US) to help me recover from c diff, in addition to vancomycin. I was surprised that it isn't refrigerated, but it certainly doesn't seem to be hurting any. My sense of taste had been knocked for a loop and my tongue had turned dark green, and coffee tasted truly horrific. Within probably 5 days of starting the florastor, my sense of taste was back to normal and my tongue was looking much more normal too.

I can't say for sure if the probiotic is making a difference, but I can say that the last time I had the green tongue problem it seemed to take much longer for the weird ick to go away.
DX: sigmoid colon cancer 5/2018. 48 F
laparoscopic sigmoid resection (24 cm removed); no stoma.
7.5cm adenocarcinoma -- mod. diff.
1 noncontiguous tumor deposit removed; 0/31 lymph nodes
T3 pN1c M0
5/18 before surgery, CEA 11.2
6/18 began FOLFOX
7/18: CEA 1.9; added neulasta post infusion
9/18: CEA 2.8
10/18: 25% chemo reduction
11/18: CEA 1.8


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