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Tumor immunosurveillance plays a major role in melanoma, prompting the development of immunotherapy strategies. The gut microbiota composition, influencing peripheral and tumoral immune tonus, earned its credentials among predictors of survival in melanoma. The MIND-DC phase III trial (NCT02993315) randomized (2:1 ratio) 148 patients with stage IIIB/C melanoma to adjuvant treatment with autologous natural dendritic cell (nDC) or placebo (PL). Overall, 144 patients collected serum and stool samples before and after 2 bimonthly injections to perform metabolomics (MB) and metagenomics (MG) as prespecified exploratory analysis. Clinical outcomes are reported separately. Here we show that different microbes were associated with prognosis, with the health-related Faecalibacterium prausnitzii standing out as the main beneficial taxon for no recurrence at 2 years ( p  = 0.008 at baseline, nDC arm). Therapy coincided with major MB perturbations (acylcarnitines, carboxylic and fatty acids). Despite randomization, nDC arm exhibited MG and MB bias at baseline: relative under-representation of F. prausnitzii , and perturbations of primary biliary acids (BA). F. prausnitzii anticorrelated with BA, medium- and long-chain acylcarnitines. Combined, these MG and MB biomarkers markedly determined prognosis. Altogether, the host-microbial interaction may play a role in localized melanoma. We value systematic MG and MB profiling in randomized trials to avoid baseline differences attributed to host-microbe interactions. MIND-DC was a randomized, placebo-controlled, phase 3 trial of adjuvant blood-derived natural dendritic cell (nDC)-based therapy in patients with stage III melanoma, showing that nDC-induced immune responses did not translate into survival benefit. Here the authors report that, despite randomization, baseline differences in fecal metagenomics and serum metabolomics profiles between treatment arms might have influenced the clinical outcome of the trial.

BackgroundAdulthood cancer results from (epi)genomic cellular changes associated with chronic inflammatory processes and maladaptive immune responses. Identifying sensors of health to disease transition culminating in early carcinogenesis beyond cell autonomous cues is an unmet medical need. A holistic view might help defining a high-risk model based on functional biomarkers amenable to personalized screening interventions and interceptive measures.MethodsWe conducted a prospective omics-based translational research study (PREVALUNG trial, NCT03976804) in 508 smokers with cardiovascular disease (CVD) aimed at predicting the 17 tobacco-associated cancers beyond the NLST, NELSON, PLCOm2012 screening scores. After inclusion, patients were scheduled for a low-dose chest CT-scan, and blood and feces samples were collected concomitantly. PREVALUNG omics-based sensors of health to disease transition included analytes related to inflammation, immunity, metabolism, metagenome, gut barrier, plasma proteomics, and clonal hematopoiesis. To validate our hypotheses, we investigated a Li-Fraumeni cohort of TP53 germline mutation carriers (LIFSCREEN trial, NCT01464086), and performed the same omics assessment on biological sample taken before cancer detection.ResultsWe could estimate cancer risk of CVD patients based on 33 soluble markers and 2 clinical risk factors, with an AUC of 0.78 (0.67; 0.79). To challenge this model of inflammation-related cancer, we investigated a Li-Fraumeni cohort of TP53 germline mutation carriers who have a significantly increased lifetime cancer risk affecting multiple organ sites. Here, 13 soluble markers and 8 clinical risk factors predicted cancer with an AUC of 0.82 (0.66; 0.91). The functional pathways shared by both cohorts paving the way to carcinogenesis include the neutrophil/lymphocyte ratio, Th2 immunity (CCL24, CCL26, IL-4/IL-4R, IL-5, CCL11, CCL22, CD163, IL-33/ST2), inflammasome activation (IL-1b, IL-1R2, IL-1RN), gut barrier permeability (IL-33/ST2, CD14/LBP, MAdCAM-1, CCL25), cholesterol and biliary salt circuitries, tryptophan and vitamin B3 metabolism, polyamines and ketogenesis.ConclusionsThese two studies suggest that health to cancer transition results from coordinated and cumulative pathological failures of the meta-organism, amenable to biologically-guided prophylactic measures beyond life style changes.AcknowledgementsMF, LZ and GK are supported by the SEERAVE Foundation, the European Union’s Horizon Europe research and innovation programme under grant agreement number No 101095604 [project acronym: PREVALUNG-EU, project title: Personalized lung cancer risk assessment leading to stratified Interception]. LIFSCREEN (NCT01464086) is funded by the French Ligue Contre le Cancer.Trial RegistrationPrevalence of Lung Cancer (PREVALUNG) study was approved according the French Jardé law; the study is referenced at the French ‘Agence Nationale de Sécurité du Médicament et des Produits de Santé’ (reference ID RCB: 2019-A00262-55) and registered on clinicaltrial.gov (NCT03976804).LIFSCREEN (ClinicalTrials.gov Identifier: NCT01464086).Ethics ApprovalPrevalence of Lung Cancer (PREVALUNG) study was approved according the French Jardé law; the study is referenced at the French ‘Agence Nationale de Sécurité du Médicament et des Produits de Santé’ (reference ID RCB: 2019-A00262-55) and registered on clinicaltrial.gov (NCT03976804).LIFSCREEN (ClinicalTrials.gov Identifier: NCT01464086).