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Dr. Nazli Dizman received a 2022 KCA Trailblazer Award for her research on the “Impact of CBM588 on metabolomic profile in patients with metastatic renal cell carcinoma (mRCC)”. Dr. Dizman is an internal medicine resident at the Yale University School of Medicine. We spoke with her about her work and the impact it can have on people with kidney cancer.

What do your gut bacteria have to do with cancer?

The gut microbiome (including not only bacteria but also fungi, viruses, and others) is in close interplay with our immune system and many other bodily functions at various levels. These microorganisms could produce compounds that may impact the immune system,  translocate into the systemic circulation or lymphatic system, and foster antigen presentation to immune cells. They could also move into the tumor microenvironment and foster immune response. All these functions may impact immune response, which is something many investigators, including our team, are exploring to help improve outcomes with treatments. They could also help maintain the integrity of the gut mucosal barrier, which would have clinical importance in case of adverse events.

Are immunotherapies the main drugs that can get an efficacy boost from a better gut microbiome or could other types of treatments also work better?

There are strong data suggesting an association between cytotoxic chemotherapies and gut microbiome. Briefly, there is a bidirectional interaction. Chemotherapy could impact gut microbiome composition and bacteria within the tumor microenvironment could degrade chemotherapies. More relevant to patients with kidney cancer, VEGF-targeted therapies’ efficacy could be impacted by the type of antibiotics the patients use, which suggests a potential association between the gut microbiome and the efficacy of VEGF-targeted treatments. Furthermore, the role of immune escape in cancer development and progression has been well established. It would be reasonable to hypothesize that gut microbiome optimization would impact the outcomes regardless of the class of anti-cancer therapeutics. Unfortunately, our understanding regarding which components or functions of gut microbiome effect the efficacy of therapeutics is currently limited. It’s challenging to define “better microbiome” until we better identify whether it is a specific type of microorganism, a microbial community, or a compound produced by the microbiome that leads to a clinically meaningful impact on outcomes.

What would you say to someone or how might you advise someone who wants to try and improve their chances of survival or quality of life through diet/nutrition?

Good nutrition and regular exercise are essential for patients with cancer as they can help ourpatients stay as healthy as possible and increase their energy levels. General recommendations include eating a balanced plant-forward diet rich in healthy proteins, fruits, vegetables, fiber content and essential micronutrients. Currently, we do not have strong prospective evidence supportive of a specific type of supplement or diet improving outcomes with anti-cancer therapies. However, there are several clinical trials around the US studying different interventions, including dietary interventions such as fiber intake, live bacterial products such as CBM588, prebiotics etc. that our patients can participate in.    

What motivates you?

My patients and their stories inspire me on a daily basis. Further, witnessing advancements in cancer research motivates me to work harder to bring better, personalized, and safe approaches to clinical practice.

Anything else you’d like others to know about you or your work?

I’d like to thank our patients and their families for inspiring us, participating in research projects and the Kidney Cancer Association for their endless support to improve management strategies for cancer.

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