Gut Microbiota Are a Novel Source of Biomarkers for Immunotherapy in Non-Small-Cell Lung Cancer (NSCLC)

Simple Summary Lung cancer is the most frequent cause of cancer-related death. Unfortunately, only 30% of patients treated with immunotherapy gain any benefit; it is, therefore, important to increase the number of patients who can benefit from immunotherapy. Biomarkers can help clinicians to reach this target and the gut microbiota is a potentially excellent source of predictive factors. All conditions that modify the gut microbiota may influence cancer onset and progression, its prognosis, and response to immunotherapy, with a relevant impact in clinical practice.Abstract Despite the recent availability of immune checkpoint inhibitors, not all patients affected by Non-Small-Cell Lung Cancer (NSCLC) benefit from immunotherapy. The reason for this variability relies on a variety of factors which may allow for the identification of novel biomarkers. Presently, a variety of biomarkers are under investigation, including the PD1/PDL1 axis, the tumor mutational burden, and the microbiota. The latter is made by all the bacteria and other microorganisms hosted in our body. The gut microbiota is the most represented and has been involved in different physiological and pathological events, including cancer. In this light, it appears that all conditions modifying the gut microbiota can influence cancer, its treatment, and its treatment-related toxicities. The aim of this review is to analyze all the conditions influencing the gut microbiota and, therefore, affecting the response to immunotherapy, iRAEs, and their management in NSCLC patients. The investigation of the landscape of these biological events can allow for novel insights into the optimal management of NSCLC immunotherapy.