[Role of Gut Mycobiome in Lung Cancer Immunotherapy: Mechanisms, Challenges and Translational Prospects].

Abstract

Lung cancer is one of the most common malignancies with the highest morbidity and mortality worldwide. Immune checkpoint inhibitors (ICIs) have significantly improved the prognosis of patients with advanced lung cancer, but more than half of patients derive limited benefit. The gut microbiota can regulate tumor immunity and ICIs efficacy via the gut-lung axis. Although accounting for a small proportion, the gut mycobiome exerts key immunomodulatory effects, yet relevant research lags far behind that of bacteria. This review systematically summarizes the clinical association between the gut mycobiome and lung cancer, clarifies the potential mechanisms by which the mycobiome and its metabolites influence ICIs efficacy through immune regulation, metabolic modulation, and cross-kingdom interactions, and summarizes potential strategies including dietary intervention, fecal microbiota transplantation, and fungal targeting. It provides theoretical support for establishing mycobiome-based predictive models, developing precise interventions, and improving the efficacy of ICIs.
.