This perspective discusses two paradigms for fecal microbiota transplantation (FMT) in cancer patients receiving immune checkpoint blockade (ICB): the traditional 'supplementation' model (adding beneficial bacteria) and an emerging 'depletion' model (removing harmful taxa).
Emerging data suggest FMT may improve ICB responses through both enrichment of beneficial microbes and depletion of harmful taxa — framing these as two distinct but complementary mechanistic paradigms in cancer immunotherapy.
This is a perspective/commentary piece, not an original clinical study; no primary data or patient outcomes are reported. Key knowledge gaps are acknowledged but not resolved.
Clinicians should be aware that FMT's role in enhancing immunotherapy responses may go beyond adding 'good' bacteria — actively reducing harmful taxa may be an equally important mechanism. This emerging framework warrants close attention as trial data mature.
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