The Woolcock Institute of Medical Research

A simple test of bacteria lurking in the lungs could soon be used to identify which cancer patients will respond well to powerful, potentially life-saving treatment.

Researchers at the Woolcock Institute of Medical Research in Sydney are investigating naturally-occurring microorganisms found in the lungs, collectively called the microbiome, thought to be promoting lung disease and interfering with lung cancer treatments. 

The team is studying the lungs of Australians diagnosed with lung cancer in the hope of finding patterns of microbes that can predict which patients respond to certain treatments, in particular immunotherapy.

"Armed with this knowledge, we hope todevelop a simple test to reveal which patients will response best to the powerful but potentially harmful treatments available," explains Anna McLean, the PhD student behind the study. "This would spare patients from undergoing ineffective treatments, thereby improving quality of life." 

This novel approach also paves the way for much-needed new lung cancer treatments, she says. "It's possible that microbiomes found to be associated with unfavourable outcomes could be manipulated with antibiotics, probiotics or via completely new techniques to significantly improve patient outcomes." 

Lung cancer is Australia's deadliest cancer, with the disease killing almost 9,000 people every year – more than breast, ovarian and prostate cancer combined. These dire statistics are largely explained by late diagnosis, with only 20 percent of cancers caught in the early stage. Funding lags behind other cancers due to its association with smoking. However, this stigma is somewhat misplaced, given that 1 in 3 women diagnosed with lung cancer are non-smokers.

Immunotherapy, a new form of treatment that boosts the patient's own immune system to target the cancer, has shown significant potential in treating lung cancer, Dr McLean says. "But, problematically, the response to treatment is extremely variable and we lack good markers to predict those more likely to respond."

The Woolcock team is investigating the role of the lung microbiome – the complex community of beneficial and harmful microbes in organs – in influencing treatment effectiveness in 200 NSW patients. When patients undergo a lymph node biopsy, respiratory clinicians also wash and brush the lining of the airway at the suspected cancer site to gather a microbiome sample.

By identifying an individual's microbiome and then tracking their treatment journey, researchers hope to uncover the impact of the microbiome on tumour progression and treatment response.

"The development of novel non-invasive tests based on microbiome markers has the potential to drastically improve treatment outcomes and quality of life for patients with lung cancer by enabling early diagnosis and the personalisation of treatment," Dr McLean says.

The project is being overseen by Professor Maija Kohonen-Corish, director of the Woolcock's Centre for Lung Cancer Research, which runs programs across all areas of lung cancer research, including genetics, drug discovery, delivery of medications and patient care. The facility’s research model ensures laboratory breakthroughs are swiftly implemented in the clinic to benefit patients at the earliest opportunity. 

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