Figure 2 A model for the future analysis

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Figure 2 A model for the future analysis and translation of the oncomicrobiome for improved cancer outcomes Figure 2 | A model for the future analysis and translation of the oncomicrobiome for improved cancer outcomes. The microbiota is highly personalized and niche specific. However, its structure and function is dynamic and it is influenced by all interventions along the modern multimodal treatment journey. The journey for patients with cancer is subject to substantial inter-individual and intra-individual variation; for example, not all patients will undergo surgery. However, sampling methodologies can be standardized, and future microbiome studies should seek to sample not only faeces, but tissue and multiple biofluids so that the broad systemic array of microbiome functions can be analysed once stored in biobanks. Metataxonomic (16S ribosomal RNA (rRNA) gene sequencing) and metagenomics (shotgun sequencing) approaches and other '–omics'-based technologies (such as metabonomics and proteomics) are providing notable insights into the mechanisms through which the microbiome modifies chemotherapy toxicity and efficacy. Given that treatment-induced dysbiosis probably affects the efficacy of second and third-line therapies, longitudinal studies will be critical in fully elucidating the role of the microbiome in this field, and microbiota-augmented clinical trials in oncology are now urgently required. There are multiple tools through which the microbiota might be modulated for improved clinical outcomes, which could be deployed at all stages of the treatment journey. However, evidence to support their use is variable, and trials for more controversial interventions such as faecal microbiota transplantation (FMT) are ongoing. However, the microbiota serves as a rich resource for answering many of the unmet clinical needs in oncology and it represents a major new avenue in drug discovery in cancer. QOL, quality of life. Alexander, J. L. et al. (2017) Gut microbiota modulation of chemotherapy efficacy and toxicity Nat. Rev. Gastroenterol. Hepatol. doi:10.1038/nrgastro.2017.20