[Current Status and Future Perspectives of Microbiome Research in Lung Cancer].
Recent advances in immune checkpoint inhibitors(ICIs)and molecular targeted therapies have substantially improved outcomes in lung cancer; however, marked inter-individual variability in efficacy and toxicity remains. Accumulating evidence suggests that the gut microbiota, acting through the"gut-lung axis,"is a key modifier of treatment response and tolerance in this setting. High microbial diversity and the abundance of beneficial taxa such as Akkermansia, Bifidobacterium, and Faecalibacterium have been associated with favorable ICI responses, whereas dysbiosis induced by antibiotics, proton pump inhibitors, cytotoxic chemotherapy, or lifestyle factors is linked to reduced efficacy and increased toxicity. Microbial metabolites, including short-chain fatty acids and tryptophan derivatives, shape antitumor immunity by modulating T-cell activation, regulatory T-cell differentiation, and the tumor immune microenvironment. In addition, emerging data indicate that the gut microbiota may influence the pharmacodynamics and adverse event profiles of EGFR tyrosine kinase inhibitors(EGFR- TKIs)and other targeted agents, particularly with respect to gastrointestinal toxicity. Smoking, a central etiological factor in lung carcinogenesis, also alters gut microbial composition, decreasing beneficial anti-inflammatory species and promoting pro-inflammatory taxa, thereby potentially aggravating systemic inflammation and impairing ICI responsiveness. Notably, partial restoration of a healthier microbiome appears possible with smoking cessation and rational supportive care. Interventions aimed at favorably modifying the gut ecosystem-such as high-fiber or plant-forward diets, probiotics, and fecal microbiotatransplantation-have begun to show promise in enhancing ICI efficacy without substantially increasing immune-related adverse events. Prospective trials in lung cancer are now underway to evaluate the clinical utility of microbiome-based biomarkers and interventions. Collectively, these findings position the gut microbiota as both a predictive biomarker and a modifiable therapeutic target, with the potential to refine patient stratification, optimize treatment selection, and advance truly personalized medicine in lung cancer.