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Guenther, Michael; Gil, Lina; Surendran, Sai Agash; Palm, Melanie Alexandra; Heinemann, Volker; von Bergwelt-Baildon, Michael; Mayerle, Julia; Engel, Jutta; Werner, Jens; Boeck, Stefan; Ormanns, Steffen (2022): Bacterial lipopolysaccharide as a negative predictor of adjuvant gemcitabine efficacy in pancreatic cancer. JNCI Cancer Spectrum: pkac039. ISSN 2515-5091

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Adjuvant gemcitabine is one standard of care after pancreatic ductal adenocarcinoma (PDAC) resection. No biomarker for its efficacy is established. As bacteria mediate gemcitabine resistance, we analyzed whether lipopolysaccharide (LPS) as surrogate for bacterial colonization is prognostic in PDAC patients treated with (aGC) or without (naGC) adjuvant gemcitabine. We detected LPS in 86 tumors from 376 patients, which defined a specific microbiome as revealed by 16 s-rRNA-sequencing. In the 230 aGC patients, LPS conferred worse disease free survival (8.3 vs 13.7 months; hazard ratio = 1.75, 95% confidence interval = 1.22–2.49, log-rank P = .002) and overall survival (21.7 vs 28.5 months; hazard ratio = 1.80, 95% confidence interval = 1.23–2.57, log-rank P = .001), but not in the 146 naGC patients, which was confirmed in an independent validation cohort (n = 178). LPS may serve as negative predictor for adjuvant gemcitabine efficacy in PDAC, which suggests a role for microbiome modification to overcome bacteria-mediated chemotherapy resistance.

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