The Role of the Microbiome on the Pathogenesis and Treatment of Colorectal Cancer

SIMPLE SUMMARY: The gut microbiome has recently become a hot topic for researchers looking to understand colorectal cancer carcinogenesis and progression. Understanding the role of the microbiome on colorectal cancer will allow us to better understand how to apply various preventative measures and therapies, including newer treatments such as immunotherapy. The aim of this manuscript is to provide a comprehensive review of the topic and explore the most recent updates on microbial mechanisms associated with the pathogenesis and progression of colorectal cancer, as well as their implications for prevention, diagnosis, treatment, and future research. ABSTRACT: The gut microbiome has long been known to play a role in various aspects of health modulation, including the pathogenesis of colorectal cancer (CRC). With immunotherapy recently emerging as a successful treatment in microsatellite instability high (MSI-high) CRC, and with a newly demonstrated involvement of the gut microbiome in the modulation of therapeutic responses, there has been an explosion of research into the mechanisms of microbial effects on CRC. Harnessing and reprogramming the microbiome may allow for the expansion of these successes to broader categories of CRC, the prevention of CRC in high-risk patients, and the enhancement of standard treatments. In this review, we pull together both well-documented phenomena and recent discoveries that pertain to the microbiome and CRC. We explore the microbial mechanisms associated with CRC pathogenesis and progression, recent advancements in CRC systemic therapy, potential options for diagnosis and prevention, as well as directions for future research.