{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T09:08:53Z","timestamp":1788858533278,"version":"build-2803163510"},"reference-count":54,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T00:00:00Z","timestamp":1788825600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Oncol. Rev."],"abstract":"<jats:p>Chemotherapy is a cornerstone of breast cancer treatment but is often limited by systemic toxicities, gastrointestinal mucositis, immunosuppression, and treatment interruptions, which compromise patient outcomes. Emerging evidence highlights the gut microbiome as a central mediator of chemotherapy tolerance and toxicity. Cytotoxic regimens induce dysbiosis, characterized by depletion of beneficial commensals, expansion of pathobionts, and impaired microbial metabolic function, exacerbating mucosal injury, inflammation, and systemic side effects. Engineered probiotic consortia\u2014rationally designed multi-strain microbial communities\u2014offer a novel strategy to restore microbial balance, reinforce epithelial barrier function, modulate immune responses, and enhance chemotherapy tolerance. Preclinical and emerging clinical studies demonstrate that multi-strain consortia can increase short-chain fatty acid production, reduce pro-inflammatory signaling, preserve mucosal integrity, and improve patient resilience during treatment. Advances in synthetic biology and microbiome engineering enable precise design of microbial consortia with complementary functions and ecological stability. This review provides a comprehensive overview of the mechanistic rationale, preclinical and clinical evidence, technological strategies, and translational implications of engineered probiotic consortia, highlighting their potential to transform supportive care in breast cancer therapy.<\/jats:p>","DOI":"10.3389\/or.2026.1909404","type":"journal-article","created":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T08:25:02Z","timestamp":1788855902000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Engineering probiotic consortia to improve chemotherapy tolerance and reduce toxicity in breast cancer patients: a new frontier in supportive precision oncology"],"prefix":"10.3389","volume":"20","author":[{"given":"Emmanuel Ifeanyi","family":"Obeagu","sequence":"first","affiliation":[{"name":"Department of Biomedical and Laboratory Science, Africa University","place":["Mutare, Zimbabwe"]},{"name":"Department of Molecular Medicine and Haematology, University of the Witwatersrand","place":["Johannesburg, South Africa"]},{"name":"Department of Haematology and Immunohaematology, Bahir Dar University","place":["Bahir Dar, Ethiopia"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,8]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"8","DOI":"10.4103\/0971-5851.68846","article-title":"NEO adjuvant chemotherapy in breast cancer: what have we learned so far?","volume":"31","author":"Raut","year":"2010","journal-title":"Indian J Med Paediatr Oncol"},{"key":"B2","doi-asserted-by":"publisher","first-page":"1169010","DOI":"10.3389\/fonc.2023.1169010","article-title":"Neoadjuvant chemotherapy for breast cancer: an evaluation of its efficacy and research progress","volume":"13","author":"Chen","year":"2023","journal-title":"Front Oncol"},{"key":"B3","doi-asserted-by":"publisher","first-page":"3190","DOI":"10.3390\/cancers17193190","article-title":"Oncologic outcomes and safety of neoadjuvant treatment with anthracyclines versus anthracycline-free regimens in HER2-Positive early breast cancer in a Colombian cancer center: an observational, analytical, retrospective study","volume":"17","author":"Acevedo-Ramos","year":"2025","journal-title":"Cancers"},{"key":"B4","doi-asserted-by":"publisher","first-page":"195","DOI":"10.1186\/s12916-015-0439-8","article-title":"Progress in adjuvant chemotherapy for breast cancer: an overview","volume":"13","author":"Anampa","year":"2015","journal-title":"BMC Med"},{"key":"B5","doi-asserted-by":"publisher","first-page":"1717","DOI":"10.1007\/s12672-025-03574-0","article-title":"Gut microbiota as a hidden modulator of chemotherapy: implications for colorectal cancer treatment","volume":"16","author":"Sadeghloo","year":"2025","journal-title":"Discov Oncol"},{"key":"B6","doi-asserted-by":"publisher","first-page":"7261","DOI":"10.3390\/ijms24087261","article-title":"Exploring the involvement of gut microbiota in cancer therapy-induced cardiotoxicity","volume":"24","author":"Kunika","year":"2023","journal-title":"Int J Mol Sci"},{"key":"B7","doi-asserted-by":"publisher","first-page":"e25020","DOI":"10.1590\/S0004-2803.24612025-020","article-title":"Efficacy of probiotics in preventing chemotherapy-induced diarrhea in gastrointestinal cancer patients","volume":"62","author":"DE Souza","year":"2025","journal-title":"Arq Gastroenterol"},{"key":"B8","doi-asserted-by":"publisher","first-page":"157","DOI":"10.1097\/SPC.0000000000000134","article-title":"Probiotics to prevent gastrointestinal toxicity from cancer therapy: an interpretive review and call to action","volume":"9","author":"Ciorba","year":"2015","journal-title":"Curr Opin Support Palliat Care"},{"key":"B9","doi-asserted-by":"publisher","first-page":"1709","DOI":"10.3390\/microbiolres15030113","article-title":"Multifaceted applications of synthetic microbial communities: advances in biomedicine, bioremediation, and industry","volume":"15","author":"Contreras-Salgado","year":"2024","journal-title":"Microbiol Res"},{"key":"B10","doi-asserted-by":"publisher","first-page":"H1508","DOI":"10.1152\/ajpheart.00377.2025","article-title":"Chemotherapy-induced cardiotoxicity in breast cancer: mechanisms, diagnostic advances, and emerging protective strategies","volume":"329","author":"Ndzie Noah","year":"2025","journal-title":"Am J Physiol Heart Circ Physiol"},{"key":"B11","doi-asserted-by":"publisher","first-page":"1901","DOI":"10.3390\/biomedicines13081901","article-title":"Treatment strategies for cutaneous and oral mucosal side effects of oncological treatment in breast cancer: a comprehensive review","volume":"13","author":"Brni\u0107","year":"2025","journal-title":"Biomedicines"},{"key":"B12","doi-asserted-by":"publisher","first-page":"648","DOI":"10.7150\/jca.99421","article-title":"Important role of intestinal microbiota in chemotherapy-induced diarrhea and therapeutics","volume":"16","author":"Jiang","year":"2025","journal-title":"J Cancer"},{"key":"B13","doi-asserted-by":"publisher","first-page":"131","DOI":"10.1016\/bs.acr.2022.02.007","article-title":"Chemotherapy induced gastrointestinal toxicities","volume":"155","author":"Akbarali","year":"2022","journal-title":"Adv Cancer Res"},{"key":"B14","doi-asserted-by":"publisher","first-page":"16","DOI":"10.20517\/mrr.2022.23","article-title":"Gut microbiota resilience and recovery after anticancer chemotherapy","volume":"2","author":"Roggiani","year":"2023","journal-title":"Microbiome Res Rep"},{"key":"B15","doi-asserted-by":"publisher","first-page":"101","DOI":"10.3390\/oral5040101","article-title":"Impact of oral and gut microbiota dysbiosis in patients with multiple myeloma and hematological malignancies: a narrative review","volume":"5","author":"Belmonte","year":"2025","journal-title":"Oral"},{"key":"B16","doi-asserted-by":"publisher","first-page":"578","DOI":"10.3390\/microorganisms10030578","article-title":"Gut microbiota dysbiosis: triggers, consequences, diagnostic and therapeutic options","volume":"10","author":"Hrncir","year":"2022","journal-title":"Microorganisms"},{"key":"B17","doi-asserted-by":"publisher","first-page":"1690279","DOI":"10.3389\/fimmu.2025.1690279","article-title":"The gut microbiota and its metabolites: novel therapeutic targets for inflammatory bowel disease","volume":"16","author":"Shen","year":"2025","journal-title":"Front Immunol"},{"key":"B18","doi-asserted-by":"publisher","first-page":"886","DOI":"10.3390\/nu13030886","article-title":"The interplay between the gut microbiome and the immune system in the context of infectious diseases throughout life and the role of nutrition in optimizing treatment strategies","volume":"13","author":"Wiertsema","year":"2021","journal-title":"Nutrients"},{"key":"B19","doi-asserted-by":"publisher","first-page":"198","DOI":"10.1038\/s41522-025-00825-4","article-title":"Optimizing breast cancer chemotherapy by harnessing gut microbiota with insights from artificial intelligence","volume":"11","author":"Zhou","year":"2025","journal-title":"NPJ Biofilms Microbiomes"},{"key":"B20","doi-asserted-by":"publisher","first-page":"3783","DOI":"10.3390\/cancers17233783","article-title":"Gut microbiota signatures associate with chemotherapy-related adverse events in breast cancer patients","volume":"17","author":"Hsu","year":"2025","journal-title":"Cancers"},{"key":"B21","doi-asserted-by":"publisher","first-page":"1107","DOI":"10.3390\/nu12041107","article-title":"The effect of probiotics on the production of short-chain fatty acids by human intestinal microbiome","volume":"12","author":"Markowiak-Kope\u0107","year":"2020","journal-title":"Nutrients"},{"key":"B22","doi-asserted-by":"publisher","first-page":"1130","DOI":"10.3390\/cells14151130","article-title":"Rethinking short-chain fatty acids: a closer look at propionate in inflammation, metabolism, and mucosal homeostasis","volume":"14","author":"Facchin","year":"2025","journal-title":"Cells"},{"key":"B23","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1021\/acs.chemrev.2c00431","article-title":"Microbiome and human health: current understanding, engineering, and enabling technologies","volume":"123","author":"Aggarwal","year":"2023","journal-title":"Chem Rev"},{"key":"B24","doi-asserted-by":"publisher","first-page":"211","DOI":"10.1186\/s12934-021-01699-9","article-title":"Engineered microbial consortia: strategies and applications","volume":"20","author":"Duncker","year":"2021","journal-title":"Microb Cell Fact"},{"key":"B25","doi-asserted-by":"publisher","first-page":"1223","DOI":"10.1186\/s12967-025-07271-y","article-title":"Engineered probiotics: a new era in treating inflammatory bowel disease","volume":"23","author":"Duan","year":"2025","journal-title":"J Transl Med"},{"key":"B26","doi-asserted-by":"publisher","first-page":"e70029","DOI":"10.1002\/cnr2.70029","article-title":"The role of microbiome and probiotics in chemo-radiotherapy-induced diarrhea: a narrative review of the current evidence","volume":"7","author":"Khorashadizadeh","year":"2024","journal-title":"Cancer Rep (Hoboken)"},{"key":"B27","doi-asserted-by":"publisher","first-page":"2687","DOI":"10.3390\/microorganisms13122687","article-title":"Role of probiotics in enhancing immune function and improving the effectiveness of treatments for pancreatic cancer","volume":"13","author":"Kaur","year":"2025","journal-title":"Microorganisms"},{"key":"B28","doi-asserted-by":"publisher","first-page":"1270","DOI":"10.3390\/ph18091270","article-title":"Anti-inflammatory and antioxidant effects of topical formulations containing plant extracts, methylsulfonylmethane, and peptiskin\u00ae in in vitro models of arthritis","volume":"18","author":"Hoang","year":"2025","journal-title":"Pharmaceuticals (Basel)"},{"key":"B29","doi-asserted-by":"publisher","first-page":"790","DOI":"10.3390\/nu16060790","article-title":"Probiotic consortium confers synergistic anti-inflammatory effects in inflammatory disorders","volume":"16","author":"Lee","year":"2024","journal-title":"Nutrients"},{"key":"B30","doi-asserted-by":"publisher","first-page":"879","DOI":"10.3390\/biom15060879","article-title":"Probiotics and cancer: mechanistic insights and organ-specific impact","volume":"15","author":"Ahmad","year":"2025","journal-title":"Biomolecules"},{"key":"B31","doi-asserted-by":"publisher","first-page":"1159","DOI":"10.1186\/s12903-024-04955-7","article-title":"Preventive effect of probiotics on oral mucositis induced by anticancer therapy: a systematic review and meta-analysis of randomized controlled trials","volume":"24","author":"Yang","year":"2024","journal-title":"BMC Oral Health"},{"key":"B32","doi-asserted-by":"publisher","first-page":"2297860","DOI":"10.1080\/19490976.2023.2297860","article-title":"Multi-omic approaches for host-microbiome data integration","volume":"16","author":"Chetty","year":"2024","journal-title":"Gut Microbes"},{"key":"B33","doi-asserted-by":"publisher","first-page":"2333","DOI":"10.3390\/microorganisms12112333","article-title":"Unraveling the role of the human gut microbiome in health and diseases","volume":"12","author":"Khalil","year":"2024","journal-title":"Microorganisms"},{"key":"B34","doi-asserted-by":"publisher","first-page":"213","DOI":"10.1007\/s00203-025-04417-w","article-title":"Therapeutic engineering of the gut microbiome using synthetic biology and metabolic tools: a comprehensive review with E. coli nissle 1917 as a model case study","volume":"207","author":"Sadhu","year":"2025","journal-title":"Arch Microbiol"},{"key":"B35","doi-asserted-by":"publisher","first-page":"2343","DOI":"10.3390\/microorganisms13102343","article-title":"Key technologies of synthetic biology in industrial microbiology","volume":"13","author":"Jiang","year":"2025","journal-title":"Microorganisms"},{"key":"B36","doi-asserted-by":"publisher","first-page":"346","DOI":"10.3390\/fermentation11060346","article-title":"Nutritional enhancement of plant-based fermented foods: microbial innovations for a sustainable future","volume":"11","author":"Dhiman","year":"2025","journal-title":"Fermentation"},{"key":"B37","doi-asserted-by":"publisher","first-page":"597","DOI":"10.3389\/fmicb.2019.00597","article-title":"Approaches to computational strain design in the multiomics era","volume":"10","author":"St John","year":"2019","journal-title":"Front Microbiol"},{"key":"B38","doi-asserted-by":"publisher","first-page":"ycaf133","DOI":"10.1093\/ismeco\/ycaf133","article-title":"Ecological design of high-performance synthetic microbial communities: from theoretical foundations to functional optimization","volume":"5","author":"Wang","year":"2025","journal-title":"ISME Commun"},{"key":"B39","doi-asserted-by":"publisher","first-page":"185","DOI":"10.3390\/pharmaceutics17020185","article-title":"Microencapsulation of probiotics for enhanced stability and health benefits in dairy functional foods: a focus on pasta filata cheese","volume":"17","author":"D'Amico","year":"2025","journal-title":"Pharmaceutics"},{"key":"B40","doi-asserted-by":"publisher","first-page":"2750","DOI":"10.3390\/biomedicines12122750","article-title":"Revolutionizing personalized medicine: synergy with multi-omics data generation, main hurdles, and future perspectives","volume":"12","author":"Molla","year":"2024","journal-title":"Biomedicines"},{"key":"B41","doi-asserted-by":"publisher","first-page":"e71146","DOI":"10.1096\/fj.202502118R","article-title":"Microbial therapeutics in cancer: translating probiotics, prebiotics, synbiotics, and postbiotics from mechanistic insights to clinical applications: a topical review","volume":"39","author":"Tegegne","year":"2025","journal-title":"FASEB J"},{"key":"B42","doi-asserted-by":"publisher","first-page":"e2412001","DOI":"10.4014\/jmb.2412.12001","article-title":"Advancing gut microbiome research: the shift from metagenomics to multi-omics and future perspectives","volume":"35","author":"Yang","year":"2025","journal-title":"J Microbiol Biotechnol"},{"key":"B43","doi-asserted-by":"publisher","first-page":"3483","DOI":"10.3390\/pr13113483","article-title":"Probiotics, prebiotics and synbiotics for combating antimicrobial resistance in the food chain","volume":"13","author":"Mora\u010danin","year":"2025","journal-title":"Processes"},{"key":"B44","doi-asserted-by":"publisher","first-page":"R92","DOI":"10.1186\/bcr3493","article-title":"Critical research gaps and translational priorities for the successful prevention and treatment of breast cancer","volume":"15","author":"Eccles","year":"2013","journal-title":"Breast Cancer Res"},{"key":"B45","doi-asserted-by":"publisher","first-page":"3597","DOI":"10.3390\/cancers17223597","article-title":"Pharmacological prevention in breast cancer: current evidence, challenges, and future directions","volume":"17","author":"Sarti","year":"2025","journal-title":"Cancers"},{"key":"B46","doi-asserted-by":"publisher","first-page":"590718","DOI":"10.2147\/BCTT.S590718","article-title":"Novel microbiome-driven approaches to counteract chemotherapy-induced mucositis in breast cancer patients","volume":"18","author":"Obeagu","year":"2026","journal-title":"Breast Cancer Dove Med Press"},{"key":"B47","doi-asserted-by":"publisher","first-page":"356","DOI":"10.3390\/nu15020356","article-title":"Postoperative probiotics administration attenuates gastrointestinal complications and gut microbiota dysbiosis caused by chemotherapy in colorectal cancer patients","volume":"15","author":"Huang","year":"2023","journal-title":"Nutrients"},{"key":"B48","doi-asserted-by":"publisher","first-page":"616","DOI":"10.1038\/s41430-024-01542-5","article-title":"Efficacy of probiotics or synbiotics supplementation on chemotherapy-induced complications and gut microbiota dysbiosis in gastrointestinal cancer: a systematic review and meta-analysis","volume":"79","author":"Yao","year":"2025","journal-title":"Eur J Clin Nutr"},{"key":"B49","doi-asserted-by":"publisher","first-page":"823288","DOI":"10.3389\/fnut.2022.823288","article-title":"Oral administration of probiotics reduces chemotherapy-induced diarrhea and oral mucositis: a systematic review and meta-analysis","volume":"9","author":"Feng","year":"2022","journal-title":"Front Nutr"},{"key":"B50","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3897\/pharmacia.72.e144998","article-title":"Effect of multi-strain probiotics supplementation on chemotherapy-related side effects among patients with breast cancer: a pilot trial","volume":"72","author":"Kirtishanti","year":"2025","journal-title":"Pharmacia"},{"key":"B51","doi-asserted-by":"publisher","first-page":"223","DOI":"10.1016\/j.jare.2023.11.027","article-title":"The role of gut microbiota and metabolites in cancer chemotherapy","volume":"64","author":"Li","year":"2024","journal-title":"J Adv Res"},{"key":"B52","doi-asserted-by":"publisher","first-page":"648","DOI":"10.7150\/jca.99421","article-title":"Important role of intestinal microbiota in chemotherapy-induced diarrhea and therapeutics","volume":"16","author":"Jiang","year":"2025","journal-title":"J Cancer"},{"key":"B53","doi-asserted-by":"publisher","first-page":"1774211","DOI":"10.3389\/fimmu.2026.1774211","article-title":"The human microbiome reshapes the breast cancer immune-metabolic-hormonal microenvironment","volume":"17","author":"Wang","year":"2026","journal-title":"Front Immunol"},{"key":"B54","doi-asserted-by":"publisher","first-page":"1945","DOI":"10.3390\/cells12151945","article-title":"The emerging role of the microbiota in breast cancer progression","volume":"12","author":"Bernardo","year":"2023","journal-title":"Cell"}],"container-title":["Oncology Reviews"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/or.2026.1909404\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T08:25:03Z","timestamp":1788855903000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/or.2026.1909404\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,8]]},"references-count":54,"alternative-id":["10.3389\/or.2026.1909404"],"URL":"https:\/\/doi.org\/10.3389\/or.2026.1909404","relation":{},"ISSN":["1970-5557"],"issn-type":[{"value":"1970-5557","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,8]]},"article-number":"1909404"}}