Gut Microbiome Modulation Through Ayurvedic Interventions in Cancer: Basti, Prebiotics, and Immunotherapy Response

Abstract

Background: The gut microbiome has emerged as one of the most consequential determinants of cancer immunotherapy response, with accumulating evidence demonstrating that the composition of the intestinal microbial community profoundly influences the efficacy of immune checkpoint inhibitors, the severity of treatment-related toxicity, and the broader immunological milieu within which tumour-immune interactions unfold. Ayurveda, the classical Indian system of medicine, has long employed a sophisticated set of gastrointestinal interventions - most notably Basti (medicated enema), dietary prebiotics, fermented preparations, and digestive herbal formulations - that are now understood, through the lens of contemporary microbiome science, to exert meaningful modulatory effects on intestinal microbial ecology. The convergence of these two knowledge traditions represents a clinically important and largely unexplored frontier. Objective: To synthesise current evidence on the mechanisms by which Ayurvedic gastrointestinal interventions - with particular emphasis on Basti therapy, dietary prebiotic prescriptions (Pathya Ahara), and phytobiotic herbal formulations - modulate gut microbial composition and function, and to examine the implications of these effects for cancer immunotherapy response, treatment toxicity, and patient outcomes. Methods: A comprehensive narrative review of peer-reviewed literature published between 2005 and 2026 was conducted using PubMed/MEDLINE, Scopus, Web of Science, and the AYUSH Research Portal. Search terms encompassed: gut microbiome, cancer immunotherapy, immune checkpoint inhibitors, Basti, Ayurveda, prebiotics, short-chain fatty acids, dysbiosis, Triphala, Lactobacillus, Bifidobacterium, PD-1/PD-L1, and tumour microenvironment. Classical Ayurvedic texts including the Charaka Samhita and Ashtanga Hridayam were consulted for primary source material on Basti formulations and dietary prescriptions. Conclusions: Ayurvedic gastrointestinal interventions - operating through modulation of microbial diversity, short-chain fatty acid (SCFA) production, intestinal barrier integrity, and mucosal immune programming - offer a mechanistically plausible and evidence-supported strategy for optimising the gut ecosystem in cancer patients. Preclinical data and emerging clinical observations suggest that Basti preparations, Triphala, and classical prebiotic dietary prescriptions may potentiate immunotherapy response by enriching immunotherapyassociated microbiota including Akkermansia muciniphila, Faecalibacterium prausnitzii, and Bifidobacterium species. Rigorous prospective clinical trials integrating Ayurvedic microbiome interventions into immunotherapy protocols are warranted as a research priority.