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For instance, although temozolomide can cross the BBB and is therefore commonly employed in clinics to treat gliomas, the response rate of this treatment is only approximately 40% of patients owing to the expression of O6-methylguanine DNA methyltransferase 18 and even goes down to 20% for those suffering from higher-grade gliomas 19

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The potential benefits of probiotic use are diverse and may include immune system activation and modulation, enhanced mucosal barrier function, competitive exclusion of pathogens, and decreased risk of infection through production of antimicrobial substances including lactic and acetic acids [131,166]

Options include bringing cooler with ice packs, planning travel during off-cycle periods, or accepting gap in protocol