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Lactobacillus plantarum AS21 is a specific strain of the Gram-positive, lactic acid-producing bacterium *Lactobacillus plantarum* (recently reclassified as *Lactiplantibacillus plantarum*). It is being investigated as a live biotherapeutic product (LBP) to modulate the gut microbiome in patients with gastric adenocarcinoma. In clinical settings, it is administered orally in combination with neoadjuvant SOX chemotherapy (S-1 and oxaliplatin) and PD-1 inhibitor immunotherapy. The primary therapeutic rationale is that the modulation of the gut microbiota can enhance the efficacy of immune checkpoint inhibitors, optimize the host immune response, and reduce the incidence of gastrointestinal adverse symptoms associated with intensive chemotherapy and immunotherapy regimens. Clinical trials are evaluating its impact on short-term efficacy, safety, and long-term outcomes such as recurrence and survival.
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