Expected and paradoxical effects of obesity on cancer treatment response
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Expected and paradoxical effects of obesity on cancer treatment response Marco Gallo 1 & Valerio Adinolfi 2 & Viola Barucca 3 & Natalie Prinzi 4 & Valerio Renzelli 5 & Luigi Barrea 6 & Paola Di Giacinto 7 & Rosaria Maddalena Ruggeri 8 & Franz Sesti 9 & Emanuela Arvat 1 & Roberto Baldelli 7 & on behalf of the EOLO Group & Emanuela Arvat & Annamaria Colao & Andrea Isidori & Andrea Lenzi & Roberto Baldell & M. Albertelli & D. Attala & A. Bianchi & A. Di Sarno & T. Feola & G. Mazziotti & A. Nervo & C. Pozza & G. Puliani & P. Razzore & S. Ramponi & S. Ricciardi & L. Rizza & F. Rota & E. Sbardella & M. C. Zatelli Accepted: 25 September 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Obesity, whose prevalence is pandemic and continuing to increase, is a major preventable and modifiable risk factor for diabetes and cardiovascular diseases, as well as for cancer. Furthermore, epidemiological studies have shown that obesity is a negative independent prognostic factor for several oncological outcomes, including overall and cancer-specific survival, for several sitespecific cancers as well as for all cancers combined. Yet, a recently growing body of evidence suggests that sometimes overweight and obesity may associate with better outcomes, and that immunotherapy may show improved response among obese patients compared with patients with a normal weight. The so-called ‘obesity paradox’ has been reported in several advanced cancer as well as in other diseases, albeit the mechanisms behind this unexpected relationship are still not clear. Aim of this review is to explore the expected as well as the paradoxical relationship between obesity and cancer prognosis, with a particular emphasis on the effects of cancer therapies in obese people. Keywords Cancer . Obesity . Overweight . Body mass index . Cancer therapy . Treatment outcome
1 Introduction The prevalence of obesity, a condition generally defined as a body mass index (BMI) greater than or equal to 30 kg/m2, has nearly tripled worldwide over the last decades, reaching pandemic proportions and continuing to increase. According to the 2016 estimates by the World Health Organization (WHO), more than 650 million people were obese (BMI
* Marco Gallo [email protected] 1
Oncological Endocrinology Unit, Department of Medical Sciences, University of Turin, AOU Città della Salute e della Scienza di Torino, Via Genova, 3, 10126 Turin, Italy
2
Endocrinology and Diabetology Unit, ASL Verbano Cusio Ossola, Domodossola, Italy
3
Oncology Unit, Department of Oncology and Medical Specialities, AO San Camillo-Forlanini, Rome, Italy
4
ENETS Center of Excellence, Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Tumori Milano, Milan, Italy
≥30 kg/m2) all over the world in 2016 (11% of men and 15% of women) [1]. Obesity is a major preventable and modifiable risk factor for diabetes and cardiovascular diseases, as well as for cancer. A causal association between high BMI and a number of solid and hematologic cancers has def
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