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Expected and paradoxical effects of obesity on cancer treatment response

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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 site-specific 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.

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Acknowledgements

This review is part of the ‘EOLO’ project ((Endocrinology and Oncology Learning Objects) led by Professors Emanuela Arvat, Annamaria Colao, Andrea Isidori, Andrea Lenzi and by dr. Roberto Baldelli, which aims at increasing the knowledge on oncological endocrinology.

We would like to acknowledge all the Collaborators of this project: 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.

Authors Contributors

All authors have contributed equally to the conception and design of the review. MG, VA, VB, NP and VR analyzed data and drafted the article. RMR, LB, PDG, FS, EA and RB revised the manuscript critically. All authors approved the final article.

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  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

    Marco Gallo & Emanuela Arvat

  2. Endocrinology and Diabetology Unit, ASL Verbano Cusio Ossola, Domodossola, Italy

    Valerio Adinolfi

  3. Oncology Unit, Department of Oncology and Medical Specialities, AO San Camillo-Forlanini, Rome, Italy

    Viola Barucca

  4. ENETS Center of Excellence, Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Tumori Milano, Milan, Italy

    Natalie Prinzi

  5. Department of Experimental Medicine, AO S. Andrea, Sapienza University of Rome, Rome, Italy

    Valerio Renzelli

  6. Endocrinology Unit, Department of Clinical Medicine and Surgery, Federico II University Medical School of Naples, Naples, Italy

    Luigi Barrea

  7. Endocrinology Unit, Department of Oncology and Medical Specialities, AO San Camillo-Forlanini, Rome, Italy

    Paola Di Giacinto & Roberto Baldelli

  8. Endocrine Unit, Department of Clinical and Experimental Medicine, University of Messina, AOU Policlinico G. Martino, Messina, Italy

    Rosaria Maddalena Ruggeri

  9. Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy

    Franz Sesti

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Correspondence to Marco Gallo.

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Gallo, M., Adinolfi, V., Barucca, V. et al. Expected and paradoxical effects of obesity on cancer treatment response. Rev Endocr Metab Disord 22, 681–702 (2021). https://doi.org/10.1007/s11154-020-09597-y

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