Obesity causes chronic low-grade inflammation and leads to changes in the immune landscape of multiple organ systems. Given the link between chronic inflammatory conditions and cancer, it is not surprising that obesity is associated with increased risk and worse outcomes in many malignancies. Paradoxically, recent epidemiological studies have shown that high BMI is associated with increased efficacy of immune checkpoint inhibitors (ICI), and a causal relationship has been demonstrated in the preclinical setting. It has been proposed that obesity-associated immune dysregulation underlies this observation by inadvertently creating a favourable microenvironment for increased ICI efficacy. The recent success of ICIs in obese cancer patients raises the possibility that additional immune-targeted therapies may hold therapeutic value in this context. Here we review how obesity affects the immunological composition of the tumor microenvironment in ways that can be exploited for cancer therapies. We discuss existing literature supporting a beneficial role for obesity during ICI therapy in cancer patients, potential opportunities for targeting the innate immune system to mitigate chronic inflammatory processes, and how to pinpoint obese patients who are most likely to benefit from immune interventions without relying solely on BMI. Given that the incidence of obesity is expanding on an international scale we propose that understanding obesity-associated inflammation is necessary to reduce cancer mortalities and capitalize on novel therapeutic opportunities in the era of cancer immunotherapy.

肥胖会导致慢性低度炎症，并导致多个器官系统的免疫环境发生变化。鉴于慢性炎症与癌症之间的联系，肥胖与许多恶性肿瘤的风险增加和结果更差有关也就不足为奇了。矛盾的是，最近的流行病学研究表明，高 BMI 与免疫检查点抑制剂 (ICI) 的疗效增加有关，并且在临床前环境中已证明存在因果关系。有人提出，肥胖相关的免疫失调是这一观察结果的基础，因为它无意中创造了一个有利的微环境，以提高 ICI 功效。最近 ICI 在肥胖癌症患者中的成功提高了其他免疫靶向疗法在这种情况下可能具有治疗价值的可能性。在这里，我们回顾了肥胖如何以可用于癌症治疗的方式影响肿瘤微环境的免疫组成。我们讨论了现有文献支持肥胖在癌症患者 ICI 治疗期间的有益作用，靶向先天免疫系统以减轻慢性炎症过程的潜在机会，以及如何确定最有可能从免疫干预中受益的肥胖患者，而不是仅仅依靠体重指数。鉴于肥胖的发病率在国际范围内不断扩大，我们建议了解肥胖相关的炎症对于降低癌症死亡率和利用癌症免疫治疗时代的新治疗机会是必要的。