TNF and obesity due to melanocortin 4 receptor deficiency: Moreover, there is an established link between obesity, inflammation, and cancer. Obesity may cause one-quarter of cancer deaths. Obesity also predisposes to inflammation and impacts the response to immunotherapy by activating pro-inflammatory mediators such as interleukin 6 (IL-6) and tumor necrosis factor-alpha (TNF α) [41]. Aurilio et al. have investigated the obesity paradox for cancer immunotherapy.