TNF and neoplasm: In particular, the presence of bone metastases and poor ECOG PS are linked to i) a state of systemic inflammation marked by elevated levels of immunosuppressive cytokines (such as IL-6, IL-10, TNF-α) and ii) an immunosuppressive tumor microenvironment characterized by reduced CD8 + T cell levels alongside increased infiltration of myeloid-derived suppressor cells and T reg cells14,15.