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PERSPECTIVE article

Front. Immunol.

Sec. Nutritional Immunology

Volume 16 - 2025 | doi: 10.3389/fimmu.2025.1612567

This article is part of the Research TopicNutritional Factors, Bacteria, and CancerView all articles

Nutritional status, immunonutrition, and gut microbiome: a coming of age for immunotherapy?

Provisionally accepted
Elisa MattavelliElisa Mattavelli1Francesco AgustoniFrancesco Agustoni2,3*Alice TartaraAlice Tartara1Francesca De SimeisFrancesca De Simeis1Lorenzo PerroneLorenzo Perrone3Riccardo CaccialanzaRiccardo Caccialanza1Paolo PedrazzoliPaolo Pedrazzoli2,3Valentina Da PratValentina Da Prat1
  • 11Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy, Pavia, Italy
  • 2Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Lombardy, Italy
  • 3Medical Oncology Unit, Oncology Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy, Pavia, Italy

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In the last decades, immunotherapy has revolutionized cancer treatment. Despite its success, a significant number of patients fail to respond, and the underlying causes of ineffectiveness remain poorly understood. Factors such as nutritional status and body composition are emerging as key predictors of immunotherapy outcomes. In particular, poor nutritional status, sarcopenia, and low skeletal muscle mass are associated with poorer survival and immunotherapy response in several cancers. Conversely, certain parameters of body composition, such as adiposity, may have beneficial effects on immunotherapy efficacy. Nutritional status and body composition can be targeted through tailored nutritional support, making it a potential strategy to improve immunotherapy outcomes. Specific nutrients and modulation of the gut microbiota may further enhance immune functions, offering promising avenues for clinical improvement. Despite the promising potential of tailored nutritional support, clinical evidence remains limited, and further research is needed to establish optimal strategies to optimize immunotherapy response and effectiveness.

Keywords: Nutritional Status, Body Composition, Immunonutrition, gut microbiome, Immunotherapy, treatment response and efficacy

Received: 15 Apr 2025; Accepted: 05 Aug 2025.

Copyright: © 2025 Mattavelli, Agustoni, Tartara, De Simeis, Perrone, Caccialanza, Pedrazzoli and Da Prat. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Francesco Agustoni, Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, 27100, Lombardy, Italy

Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

Supplementary Material