Addition of diabetes drug Metformin improves survival in lung cancer patients: JAMA Oncology
Mexico: The diabetes drug metformin apart from lowering blood sugar in type 2 diabetes patients has been previously shown to have varied benefit in other health conditions as well. Now, a recent study has shown benefit of the drug for lung cancer patients.
According to results of the phase 3 study, published in the JAMA Oncology journal, the addition of metformin in patients with EGFR (epidermal growth factor receptor)-mutated lung adenocarcinoma increased progression-free and overall survival sans any significant increase in adverse events.
Metformin hydrochloride is emerging as a repurpose anticancer drug. The drug has shown to improve outcomes across a wide variety of neoplasms, including lung cancer in preclinical and retrospective studies.
Oscar Arrieta, Thoracic Oncology Unit, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico, and colleagues assessed the progression-free survival in patients with advanced lung adenocarcinoma who received EGFR–TKIs (tyrosine kinase inhibitors) therapy plus metformin compared to those who received EGFR-TKIs alone.
In the study, 139 patients (Mean age: 59.4 and 65.5% were female) were randomized to receive standard EGFR-TKIs (n=70) or EGFR-TKIs plus metformin 500 mg twice daily (n=69) from March 2016 to December 2017.
All the participants had histologically confirmed stage IIIb/IV lung adenocarcinoma with an activating EGFR mutation and measurable lesions. All were naïve to EGFR-TKIs, had an Eastern Cooperative Oncology Group performance status of 2 or less, and a life expectancy of at least 12 weeks. Median follow-up was 16.9 months.
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Key findings include:
- The median PFS was significantly longer in the EGFR-TKIs plus metformin group compared with the EGFR-TKIs group (13.1 months compared with 9.9 months).
- The median overall survival was also significantly longer for patients receiving combination therapy: 31.7 months vs 17.5 months.
- Patients allocated to receive added metformin were more likely to respond to EGFR-TKI therapy: 71.0% vs 54.3%.
- The combination lowered the risk of non-response, achieving an objective response rate of 0.48.
- The addition of metformin was the only factor independently associated with better overall survival, decreasing the risk of death by half.
- Grade 3/4 adverse events in both arms were similar in frequency in both arms and included diarrhoea, rash, nausea, and mucositis.
"To our knowledge, this is the first study to prospectively show that the addition of metformin to standard EGFR-TKIs therapy in patients with advanced lung adenocarcinoma significantly improves PFS. These results justify the design of phase 3, placebo-controlled study," wrote the authors.
To read the complete study log on to doi:10.1001/jamaoncol.2019.2553