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Bouland C, Vanden Eynden X, Lalmand M, Buset T, Yanni A, Javadian R, Rodriguez A, Loeb I, Lechien JR, Journe F, Saussez S, Dequanter D. Preventive and Therapeutic Effect of Metformin in Head and Neck Cancer: A Concise Review. J Clin Med 2023; 12:6195. [PMID: 37834839 PMCID: PMC10573641 DOI: 10.3390/jcm12196195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 09/14/2023] [Accepted: 09/18/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Head and neck cancer (HNC) is a complex affection. Nowadays, conventional treatments are associated with many side effects, reducing the patient's quality of life. Recent studies suggest that metformin, a first-line treatment for diabetes, could decrease cancer incidence and improve cancer-related survival rates. METHODS This systematic review summarizes important data from studies evaluating metformin's contribution to preventing and treating HNC. RESULTS The results suggest a protective effect of metformin in HNC. However, no consensus has been found on its therapeutic effects. Metformin seems to confer an improved cancer-related survival rate in a diabetic population, but compared to a non-diabetic population, the review could not identify any advantages. Nevertheless, no studies presented a negative impact. CONCLUSION In conclusion, the results of this systematic review suggest that HNC patients may benefit from metformin. Indeed, it would reduce the HNC incidence. However, more studies are required to evaluate the effect on cancer-related survival rates.
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Affiliation(s)
- Cyril Bouland
- Department of Stomatology—Maxillofacial Surgery, CHU-Saint-Pierre, Université Libre de Bruxelles (ULB), 1000 Brussels, Belgium (M.L.)
| | - Xavier Vanden Eynden
- Department of Stomatology—Maxillofacial Surgery, CHU-Saint-Pierre, Université Libre de Bruxelles (ULB), 1000 Brussels, Belgium (M.L.)
| | - Martin Lalmand
- Department of Stomatology—Maxillofacial Surgery, CHU-Saint-Pierre, Université Libre de Bruxelles (ULB), 1000 Brussels, Belgium (M.L.)
| | - Thibaut Buset
- Department of Stomatology—Maxillofacial Surgery, CHU-Saint-Pierre, Université Libre de Bruxelles (ULB), 1000 Brussels, Belgium (M.L.)
| | - Antoine Yanni
- Department of Stomatology—Maxillofacial Surgery, CHU-Saint-Pierre, Université Libre de Bruxelles (ULB), 1000 Brussels, Belgium (M.L.)
| | - Rokneddine Javadian
- Department of Stomatology—Maxillofacial Surgery, CHU-Saint-Pierre, Université Libre de Bruxelles (ULB), 1000 Brussels, Belgium (M.L.)
| | - Alexandra Rodriguez
- Department of Otorhinolaryngology—Head and Neck Surgery, CHU-Saint-Pierre, Université Libre de Bruxelles (ULB), 1000 Brussels, Belgium (S.S.)
| | - Isabelle Loeb
- Department of Stomatology—Maxillofacial Surgery, CHU-Saint-Pierre, Université Libre de Bruxelles (ULB), 1000 Brussels, Belgium (M.L.)
| | - Jérôme R. Lechien
- Department of Otorhinolaryngology—Head and Neck Surgery, CHU-Saint-Pierre, Université Libre de Bruxelles (ULB), 1000 Brussels, Belgium (S.S.)
- Laboratory of Human Anatomy and Experimental Oncology, Faculty of Medicine and Pharmacy, Research Institute for Health Sciences and Technology, University of Mons (UMONS), 7000 Mons, Belgium
| | - Fabrice Journe
- Laboratory of Human Anatomy and Experimental Oncology, Faculty of Medicine and Pharmacy, Research Institute for Health Sciences and Technology, University of Mons (UMONS), 7000 Mons, Belgium
- Laboratory of Oncology and Experimental Surgery, Jules Bordet Institute, Université Libre de Bruxelles (ULB), 1070 Brussels, Belgium
| | - Sven Saussez
- Department of Otorhinolaryngology—Head and Neck Surgery, CHU-Saint-Pierre, Université Libre de Bruxelles (ULB), 1000 Brussels, Belgium (S.S.)
- Laboratory of Human Anatomy and Experimental Oncology, Faculty of Medicine and Pharmacy, Research Institute for Health Sciences and Technology, University of Mons (UMONS), 7000 Mons, Belgium
| | - Didier Dequanter
- Department of Stomatology—Maxillofacial Surgery, CHU-Saint-Pierre, Université Libre de Bruxelles (ULB), 1000 Brussels, Belgium (M.L.)
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Yang J, Yang H, Cao L, Yin Y, Shen Y, Zhu W. Prognostic value of metformin in cancers: An updated meta-analysis based on 80 cohort studies. Medicine (Baltimore) 2022; 101:e31799. [PMID: 36626437 PMCID: PMC9750609 DOI: 10.1097/md.0000000000031799] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Experiments have shown that metformin can inhibit cancer cell growth, but clinical observations have been inconsistent, so we pooled the currently available data to evaluate the impact of metformin on cancer survival and progression. METHODS PubMed, web of science, Embase, and Cochrane databases were searched. Pooled hazard ratios (HRs) were identified using a random-effects model to estimate the strength of the association between metformin and survival and progression in cancer patients. RESULTS We incorporated 80 articles published from all databases which satisfied the inclusion criterion. It showed that metformin was associated with better overall survival (hazard ratio [HR] = 0. 81; 95% confidence interval [CI]: [0.77-0.85]) and cancer-specific survival (HR = 0.79; 95% CI: [0.73-0.86]), and metformin was associated with progression-free survival (HR = 0.76; 95% CI: [0.66-0.87]). In patients with diabetes mellitus, the HR of overall survival was 0.79(95% CI: [0.75-0.83]), progression-free survival was 0.72(95% CI: [0.60-0.85]), and the cancer-specific survival was 0.76(95% CI: [0.68-0.86]). It was proposed that metformin can improve the prognosis of cancer patients with diabetes mellitus. CONCLUSION Based on cohort studies, metformin therapy has potential survival benefits for patients with malignancy, especially with the greatest benefits seen in breast cancer on overall survival, progression-free survival, and cancer-specific survival. And metformin also showed potential benefits in cancer-specific survival in colorectal and prostate cancer.
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Affiliation(s)
- Jing Yang
- Oncology Center, The Affiliated Jiangsu Shengze Hospital of Nanjing Medical University, Wujiang, Jiangsu Province, P.R. China
| | - Hang Yang
- Oncology Center, The Affiliated Jiangsu Shengze Hospital of Nanjing Medical University, Wujiang, Jiangsu Province, P.R. China
| | - Ling Cao
- Oncology Center, The Affiliated Jiangsu Shengze Hospital of Nanjing Medical University, Wujiang, Jiangsu Province, P.R. China
| | - Yuzhen Yin
- Oncology Center, The Affiliated Jiangsu Shengze Hospital of Nanjing Medical University, Wujiang, Jiangsu Province, P.R. China
| | - Ying Shen
- Department of Endocrinology, The Affiliated Jiangsu Shengze Hospital of Nanjing Medical University, Wujiang, Jiangsu Province, P.R. China
| | - Wei Zhu
- Department of Oncology, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, P.R. China
- * Correspondence: Wei Zhu, Department of Oncology, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province 210029, P.R. China (e-mail: )
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Jiao Y, Liu D, Sun Y, Chen Z, Liu S. Survival Benefit of Metformin as an Adjuvant Treatment for Head and Neck Cancer: A Systematic Review and Meta-Analysis. Front Pharmacol 2022; 13:850750. [PMID: 35645803 PMCID: PMC9136048 DOI: 10.3389/fphar.2022.850750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 04/28/2022] [Indexed: 11/14/2022] Open
Abstract
Background/Aims: The relationship between the efficacy of metformin and the prognosis of patients with head and neck cancer (HNC) was still unclear. This study aims to clarify the prognostic value of metformin treatment using meta-analysis. Methods: Studies related to HNC prognosis and metformin were searched in Cochrane Library, Embase, LILACS, MEDLINE and PubMed databases. A meta-analysis was performed to evaluate the association between metformin therapy and the prognosis of HNC on overall survival (OS), disease-free survival (DFS) and disease-specific survival (DSS) and whether article quality, comorbidities, age, region or smoking had an influence on the prognosis of metformin treatment. Pooled hazard ratio (HR) and 95% confidence interval (CI) were analyzed to assess the effect. Results: Eleven eligible studies involving 14,694 participants were included. Metformin increased the OS (HR = 0.87, 95% CI: 0.76–0.99), but failed on DFS (HR = 0.67, 95% CI: 0.40–1.09) or DSS (HR = 0.69, 95% CI: 0.41–1.14) in HNC patients. Subgroup analysis showed metformin was associated with improved OS (HR = 0.66, 95% CI: 0.49–0.88), DFS (HR = 0.49, 95% CI: 0.26–0.92) and DSS (HR = 0.38, 95% CI: 0.22–0.65) in studies with higher Newcastle-Ottawa Scale (NOS) scores. Subgroup analysis of age indicated that patients younger than 65 years (OS, HR = 0.67, 95% CI: 0.49–0.92) were more likely to benefit from metformin treatment. Subgroup analysis of comorbidities showed metformin significantly improved patient outcomes in studies without adjusted for comorbidities (OS, HR = 0.66, 95% CI: 0.51–0.85; DSS, HR = 0.38, 95% CI: 0.22–0.65), but not in studies that adjusted for comorbidities. Conclusions: Metformin improved the prognosis of HNC patients as an adjuvant therapy, especially in those with higher NOS scores. Age and comorbidities of HNC patients influenced the therapeutic effect of metformin. Further well-conducted investigations are needed.
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Affiliation(s)
- Yu Jiao
- The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Dongjuan Liu
- Liaoning Provincial Key Laboratory of Oral Diseases, School and Hospital of Stomatology, China Medical University, Shenyang, China
| | - Yi Sun
- The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Zitong Chen
- The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Sai Liu
- Liaoning Provincial Key Laboratory of Oral Diseases, School and Hospital of Stomatology, China Medical University, Shenyang, China
- *Correspondence: Sai Liu,
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Jeong HS, Lee DH, Kim SH, Lee CH, Shin HM, Kim HR, Cho CH. Hyperglycemia-induced oxidative stress promotes tumor metastasis by upregulating vWF expression in endothelial cells through the transcription factor GATA1. Oncogene 2022; 41:1634-1646. [DOI: 10.1038/s41388-022-02207-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 01/06/2022] [Accepted: 01/20/2022] [Indexed: 01/16/2023]
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Brancher S, Ribeiro AE, Toporcov TN, Weiderpass E. The role of metformin on lung cancer survival: the first systematic review and meta-analysis of observational studies and randomized clinical trials. J Cancer Res Clin Oncol 2021; 147:2819-2836. [PMID: 34264392 DOI: 10.1007/s00432-021-03728-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 07/04/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To assess the effects of metformin use on lung cancer (LC) survival according to summarized results from observational studies (OBs) and randomized clinical trials (RCTs). METHODS We systematically searched electronic databases and, to our knowledge, for the first time, RCTs were included in a systematic review and meta-analysis about the role of metformin on LC survival. We carried out meta-analyses separately for OBs and RCTs. Analyses for overall survival (OS) concerning OBs were stratified by studies with and without time-dependent approach. Subgroup analyses were adopted for OBs to identify the sources of heterogeneity. Included studies were assessed for quality. RESULTS We identified ten OBs and four RCTs. For OBs, metformin use was associated with improved OS for LC patients. Only two studies used time-dependent approach in which a higher ratio was found when compared to the non-use of the time-dependent analysis in eight studies. OBs were classified as high quality but the risk of bias was "unclear" in eight OBs due to absence of the time-dependent analysis. For RCTs, metformin use was not beneficial for OS and neither for progression-free survival. Heterogeneous quality was found among RCTs. Sources of bias that could alter significantly the results or raise doubts were identified in RCTs. CONCLUSION Time-dependent analysis should be considered an appropriate strategy for OBs focused on the metformin use for LC patients' survival, and further studies applying this approach are required. More well-designed RCTs are needed to provide consistent results for the association between metformin use and LC survival.
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Affiliation(s)
- Suzan Brancher
- Department of Epidemiology, School of Public Health, University of São Paulo, Av. Dr. Arnaldo 715, Cerqueira César, São Paulo, SP, CEP 01246-904, Brazil.
| | - Ana Elisa Ribeiro
- Department of Dentistry, State University of Ponta Grossa, Ponta Grossa, Brazil
| | - Tatiana Natasha Toporcov
- Department of Epidemiology, School of Public Health, University of São Paulo, Av. Dr. Arnaldo 715, Cerqueira César, São Paulo, SP, CEP 01246-904, Brazil
| | - Elisabete Weiderpass
- International Agency for Research on Cancer (IARC), World Health Organization, Lyon, France
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Skinner H, Hu C, Tsakiridis T, Santana-Davila R, Lu B, Erasmus JJ, Doemer AJ, Videtic GMM, Coster J, Yang AX, Lee RY, Werner-Wasik M, Schaner PE, McCormack SE, Esparaz BT, McGarry RC, Bazan J, Struve T, Paulus R, Bradley JD. Addition of Metformin to Concurrent Chemoradiation in Patients With Locally Advanced Non-Small Cell Lung Cancer: The NRG-LU001 Phase 2 Randomized Clinical Trial. JAMA Oncol 2021; 7:1324-1332. [PMID: 34323922 DOI: 10.1001/jamaoncol.2021.2318] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Importance Non-small cell lung cancer (NSCLC) has relatively poor outcomes. Metformin has significant data supporting its use as an antineoplastic agent. Objective To compare chemoradiation alone vs chemoradiation and metformin in stage III NSCLC. Design, Setting, and Participants The NRG-LU001 randomized clinical trial was an open-label, phase 2 study conducted from August 24, 2014, to December 15, 2016. Patients without diabetes who were diagnosed with unresectable stage III NSCLC were stratified by performance status, histology, and stage. The setting was international and multi-institutional. This study examined prespecified endpoints, and data were analyzed on an intent-to-treat basis. Data were analyzed from February 25, 2019, to March 6, 2020. Interventions Chemoradiation and consolidation chemotherapy with or without metformin. Main Outcomes and Measures The primary outcome was 1-year progression-free survival (PFS), designed to detect 15% improvement in 1-year PFS from 50% to 65% (hazard ratio [HR], 0.622). Secondary end points included overall survival, time to local-regional recurrence, time to distant metastasis, and toxicity per Common Terminology Criteria for Adverse Events, version 4.03. Results A total of 170 patients were enrolled, with 167 eligible patients analyzed after exclusions (median age, 64 years [interquartile range, 58-72 years]; 97 men [58.1%]; 137 White patients [82.0%]), with 81 in the control group and 86 in the metformin group. Median follow-up was 27.7 months (range, 0.03-47.21 months) among living patients. One-year PFS rates were 60.4% (95% CI, 48.5%-70.4%) in the control group and 51.3% (95% CI, 39.8%-61.7%) in the metformin group (HR, 1.15; 95% CI, 0.77-1.73; P = .24). Clinical stage was the only factor significantly associated with PFS on multivariable analysis (HR, 1.79; 95% CI, 1.19-2.69; P = .005). One-year overall survival was 80.2% (95% CI, 69.3%-87.6%) in the control group and 80.8% (95% CI, 70.2%-87.9%) in the metformin group. There were no significant differences in local-regional recurrence or distant metastasis at 1 or 2 years. No significant difference in adverse events was observed between treatment groups. Conclusions and Relevance In this randomized clinical trial, the addition of metformin to concurrent chemoradiation was well tolerated but did not improve survival among patients with unresectable stage III NSCLC. Trial Registration ClinicalTrials.gov Identifier: NCT02186847.
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Affiliation(s)
- Heath Skinner
- UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania
| | - Chen Hu
- NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvania.,Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, Maryland
| | | | | | - Bo Lu
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | | | | | | | | | | | | | | | | | - Steven E McCormack
- Metro-Minnesota Community Oncology Research Consortium, St Louis Park, Minnesota
| | | | | | - Jose Bazan
- Ohio State University Comprehensive Cancer Center, Columbus
| | - Timothy Struve
- University of Cincinnati/Barrett Cancer Center, Cincinnati, Ohio
| | - Rebecca Paulus
- NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvania
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Metformin: (future) best friend of the radiation oncologist? Radiother Oncol 2020; 151:95-105. [PMID: 32592892 DOI: 10.1016/j.radonc.2020.06.030] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 06/10/2020] [Accepted: 06/19/2020] [Indexed: 02/08/2023]
Abstract
Several molecules are being investigated for their ability to enhance the anti-tumor effect of radiotherapy. The widely prescribed antidiabetic drug metformin has been suggested to possess anti-cancer activity; data indicate that metformin could also enhance radiation sensitivity. The purpose of this review is to summarize current knowledge on the specific effect of metformin in the field of RT, while also discussing the many unknowns that persist. Preclinical models point to multiple mechanisms involved in the radiosensitizing effects of metformin that are mainly linked to mitochondrial complex I inhibition and AMP-activated protein kinase. Transposition of results from bench to bedside will be discussed through the lens of the drug concentration, its potential limits in human settings, and possible alternatives. Clinical data suggest metformin improves progression-free and overall survival in patients for many different cancers treated with RT; nevertheless, the results are not always consistent. The main limitations of the reviewed literature are the retrospective nature of studies, and most of the time, a lack of information on MTF treatment duration and the administered dosages. Despite these limitations, the possible mechanisms of the role of metformin and its utility in enhancing radiotherapy treatments are analyzed. Ongoing clinical trials are also discussed.
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Yin LX, Puccinelli CL, Price DL, Karp EE, Price KA, Ma DJ, Lohse C, Moore EJ, Abel KMV. The prognostic role of medical comorbidities in surgically treated human papillomavirus-associated oropharyngeal squamous cell carcinoma. Oral Oncol 2020; 108:104822. [PMID: 32504888 DOI: 10.1016/j.oraloncology.2020.104822] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 05/21/2020] [Accepted: 05/24/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Prognostic factors specific to surgically managed human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma (HPV(+)OPSCC) are not fully understood. Medical co-morbidities may have an impact on survival after surgical treatment. We aimed to identify co-morbidities associated with distant metastases-free survival (DMFS) and cancer-specific survival (CSS) in HPV(+)OPSCCs. METHODS This is a retrospective case series of HPV(+)OPSCC patients at a tertiary referral center from 2007 to 2016. All patients in the study underwent primary intent-to-cure transoral resection with concomitant neck dissection ± adjuvant radiation ± chemotherapy. Exclusion criteria included a history of previous head and neck cancer or distant metastases at diagnosis. Associations with DMFS and CSS were evaluated using univariable and multivariable Cox regression and summarized with hazard ratios (HRs). RESULTS 406 patients were included in the cohort (100% HPV(+), 90% Male). All had tumors of the tonsil (62%) or base of tongue (38%). Median follow-up for the cohort was 4.0 years (IQR: 2.6-6.2). Higher tumor stage and a higher Adult Comorbidity Evaluation-27 score were significantly associated with worse DMFS and CSS (p < 0.02 for all). A history of diabetes mellitus (N = 36, 9%) was significantly associated with DMFS (HR 3.05 [95%CI 1.26-7.37], p = 0.014) and CSS (HR 4.82 [95%CI 1.84-12.61], p = 0.001). On multivariable analysis, after adjusting for tumor stage, diabetes remained significantly associated with worse DMFS (HR 2.58 [95%CI 1.06-6.26], p = 0.037). CONCLUSION Diabetes mellitus may be associated with worse DMFS and CSS in surgically managed HPV(+)OPSCC.
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Affiliation(s)
- Linda X Yin
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | - Cassandra L Puccinelli
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | - Daniel L Price
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | - Emily E Karp
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | | | - Dan J Ma
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN 55905, USA
| | - Christine Lohse
- Department of Heath Sciences Research, Mayo Clinic, Rochester, MN 55905, USA
| | - Eric J Moore
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | - Kathryn M Van Abel
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN 55905, USA.
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Impact of Diabetes Mellitus on Head and Neck Cancer Patients Undergoing Concurrent Chemoradiotherapy. Sci Rep 2020; 10:7702. [PMID: 32382160 PMCID: PMC7205991 DOI: 10.1038/s41598-020-64844-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 04/22/2020] [Indexed: 11/18/2022] Open
Abstract
In this retrospective study, we investigated the impact of diabetes mellitus (DM) on patients with head and neck cancer (HNC) undergoing concurrent chemoradiotherapy (CCRT). We analyzed the demographic and clinical characteristics, treatment tolerance, and toxicities of patients with HNC undergoing primary or adjuvant CCRT with or without DM between 2007 and 2016. Of the 556 patients undergoing CCRT, 84 (15.1%) had DM. Compared with patients without DM, patients with DM were significantly older (56.2 ± 11.2 vs. 51.9 ± 9.5 years, P < 0.001), received lower doses of cisplatin (adjuvant CCRT: 175.30 ± 84.03 vs. 214.88 ± 68.25, P = 0.014; primary CCRT: 142.84 ± 79.49 vs. 187.83 ± 76.19, P < 0.001), and experienced higher rates of infection (adjuvant CCRT: 52% vs. 30.5%, P = 0.042; primary CCRT: 45.8% vs. 22.9%, P < 0.001). Among patients undergoing primary CCRT, compared with those without DM, the patients with DM experienced significantly higher rates of hematologic toxicity (65.7% vs. 39.3%, P = 0.004) and treatment-related deaths (10.2% vs. 3.5%, P = 0.051); and a greater weight loss (−6.17 ± 9.27% vs. −4.49 ± 6.84, P = 0.078). Patients with HNC and DM undergoing CCRT, compared with patients without DM, experienced higher rates of infection and hematotoxicity, loss of body weight, and higher treatment-related mortality.
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Tsou YA, Chang WD, Lu JJ, Wu TF, Chen HL, Chen CM, Tsai MH. The effect of metformin use on hypopharyngeal squamous cell carcinoma in diabetes mellitus patients. BMC Cancer 2019; 19:862. [PMID: 31470817 PMCID: PMC6716861 DOI: 10.1186/s12885-019-6083-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 08/23/2019] [Indexed: 12/03/2022] Open
Abstract
Background Metformin is proven to improve the prognosis of various cancers, but it is unknown if metformin could ameliorate hypopharyngeal cancer in diabetes mellitus patients. This was a retrospective cohort study, and the effect and survival outcome of metformin on hypopharyngeal cancer with diabetes mellitus was investigated. Methods There were 141 hypopharyngeal cancer patients collected in a tertiary referral center from December 1st, 2011 to December 31st, 2013. There were 49 patients without diabetes mellitus (DM) and 92 patients with DM. In the 92 DM patients, there were 43 patients with metformin used and 49 patients without metformin used. All received patients followed up until September 1st, 2015. Results There was no significant difference in patients’ characteristics between the non-DM and DM groups, and also no significant difference in clinical T stage, N stage, metastatic condition, and disease stage between the non-DM and DM groups. DM with metformin patients had lower metastasis rates and better overall survival (OS) (p = 0.011) and disease-free survival (DFS) (p = 0.004) compared to non-DM and DM without metformin. Multivariate analysis also showed a better OS and DFS in DM-Met (+) with advanced hypopharyngeal cancer but not in early stage. Conclusion There was less distant metastasis and better survival outcomes in hypopharyngeal cancer DM patients who use metformin.
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Affiliation(s)
- Yung-An Tsou
- Department of Otolaryngology-Head and Neck Surgery, China Medical University Hospital, Taichung, Taiwan.,Department of Audiology and Speech-Language Pathology, Asia University, Taichung, Taiwan
| | - Wen-Dien Chang
- Department of Sport Performance, National Taiwan University of Sport, No.16, Sec. 1, Shuang-Shih Rd, Taichung, 40404, Taiwan.
| | - Jian-Ji Lu
- Department of Otolaryngology-Head and Neck Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Tsu-Fang Wu
- Graduate Institute of Biomedicine Sciences, China Medical University, Taichung, Taiwan
| | - Hsiao-Ling Chen
- Biological Resources Department, Da-Yeh University, Changhua, Taiwan
| | - Chuan-Mu Chen
- Department of Life Sciences, and Agricultural Biotechnology Center, National Chung Hsing University, Taichung, Taiwan
| | - Ming Hsui Tsai
- Department of Otolaryngology-Head and Neck Surgery, China Medical University Hospital, Taichung, Taiwan
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Lee DJ, McMullen CP, Foreman A, Huang SH, Lu L, Xu W, de Almeida JR, Liu G, Bratman SV, Goldstein DP. Impact of metformin on disease control and survival in patients with head and neck cancer: a retrospective cohort study. J Otolaryngol Head Neck Surg 2019; 48:34. [PMID: 31345259 PMCID: PMC6659246 DOI: 10.1186/s40463-019-0348-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 05/21/2019] [Indexed: 01/03/2023] Open
Abstract
Objective A number of in vitro and clinical studies have suggested potential antineoplastic effects of metformin. The impact of this medication on outcomes in head and neck cancer is less clear. Our aim was to determine the effect of metformin on outcomes within our large cohort of head and neck cancer patients with Type II Diabetes (T2DM). Study design Retrospective cohort study. Setting Tertiary Cancer Centre. Subjects and methods A retrospective review of individuals with head and neck squamous carcinoma (HNSCC) and T2DM between January 2005 and December 2011 at Princess Margaret Cancer Centre was conducted. Medication history was obtained from surveys at initial presentation and electronic medical record review. Using Cox regression analyses, the association between metformin use and local, regional and distant failures was explored. Subgroup analyses were conducted for oral cavity, oropharynx and larynx. Results A total of 329 HNSCC patients with T2DM were identified, including 195 metformin users and 134 non-metformin users. Patients were well-matched in terms of clinical, pathologic, and treatment factors. No difference in local, regional, or distant failure was observed between diabetic metformin users and diabetic non-metformin users for the entire cohort or within subgroup analysis for subsite. No difference between the two groups was observed for overall survival, recurrence-free survival, and disease-specific survival at 5 years. Conclusion No association between metformin use and oncologic outcomes were observed in this large cohort of HNSCC patients. Multicenter, prospective studies may be needed to verify previous studies identifying a potential anti-neoplastic effect of this medication.
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Affiliation(s)
- Daniel J Lee
- Department of Otolaryngology Head and Neck Surgery/Surgical Oncology, University Health Network, Princess Margaret Cancer Center, University of Toronto, 610 University Ave 3-952, Toronto, ON, M4V 2N8, Canada
| | - Caitlin P McMullen
- Department of Otolaryngology Head and Neck Surgery/Surgical Oncology, University Health Network, Princess Margaret Cancer Center, University of Toronto, 610 University Ave 3-952, Toronto, ON, M4V 2N8, Canada
| | - Andrew Foreman
- Department of Otolaryngology Head and Neck Surgery/Surgical Oncology, University Health Network, Princess Margaret Cancer Center, University of Toronto, 610 University Ave 3-952, Toronto, ON, M4V 2N8, Canada
| | - Shao Hui Huang
- Department of Radiation Oncology, University Health Network, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Lin Lu
- Biostatistics Department, Princess Margaret Cancer Centre and Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Wei Xu
- Biostatistics Department, Princess Margaret Cancer Centre and Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - John R de Almeida
- Department of Otolaryngology Head and Neck Surgery/Surgical Oncology, University Health Network, Princess Margaret Cancer Center, University of Toronto, 610 University Ave 3-952, Toronto, ON, M4V 2N8, Canada
| | - Geoffrey Liu
- Biostatistics Department, Princess Margaret Cancer Centre and Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Scott V Bratman
- Department of Radiation Oncology, University Health Network, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - David P Goldstein
- Department of Otolaryngology Head and Neck Surgery/Surgical Oncology, University Health Network, Princess Margaret Cancer Center, University of Toronto, 610 University Ave 3-952, Toronto, ON, M4V 2N8, Canada.
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12
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Rao M, Gao C, Guo M, Law BYK, Xu Y. Effects of metformin treatment on radiotherapy efficacy in patients with cancer and diabetes: a systematic review and meta-analysis. Cancer Manag Res 2018; 10:4881-4890. [PMID: 30425579 PMCID: PMC6205529 DOI: 10.2147/cmar.s174535] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Purpose Metformin is a key pharmaceutical for patients with diabetes mellitus (DM). Metformin also can enhance tumor radiosensitivity in vitro and in vivo. Some retrospective cohort studies have indicated that metformin can improve the efficacy of radiotherapy in patients with cancer and DM. The aim of this systematic review was to evaluate the radiotherapy efficacy of metformin in patients with cancer and DM. Methods Multiple databases were queried for studies that address the efficacy of metformin in radiotherapy of patients with cancer and DM. Studies were included that involved comparisons of the short-term tumor responses and long-term survival outcomes of these patients who were managed with or without metformin as well as of nondiabetic patients without metformin. The OR and HR with accompanying 95% CI were assessed in a random effects model. The main endpoints were 2-year and 5-year overall survival (2y-OS and 5y-OS, respectively). Results The database search yielded 17 cohort studies that met the inclusion criteria. The results indicated that the tumor response was higher in patients who also were treated with metformin than in those who were not (OR, 0.48; 95% CI, 0.22-1.07; P=0.07) and nondiabetic (OR, 0.27; 95% CI, 0.07-0.98; P=0.05). Moreover, patients who received metformin had survival benefits compared with patients not treated with metformin (2y-OS: OR, 0.48; 95% CI, 0.29-0.80; P=0.005; 5y-OS: OR, 0.38; 95% CI, 0.25-0.56; P<0.00001). The metformin-related HRs of OS values were not significantly different. Conclusion Metformin appears to improve the tumor response to radiotherapy in patients with cancer and DM and partly yield survival benefits. Despite the apparent advantages provided by metformin treatment on 2y-OS and 5y-OS, these retrospective data are at risk of bias and should be interpreted with caution.
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Affiliation(s)
- Mingyue Rao
- Faculty of Chinese Medicine, Macau University of Science and Technology, Avenida Wai Long, Taipa, Macau, China, , .,Department of Endocrinology, .,Department of Oncology, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, China
| | - Chenlin Gao
- Faculty of Chinese Medicine, Macau University of Science and Technology, Avenida Wai Long, Taipa, Macau, China, , .,Department of Endocrinology,
| | - Man Guo
- Department of Endocrinology,
| | - Betty Yuen Kwan Law
- Faculty of Chinese Medicine, Macau University of Science and Technology, Avenida Wai Long, Taipa, Macau, China, , .,State Key Laboratory of Quality Research in Chinese Medicine, Macau University of Science and Technology, Avenida Wai Long, Taipa, Macau, China,
| | - Yong Xu
- Faculty of Chinese Medicine, Macau University of Science and Technology, Avenida Wai Long, Taipa, Macau, China, , .,Department of Endocrinology,
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13
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Stokes WA, Eguchi M, Amini A, Hararah MK, Ding D, McDermott JD, Bradley CJ, Karam SD. Survival impact and toxicity of metformin in head and neck cancer: An analysis of the SEER-Medicare dataset. Oral Oncol 2018; 84:12-19. [PMID: 30115470 DOI: 10.1016/j.oraloncology.2018.06.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 06/11/2018] [Accepted: 06/18/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Recent preclinical research has renewed interest in the interplay between glucose dysregulation and cancer. Metformin holds promise as an adjunctive antineoplastic agent in head and neck cancer (HNC). We aimed to explore the impact of metformin in HNC patients from a population-based dataset. PATIENTS & METHODS Patients diagnosed with HNC from 2008 to 2011 were identified from the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked dataset and categorized into three groups: non-diabetics (nD), diabetics not taking metformin (DnM), and diabetics taking metformin (D + M). Overall survival (OS) and cancer-specific survival (CSS) were compared between groups using Kaplan-Meier and Cox regression controlling for sociodemographic, clinical, and treatment covariates. The incidence of toxicities associated with HNC therapy was compared among groups using χ2 analysis. RESULTS Among 1646 patients, there were 1144 nD, 378 DnM, and 124 D + M. 2-year OS rates was 65.6% for nD, 57.7% for DnM, and 73.4% for D + M by Kaplan-Meier (p < 0.01), and corresponding rates of 2-year CSS were 73.7%, 66.1%, and 88.8% (p < 0.01), respectively. On Cox multivariable analysis, OS among the three groups did not significantly differ; however, CSS was significantly worse among both nD versus DnM as compared to D + M. Toxicity rates were not significantly increased among D + M. CONCLUSION HNC patients with diabetes taking metformin experience improved CSS. Prospective investigation of the addition of metformin to standard-of-care HNC therapy is warranted.
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Affiliation(s)
- William A Stokes
- Department of Radiation Oncology, University of Colorado Denver, USA
| | - Megan Eguchi
- Department of Health Systems, Management, and Policy, Colorado School of Public Health, USA
| | - Arya Amini
- Department of Radiation Oncology, City of Hope Cancer Center, USA
| | | | - Ding Ding
- Department of Radiation Oncology, University of Colorado Denver, USA
| | | | - Cathy J Bradley
- Department of Health Systems, Management, and Policy, Colorado School of Public Health, USA
| | - Sana D Karam
- Department of Radiation Oncology, University of Colorado Denver, USA.
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14
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Foreman A, Lee DJ, McMullen C, de Almeida J, Muhanna N, Gama RR, Giuliani M, Liu G, Bratman SV, Huang SH, O'Sullivan B, Song Y, Xu W, Goldstein DP. Impact of Type 2 Diabetes Mellitus on Survival in Head and Neck Squamous Cell Carcinoma. Otolaryngol Head Neck Surg 2017; 157:657-663. [PMID: 28849730 DOI: 10.1177/0194599817726756] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Objective To identify any association between type 2 diabetes mellitus (T2DM) and survival outcomes for mucosal squamous cell carcinoma of the head and neck. An association has been demonstrated between T2DM and cancer outcomes at numerous sites, but data for the head and neck are limited. Improving our understanding of the impact that diabetes has on head and neck cancer survival is relevant for making treatment decisions and counseling patients regarding prognosis. Study Design Retrospective cohort study. Setting Academic tertiary referral head and neck cancer center. Subjects and Methods By accessing data retrospectively from prospectively collected databases at the Princess Margaret Cancer Centre, patients were studied who were treated for mucosal head and neck squamous cell cancer between January 2005 and December 2011. Collection of clinical, pathologic, and survival data was completed with an emphasis on T2DM. Results Of 2498 patients identified in the study period, 319 (12.8%) had T2DM. Five-year overall survival was not different between the diabetic (64%, 95% CI = 58%-71%) and nondiabetic (67%, 95% CI = 65%-69%; P = .078) groups. Furthermore, cause-specific survival did not demonstrate a statistically significant difference between groups (diabetic: 84%, 95% CI = 79%-88%, vs nondiabetic: 84%, 95% CI = 82%-86%; P = .67). Conclusion Despite contradictory evidence at other cancer sites, the presence of T2DM alone does not appear to adversely affect cancer survival outcomes in head and neck squamous cell cancer. This is encouraging for the diabetic patients with head and neck squamous cell cancer, and it provides guidance for the multidisciplinary team that treats them.
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Affiliation(s)
- Andrew Foreman
- 1 Department of Otolaryngology-Head and Neck Surgery, University Health Network, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada.,2 Department of Otolaryngology-Head and Neck Surgery, University of Adelaide, Royal Adelaide Hospital, Adelaide, Australia
| | - Daniel J Lee
- 1 Department of Otolaryngology-Head and Neck Surgery, University Health Network, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
| | - Caitlin McMullen
- 1 Department of Otolaryngology-Head and Neck Surgery, University Health Network, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
| | - John de Almeida
- 1 Department of Otolaryngology-Head and Neck Surgery, University Health Network, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
| | - Nidal Muhanna
- 1 Department of Otolaryngology-Head and Neck Surgery, University Health Network, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
| | - Ricardo Ribeiro Gama
- 3 Department of Head and Neck Surgery, Hospital do Câncer de Barretos, Barretos, Brazil
| | - Meredith Giuliani
- 4 Department of Radiation Oncology, University Health Network, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
| | - Geoffrey Liu
- 5 Department of Medicine, Princess Margaret Cancer Centre and Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Scott V Bratman
- 4 Department of Radiation Oncology, University Health Network, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
| | - Shao Hui Huang
- 4 Department of Radiation Oncology, University Health Network, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
| | - Brian O'Sullivan
- 4 Department of Radiation Oncology, University Health Network, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
| | - Yuyao Song
- 6 Department of Biostatistics, Princess Margaret Cancer Centre and Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Wei Xu
- 6 Department of Biostatistics, Princess Margaret Cancer Centre and Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - David P Goldstein
- 1 Department of Otolaryngology-Head and Neck Surgery, University Health Network, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
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15
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Samsuri NAB, Leech M, Marignol L. Metformin and improved treatment outcomes in radiation therapy - A review. Cancer Treat Rev 2017; 55:150-162. [PMID: 28399491 DOI: 10.1016/j.ctrv.2017.03.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 03/15/2017] [Accepted: 03/17/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND Metformin, a primary treatment for diabetes mellitus (DM) patients, is associated with improved outcomes for diabetic cancer patients fuelling further investigation on its mechanisms of action. The radiosensitising properties of metformin are increasingly reported in pre-clinical studies. This review discusses whether metformin should be offered to radiotherapy (RT) cancer patients as a means to improve their treatment outcomes. MATERIALS AND METHODS A database search was conducted for articles published with metformin as the main intervention between 2010 and 2016. Three groups of RT cancer patients were analysed: diabetic patients using metformin, diabetic patients not using metformin and non-diabetic patients not using metformin. Data on survival and recurrence metrics were extracted. RESULTS Thirteen studies were included. Conflicting evidence exists with regards to the impact of metformin administration on recurrence and survival outcomes following radiotherapy. Three studies reported improved tumour response determined by recurrence rates while five studies did not observe differences or metformin use was not the associated reason. One study revealed inconsistent tumour response results. Metformin was reported as improving survival outcomes in 2 studies and not improving outcomes in 5 studies. 4 studies showed indefinite results. CONCLUSION Although metformin may improve tumour response in the non-randomized, retrospective studies analysed, it may not necessarily confer survival benefits. Future prospective and randomised trials are required to translate the positive impact of metformin documented in pre-clinical and retrospective studies into improve management of RT cancer patients.
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Affiliation(s)
- Nur Atiqah Binte Samsuri
- Applied Radiation Therapy Trinity Research Group, Trinity College Dublin, Ireland; Division of Radiation Oncology, National Cancer Centre, Singapore
| | - Michelle Leech
- Applied Radiation Therapy Trinity Research Group, Trinity College Dublin, Ireland.
| | - Laure Marignol
- Applied Radiation Therapy Trinity Research Group, Trinity College Dublin, Ireland
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CT-guided 125I brachytherapy in the treatment of distant metastases in the oral cavity and maxillofacial region. Transl Oncol 2016; 10:90-98. [PMID: 27992832 PMCID: PMC5175989 DOI: 10.1016/j.tranon.2016.11.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Revised: 11/28/2016] [Accepted: 11/28/2016] [Indexed: 11/23/2022] Open
Abstract
PURPOSE We aimed to evaluate the feasibility and clinical effectiveness of CT-guided 125I brachytherapy for distant oral and maxillofacial metastases. MATERIALS AND METHODS We retrospectively analyzed 65 patients with 84 distant oral and maxillofacial metastases. Thirty-one patients with 38 lesions received 125I brachytherapy (group A) and 34 with 46 lesions received external beam radiotherapy (EBRT; group B). RESULTS Median follow-up time was 16 months. The 3-, 6-, 12-, 18-, and 24-month local control rates for group A were 83.9%, 75.9%, 66.7%, 38.4%, and 25.0%, respectively; for group B they were 76.5%, 62.5%, 43.8%, 25.0%, and 0.0%, respectively (P<.05); the median local tumor progression-free survival times were 14 and 9 months, respectively. Group A had a better local tumor progression-free survival (LTPFS) relative to group B (P<.001; HR, 6.961 [95%CI, 2.109, 9.356]). Cox proportional hazards regression analysis indicated that 125I brachytherapy, tumor size, and primary pathological type were the independent factors affecting LTPFS. Additionally, 125I brachytherapy showed better performance in relieving patient clinical symptoms relative to EBRT (P<.05). Group A also had fewer complications than group B, especially regarding grade 3/4 complications according to Radiation Therapy Oncology Group grading criteria. Mean overall survival times in groups A and B were 17.1 and 14.8 months, respectively. CONCLUSION CT-guided 125I brachytherapy is feasible and safe for distant oral and maxillofacial metastases; it achieved a better local control rate, longer LTPFS and fewer complications without compromising overall survival compared with EBRT.
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