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Yu S, Ren H, Liu T, Han X, Guo H, Ning Q, Li Y, Zhou H, Chen M, Hu T. Metformin suppresses NFE2L1 pathway activation to inhibit gap junction beta protein expression in NSCLC. Cancer Med 2024; 13:e7021. [PMID: 38562019 PMCID: PMC10985411 DOI: 10.1002/cam4.7021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 01/05/2024] [Accepted: 01/31/2024] [Indexed: 04/04/2024] Open
Abstract
OBJECTIVE Non-small-cell lung cancer (NSCLC) is a deadly form of cancer that exhibits extensive intercellular communication which contributed to chemoradiotherapy resistance. Recent evidence suggests that arrange of key proteins are involved in lung cancer progression, including gap junction proteins (GJPs). METHODS AND RESULTS In this study, we examined the expression patterns of GJPs in NSCLC, uncovering that both gap junction protein, beta 2 (GJB2) and gap junction protein, beta 2 (GJB3) are increased in LUAD and LUSC. We observed a correlation between the upregulation of GJB2, GJB3 in clinical samples and a worse prognosis in patients with NSCLC. By examining the mechanics, we additionally discovered that nuclear factor erythroid-2-related factor 1 (NFE2L1) had the capability to enhance the expression of connexin26 and connexin 31 in the NSCLC cell line A549. In addition, the use of metformin was discovered to cause significant downregulation of gap junction protein, betas (GJBs) by limiting the presence of NFE2L1 in the cytoplasm. CONCLUSION This emphasizes the potential of targeting GJBs as a viable treatment approach for NSCLC patients receiving metformin.
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Affiliation(s)
- Shuo Yu
- Department of Respiratory and Critical Care MedicineThe First Affiliated Hospital of Xi'an Jiaotong UniversityXi'anShaanxiChina
- Department of General SurgeryThe Second Affiliated Hospital of Xi'an Jiaotong UniversityXi'anShaanxiChina
| | - Hui Ren
- Department of Respiratory and Critical Care MedicineThe First Affiliated Hospital of Xi'an Jiaotong UniversityXi'anShaanxiChina
| | - Tingting Liu
- Department of Respiratory and Critical Care MedicineThe First Affiliated Hospital of Xi'an Jiaotong UniversityXi'anShaanxiChina
| | - Xiaoyan Han
- Department of General SurgeryWeifang People's HospitalWeifangShandongChina
| | - Hui Guo
- Department of OncologyThe First Affiliated Hospital of Xi'an Jiaotong UniversityXi'anShaanxiChina
| | - Qian Ning
- Department of Respiratory and Critical Care MedicineThe First Affiliated Hospital of Xi'an Jiaotong UniversityXi'anShaanxiChina
| | - Yang Li
- Department of Respiratory and Critical Care MedicineThe First Affiliated Hospital of Xi'an Jiaotong UniversityXi'anShaanxiChina
| | - Hong Zhou
- Department of Respiratory and Critical Care MedicineThe First Affiliated Hospital of Xi'an Jiaotong UniversityXi'anShaanxiChina
| | - Mingwei Chen
- Department of Respiratory and Critical Care MedicineThe First Affiliated Hospital of Xi'an Jiaotong UniversityXi'anShaanxiChina
| | - Tinghua Hu
- Department of Respiratory and Critical Care MedicineThe First Affiliated Hospital of Xi'an Jiaotong UniversityXi'anShaanxiChina
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Shameem M, Jian Bagherpoor A, Nakhi A, Dosa P, Georg G, Kassie F. Mitochondria-targeted metformin (mitomet) inhibits lung cancer in cellular models and in mice by enhancing the generation of reactive oxygen species. Mol Carcinog 2023; 62:1619-1629. [PMID: 37401866 PMCID: PMC10961008 DOI: 10.1002/mc.23603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 05/04/2023] [Accepted: 06/08/2023] [Indexed: 07/05/2023]
Abstract
Lung cancer is the leading cause of cancer-related mortality in the United States. Although some epidemiological studies have shown an inverse relationship between the use of metformin, a widely used antidiabetic drug, and the incidence of lung cancer, the real benefits of the drug are unclear as the efficacy is low and the outcomes are quite heterogeneous. To develop a more potent form of metformin, we synthesized mitochondria-targeted metformin (mitomet) and tested its efficacy in in vitro and in vivo models of lung cancer. Mitomet was cytotoxic to transformed bronchial cells and several non-small cell lung cancer (NSCLC) cell lines but relatively safe to normal bronchial cells, and these effects were mediated mainly via induction of mitochondrial reactive oxygen species. Studies using isogenic A549 cells showed that mitomet was selectively toxic to those cells deficient in the tumor suppressor gene LKB1, which is widely mutated in NSCLC. Mitomet also significantly reduced the multiplicity and size of lung tumors induced by a tobacco smoke carcinogen in mice. Overall, our findings showed that mitomet, which was about 1000 and 100 times more potent than metformin, in killing NSCLC cells and reducing the multiplicity and size of lung tumors in mice, respectively, is a promising candidate for the chemoprevention and treatment of lung cancer, in particular against LKB1-deficient lung cancers which are known to be highly aggressive.
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Affiliation(s)
- Mohammad Shameem
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN 55455, USA
| | | | - Ali Nakhi
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN 55455, USA
- Department of Medicinal Chemistry, Institute for Therapeutics Discovery and Development, College of Pharmacy, University of Minnesota, Minneapolis, MN, 55455, USA
| | - Peter Dosa
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN 55455, USA
- Department of Medicinal Chemistry, Institute for Therapeutics Discovery and Development, College of Pharmacy, University of Minnesota, Minneapolis, MN, 55455, USA
| | - Gunda Georg
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN 55455, USA
- Department of Medicinal Chemistry, Institute for Therapeutics Discovery and Development, College of Pharmacy, University of Minnesota, Minneapolis, MN, 55455, USA
| | - Fekadu Kassie
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN 55455, USA
- College of Veterinary Medicine, University of Minnesota, Saint Paul, MN 55108, USA
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3
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Wang Y, Hu Y, Wang T, Che G, Li L. Addition of metformin for non-small cell lung cancer patients receiving antineoplastic agents. Front Pharmacol 2023; 14:1123834. [PMID: 36969876 PMCID: PMC10036803 DOI: 10.3389/fphar.2023.1123834] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 02/21/2023] [Indexed: 03/12/2023] Open
Abstract
Background and purpose: Previous studies have found that metformin can inhibit tumor growth and improve outcomes for cancer patients. However, the association between the addition of metformin to the treatment regimen and survival in non-small cell lung cancer (NSCLC) patients receiving antineoplastic agents such as chemotherapy drugs, epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs), and immune checkpoint inhibitors (ICIs) remains unclear. This study aimed to evaluate the effect of metformin in NSCLC patients who received the aforementioned antineoplastic therapies.Methods: Several electronic databases were searched for relevant studies published by 10 September 2022. The primary and secondary outcomes were overall survival (OS) and progression-free survival (PFS); eligible studies were those comparing patients with and without the addition of metformin. Hazard ratios (HRs) and 95% confidence intervals (CIs) were combined, with all statistical analyses performed using STATA 15.0.Results: A total of 19 studies involving 6,419 participants were included, of which six were randomized controlled trials. The overall pooled results indicate that the addition of metformin improved OS (HR = 0.84, 95% CI: 0.71–0.98, p = 0.029) and PFS (HR = 0.85, 95% CI: 0.74–0.99, p = 0.039). However, subgroup analysis based on treatment type and comorbidity of diabetes mellitus demonstrated that improvements in OS and PFS were observed only in diabetic and EGFR-TKI-treated patients (OS: HR = 0.64, 95% CI: 0.45–0.90, p = 0.011; PFS: HR = 0.59, 95% CI: 0.34–1.03, p = 0.061).Conclusion: Overall, this meta-analysis found that metformin use could improve outcomes for diabetic patients receiving EGFR-TKIs. However, no significant association between the addition of metformin and the survival of non-diabetic NSCLC patients receiving chemotherapy or ICI therapy was identified based on the current evidence.
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Affiliation(s)
- Yan Wang
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yuanyuan Hu
- Department of Obstetrics and Gynecology, West China Second University Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Ting Wang
- Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Guowei Che
- Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Guowei Che, ; Lu Li,
| | - Lu Li
- Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Guowei Che, ; Lu Li,
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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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Cargill KR, Hasken WL, Gay CM, Byers LA. Alternative Energy: Breaking Down the Diverse Metabolic Features of Lung Cancers. Front Oncol 2021; 11:757323. [PMID: 34745994 PMCID: PMC8566922 DOI: 10.3389/fonc.2021.757323] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 09/29/2021] [Indexed: 12/24/2022] Open
Abstract
Metabolic reprogramming is a hallmark of cancer initiation, progression, and relapse. From the initial observation that cancer cells preferentially ferment glucose to lactate, termed the Warburg effect, to emerging evidence indicating that metabolic heterogeneity and mitochondrial metabolism are also important for tumor growth, the complex mechanisms driving cancer metabolism remain vastly unknown. These unique shifts in metabolism must be further investigated in order to identify unique therapeutic targets for individuals afflicted by this aggressive disease. Although novel therapies have been developed to target metabolic vulnerabilities in a variety of cancer models, only limited efficacy has been achieved. In particular, lung cancer metabolism has remained relatively understudied and underutilized for the advancement of therapeutic strategies, however recent evidence suggests that lung cancers have unique metabolic preferences of their own. This review aims to provide an overview of essential metabolic mechanisms and potential therapeutic agents in order to increase evidence of targeted metabolic inhibition for the treatment of lung cancer, where novel therapeutics are desperately needed.
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Affiliation(s)
| | | | | | - Lauren A. Byers
- Department of Thoracic/Head and Neck Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, United States
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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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7
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Brancher S, Støer NC, Weiderpass E, Damhuis RAM, Johannesen TB, Botteri E, Strand TE. Metformin use and lung cancer survival: a population-based study in Norway. Br J Cancer 2021; 124:1018-1025. [PMID: 33262518 PMCID: PMC7921644 DOI: 10.1038/s41416-020-01186-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 10/30/2020] [Accepted: 11/05/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND We assessed associations between metformin use and survival in a nationwide Norwegian cohort of lung cancer (LC) patients. METHODS The study linked 22,324 LC patients from the Cancer Registry of Norway diagnosed 2005-2014 with the Norwegian Prescription Database. We estimated associations of pre- and post-diagnostic metformin use with overall survival (OS) and LC-specific survival (LCSS) using multivariable time-fixed and time-dependent Cox regression. RESULTS Pre-diagnostic metformin use was not associated with improved survival in all patients. Nevertheless, pre-diagnostic metformin use was associated with better LCSS in squamous cell carcinoma (SCC) patients (hazard ratio (HR) = 0.79; 95% confidence interval (CI) 0.62-0.99) and in patients with regional stage SCC (HR = 0.67; 95%CI 0.47-0.95). Post-diagnostic metformin use was associated with improved LCSS in all patients (HR = 0.83; 95%CI 0.73-0.95), in patients with SCC (HR = 0.75; 95%CI 0.57-0.98), regional stage LC (HR = 0.74; 95%CI 0.59-0.94), and regional stage SCC (HR = 0.57; 95%CI 0.38-0.86). OS showed similar results. Analyses of cumulative use showed a dose-response relationship in all patients, patients with adenocarcinoma and SCC, and with regional and metastatic LC. CONCLUSIONS Metformin use was associated with improved survival, especially LCSS in patients with regional stage SCC. Further prospective studies are required to clarify the role of metformin in LC treatment.
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MESH Headings
- Adenocarcinoma of Lung/drug therapy
- Adenocarcinoma of Lung/epidemiology
- Adenocarcinoma of Lung/mortality
- Adenocarcinoma of Lung/pathology
- Aged
- Aged, 80 and over
- Carcinoma, Large Cell/drug therapy
- Carcinoma, Large Cell/epidemiology
- Carcinoma, Large Cell/mortality
- Carcinoma, Large Cell/pathology
- Carcinoma, Non-Small-Cell Lung/drug therapy
- Carcinoma, Non-Small-Cell Lung/epidemiology
- Carcinoma, Non-Small-Cell Lung/mortality
- Carcinoma, Non-Small-Cell Lung/pathology
- Carcinoma, Squamous Cell/drug therapy
- Carcinoma, Squamous Cell/epidemiology
- Carcinoma, Squamous Cell/mortality
- Carcinoma, Squamous Cell/pathology
- Combined Modality Therapy
- Female
- Follow-Up Studies
- Humans
- Hypoglycemic Agents/therapeutic use
- Lung Neoplasms/drug therapy
- Lung Neoplasms/epidemiology
- Lung Neoplasms/mortality
- Lung Neoplasms/pathology
- Male
- Metformin/therapeutic use
- Middle Aged
- Norway/epidemiology
- Prognosis
- Small Cell Lung Carcinoma/drug therapy
- Small Cell Lung Carcinoma/epidemiology
- Small Cell Lung Carcinoma/mortality
- Small Cell Lung Carcinoma/pathology
- Survival Rate
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Affiliation(s)
- Suzan Brancher
- Department of Epidemiology, School of Public Health, University of São Paulo, São Paulo, Brazil.
| | - Nathalie C Støer
- Norwegian National Advisory Unit on Women's Health, Women's Clinic, Oslo University Hospital, Oslo, Norway
- Cancer Registry of Norway, Oslo University Hospital, Oslo, Norway
| | - Elisabete Weiderpass
- International Agency for Research on Cancer (IARC), World Health Organization, Lyon, France
| | - Ronald A M Damhuis
- Department of Research, Comprehensive Cancer Organization, Utrecht, The Netherlands
| | - Tom B Johannesen
- Cancer Registry of Norway, Oslo University Hospital, Oslo, Norway
| | - Edoardo Botteri
- Cancer Registry of Norway, Oslo University Hospital, Oslo, Norway
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Kaseda K, Hishida T, Masai K, Asakura K, Hayashi Y, Asamura H. Clinicopathological and prognostic features of operable non-small cell lung cancer patients with diabetes mellitus. J Surg Oncol 2020; 123:332-341. [PMID: 33002203 DOI: 10.1002/jso.26243] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 09/17/2020] [Accepted: 09/19/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND The aim of this study was to investigate the clinicopathological and prognostic features of operable non-small cell lung cancer (NSCLC) patients with diabetes mellitus (DM). METHODS A total of 1231 surgically resected NSCLC patients were retrospectively reviewed. Clinicopathological characteristics were compared between patients with DM (DM group, n = 139) and those without DM (non-DM group, n = 1092). The clinical factors associated with postoperative complications and prognostic factors were identified. RESULTS The DM group had distinct clinicopathological features. No significant differences in histological invasiveness or stage were found. The presence and control status of DM were independent predictors of postoperative complications. No significant differences in recurrence-free survival or cancer-specific survival were observed; however, the DM group had worse overall survival (OS). The DM group had a higher number of deaths from other diseases than the non-DM group, and these patients had significantly higher postoperative hemoglobin A1c levels than patients with cancer-related death. CONCLUSION The presence and control status of preoperative DM are useful predictors of both postoperative complications and OS in operable NSCLC patients. Concomitant diabetes-related complications have a negative effect on long-term survival in diabetic NSCLC patients, and long-term glycemic control is important to prolong OS.
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Affiliation(s)
- Kaoru Kaseda
- Division of Thoracic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Tomoyuki Hishida
- Division of Thoracic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Kyohei Masai
- Division of Thoracic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Keisuke Asakura
- Division of Thoracic Surgery, Keio University School of Medicine, Tokyo, Japan
| | | | - Hisao Asamura
- Division of Thoracic Surgery, Keio University School of Medicine, Tokyo, Japan
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Xiao K, Liu F, Liu J, Xu J, Wu Q, Li X. The effect of metformin on lung cancer risk and survival in patients with type 2 diabetes mellitus: A meta-analysis. J Clin Pharm Ther 2020; 45:783-792. [PMID: 32406122 DOI: 10.1111/jcpt.13167] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 04/17/2020] [Accepted: 04/18/2020] [Indexed: 12/13/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Metformin has received increasing attention owing to its potential protective effect against cancer. We aimed to summarize evidence regarding the association between metformin and the risk or survival in lung cancer patients with type 2 diabetes. METHODS We selected observational studies examining the association between exposure to metformin and the risk or survival in lung cancer. Available publications were searched in PubMed, Cochrane Library, ScienceDirect, Wiley and SpringerLink databases. Meta-analysis was performed with hazard ratios (HRs) and 95% confidence intervals (95% CIs) as effect measures for risk or survival in lung cancer. RESULTS Eighteen studies (eight on lung cancer risk and ten on lung cancer survival) were included. Metformin treatment was associated with decreased lung cancer incidence (HR 0.78; 95% CI 0.70-0.86) and increased lung cancer survival (HR 0.65; 95% CI 0.55-0.77). In the subgroup analysis by ethnicity, a significant protective effect of metformin use on lung cancer risk was observed among Asian patients (HR 0.66; 95% CI 0.56-0.76), but not in European patients. On the other hand, the protective effect of metformin use on lung cancer survival was observed in both Asian (HR 0.57; 95% CI 0.49-0.66) and non-Asian (HR 0.79; 95% CI 0.71-0.88) patients. In the subgroup analysis by histology, a protective effect of metformin on lung cancer survival was observed in both non-small-cell lung cancer (HR 0.68; 95% CI 0.54-0.84) and small-cell lung cancer (HR 0.52; 95% CI 0.39-0.69). Funnel plot showed that no significant publication bias existed. CONCLUSIONS Our findings demonstrate that metformin is significantly associated with a decreased risk and increased survival in lung cancer.
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Affiliation(s)
- Kang Xiao
- Department of Clinical Pharmacy, The First Affiliated Hospital of Shandong First Medical University, Shandong First Medical University, Jinan, China.,Department of Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Fengxi Liu
- Department of Clinical Pharmacy, The First Affiliated Hospital of Shandong First Medical University, Shandong First Medical University, Jinan, China.,Department of Clinical pharmacy, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
| | - Juan Liu
- Department of Clinical Pharmacy, The First Affiliated Hospital of Shandong First Medical University, Shandong First Medical University, Jinan, China
| | - Jiwei Xu
- Department of Clinical Pharmacy, The First Affiliated Hospital of Shandong First Medical University, Shandong First Medical University, Jinan, China
| | - Qiuyun Wu
- Department of Clinical Pharmacy, The First Affiliated Hospital of Shandong First Medical University, Shandong First Medical University, Jinan, China
| | - Xiao Li
- Department of Clinical Pharmacy, The First Affiliated Hospital of Shandong First Medical University, Shandong First Medical University, Jinan, China.,Department of Clinical pharmacy, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
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A Cohort Study of Exposure to Antihyperglycemic Therapy and Survival in Patients with Lung Cancer. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17051747. [PMID: 32156062 PMCID: PMC7084663 DOI: 10.3390/ijerph17051747] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 03/03/2020] [Accepted: 03/04/2020] [Indexed: 12/24/2022]
Abstract
We evaluated the effect of antihyperglycemic therapy on the survival of patients with lung cancer (LC). The analysis included patients with LC and concomitant type 2 diabetes. 15,929 patients were classified into five groups: metformin users, insulin users, metformin and insulin users, sulphonylurea users and non-diabetic group. A multivariate analysis showed that exposure to either metformin or to insulin was associated with a lower risk of LC-specific mortality, and this approached statistical significance (HR 0.82, 95% CI 0.72–92 for metformin and HR 0.65, 95% CI 0.44–95 for insulin). When deaths from all causes were considered, only metformin exposure was associated with a significantly lower risk of death (HR 0.82, 95% CI 0.73–0.92). Users of sulphonylurea were at a higher risk of LC-specific and overall mortality (HRs 1.19, 95% CI 0.99–1.43 and 1.22, 95% CI 1.03–1.45). Our study shows a positive effect of metformin on the survival of patients with LC. Moreover, our results show that exposure to insulin was associated with a lower risk of LC-specific mortality, but not with deaths from all causes. The study results suggested that users of sulphonylurea may be at a higher risk of LC-specific and overall mortality.
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11
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Bi G, Yao G, Bian Y, Xue L, Zhang Y, Lu T, Fan H. The Effect of Diabetes Mellitus on Prognosis of Patients with Non-Small-Cell Lung Cancer: A Systematic Review and Meta-Analysis. Ann Thorac Cardiovasc Surg 2019; 26:1-12. [PMID: 31588071 PMCID: PMC7046927 DOI: 10.5761/atcs.ra.19-00170] [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] [Indexed: 12/24/2022] Open
Abstract
Purpose: To quantitatively evaluate the effect of preexisting diabetes mellitus (DM) on the outcomes of patients with non-small-cell lung cancer (NSCLC). Materials and Methods: Observational studies comparing the prognosis of NSCLC patients with and without diabetes were identified from PubMed, EMBASE, and The Cochrane Central Register of Controlled Trials (CENTRAL). We searched for studies that published in English from inception to March 30, 2019, using search terms related to diabetes and NSCLC. Pooled hazard ratio (HR) and 95% confidence interval (CI) were calculated by a random-effect model and subgroup analyses were performed. Results: In all, 17 of 1475 identified studies were finally included in the meta-analysis. The result revealed that preexisting diabetes had a significantly negative impact on the overall survival (OS) of patients with NSCLC (HR: 1.31, 95% CI: 1.12–1.54), especially in patients undergoing surgical treatment (HR: 1.46, 95% CI: 1.02–2.09) in comparison with those receiving only non-surgical treatment (HR: 1.33, 95% CI: 0.87–2.03). In addition, preexisting diabetes was more likely to be associated with a worse prognosis among Asian NSCLC patients than Western patients. Sensitivity analysis indicated that the main result was robust, and no evidence of publication bias was found. Conclusion: Preexisting DM has a negative impact on diabetic NSCLC patients’ prognosis.
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Affiliation(s)
- Guoshu Bi
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Guangyu Yao
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yunyi Bian
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Liang Xue
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yi Zhang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Tao Lu
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Hong Fan
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
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12
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Roos JF, Qudsi M, Samara A, Rahim MM, Al-Bayedh SA, Ahmed H. Metformin for lung cancer prevention and improved survival: a novel approach. Eur J Cancer Prev 2019; 28:311-315. [PMID: 29481337 DOI: 10.1097/cej.0000000000000442] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Diabetes mellitus has been associated with increased risk for the development of many types of cancer. Metformin, an oral medication and first-line treatment for type 2 diabetes mellitus, has been suggested to reduce cancer risk and mortality in various types of cancer. This study focuses on assessing metformin association with lung cancer as reported in the literature. Recent studies and reviews investigating metformin effects on lung cancer incidence and patient survival are critically and systematically discussed.
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Affiliation(s)
- Juliana F Roos
- Department of Clinical Pharmacy and Pharmacy Practice, Dubai Pharmacy College
| | - Mariam Qudsi
- Department of Clinical Pharmacy and Pharmacy Practice, Dubai Pharmacy College
| | - Arwa Samara
- Department of Clinical Pharmacy and Pharmacy Practice, Dubai Pharmacy College
| | - Madina M Rahim
- Department of Clinical Pharmacy and Pharmacy Practice, Dubai Pharmacy College
| | - Samar A Al-Bayedh
- Department of Clinical Pharmacy and Pharmacy Practice, Dubai Pharmacy College
| | - Hafez Ahmed
- Department of Biochemistry, Dubai Medical College, Dubai, United Arab Emirates
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13
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Zeng S, Gan HX, Xu JX, Liu JY. Metformin improves survival in lung cancer patients with type 2 diabetes mellitus: A meta-analysis. Med Clin (Barc) 2019; 152:291-297. [DOI: 10.1016/j.medcli.2018.06.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 06/16/2018] [Accepted: 06/21/2018] [Indexed: 12/14/2022]
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14
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Deng HY, Zheng X, Zha P, Peng L, Huang KL, Qiu XM. Diabetes mellitus and survival of non-small cell lung cancer patients after surgery: A comprehensive systematic review and meta-analysis. Thorac Cancer 2019; 10:571-578. [PMID: 30706684 PMCID: PMC6397907 DOI: 10.1111/1759-7714.12985] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 01/01/2019] [Accepted: 01/02/2019] [Indexed: 02/05/2023] Open
Abstract
Background Diabetes mellitus (DM) is one of the most common comorbidities in surgically treated non‐small cell lung cancer (NSCLC) patients and has a negative impact on short‐term outcomes. However, the impact of DM on long‐term survival of such patients remains controversial; therefore, we conducted a comprehensive updated meta‐analysis. Methods We systematically searched relevant studies in PubMed, Embase, Cochrane Library, and Web of Science up to 6 September 2018. Hazard ratios (HRs) for the impact of DM on overall survival (OS) and recurrence‐free survival (RFS) of patients with surgically treated NSCLC were extracted and analyzed using the STATA 12.0 package. Results We included 13 cohort studies consisting of 4343 patients (730 patients with DM and 3613 patients without) with surgically treated NSCLC. Meta‐analysis showed that patients with DM had significantly poorer OS (random effects: HR 1.30, 95% confidence interval 1.05–1.60; P = 0.016) than those without. However, with a limited sample size, there was no significant difference in RFS (random effects: HR 1.06, 95% confidence interval 0.71–1.58; P = 0.786) between patients with and without DM after surgical resection of NSCLC. Conclusion DM is an independent unfavorable prognostic factor for patients with surgically treated NSCLC. High‐quality studies with appropriate adjustment for confounding factors are needed to confirm our conclusions.
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Affiliation(s)
- Han-Yu Deng
- Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, China.,Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Xi Zheng
- Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Panpan Zha
- Department of Endocrinology, West China Hospital, Sichuan University, Chengdu, China
| | - Lei Peng
- Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Kai-Li Huang
- Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Xiao-Ming Qiu
- Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, China
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15
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Wen-Xiu X, Xiao-Wei Z, Hai-Ying D, Ying-Hui T, Si-Si K, Xiao-Fang Z, Huang P. Impact of metformin use on survival outcomes in non-small cell lung cancer treated with platinum. Medicine (Baltimore) 2018; 97:e13652. [PMID: 30572481 PMCID: PMC6320173 DOI: 10.1097/md.0000000000013652] [Citation(s) in RCA: 6] [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: 12/20/2022] Open
Abstract
Preclinical evidence suggests that metformin, a widely used antidiabetic drug, may have a sensitizing effect on platinum. The purpose of this study was to evaluate the survival outcomes for non-small cell lung cancer (NSCLC) patients with type 2 diabetes mellitus (T2DM) using metformin during platinum-based chemotherapy.The clinicopathological parameters and survival data of 75 NSCLC patients with T2DM from January 2008 to December 2011 were collected and analyzed retrospectively. Patients were divided into 2 groups: metformin exposure group (n = 27) and non-metformin group (patients using other hypoglycemic agents or no drug for controlling n = 48). Univariate and multivariate analyses were performed to assess the association of metformin usage with overall survival (OS).Mean follow-up time was 58.7 months. The mean survival time was 36.74 months in the metformin group and 40.21 months in the non-metformin group. There was no significant difference in survival time between the 2 groups (P = .661). After adjusting gender, age, smoking status, tumor stage, tumor histology, and differentiation, multivariate analysis showed that metformin was not associated with the OS in NSCLC patients treated with concurrent platinum-based chemotherapy (hazard ratio: 1.071, 95% confidence interval: 0.577-1.986, P = .828).Our results indicated that metformin exposure had no significant effect on OS in NSCLC patients treated with platinum-based chemotherapy. Further studies are warranted to evaluate whether metformin could affect the survival of NSCLC patients treated with platinum-based chemotherapy.
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Affiliation(s)
- Xin Wen-Xiu
- Laboratory of Clinical Pharmacy
- Key Laboratory of Head and Neck Translational Research of Zhejiang Province Zhejiang Cancer Hospital, Hangzhou, P.R. China
| | | | | | | | | | | | - Ping Huang
- Laboratory of Clinical Pharmacy
- Key Laboratory of Head and Neck Translational Research of Zhejiang Province Zhejiang Cancer Hospital, Hangzhou, P.R. China
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16
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Wang Y, Meng Y, Zhang S, Wu H, Yang D, Nie C, Hu Q. Phenformin and metformin inhibit growth and migration of LN229 glioma cells in vitro and in vivo. Onco Targets Ther 2018; 11:6039-6048. [PMID: 30275708 PMCID: PMC6157995 DOI: 10.2147/ott.s168981] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background Malignant glioma is refractory to conventional treatment, highlighting a need to develop novel efficacious therapies. Biguanides, a class of oral antidiabetic drug, have been thought to inhibit proliferation and metastasis in a variety of cancers. Purpose The objective of this study was to investigate the affections of biguanides, phenformin (Phen) and metformin (Met), on growth and migration of glioma cells LN229 in vitro and in vivo. Methods Glioma cells LN229 were treated with Phen or Met, then cell proliferation and death were evaluated by MTT assay and PI stain, and cell cycle were evaluated using flow cytometric analysis, meantime wound healing assay and transwell migration assay were performed to detect cell migration ability. In addition, LN229 were injected in thigh of nude mice, and the mice were treated with Phen or Met to detect the effect of Phen and Met in vivo. Results Phen and Met could significantly inhibit cell growth through inhibiting cell proliferation, promoting cell death and disturbing cell cycle, and these drugs also could inhibit cell colony formation in glioma cells LN229 in vitro. Meanwhile, both Phen and Met could significantly inhibit cell migration of LN229 in vitro, through effecting the expression of E-cadherin and Vimentin. In addition, both Phen and Met inhibited the growth and migration of LN229 in a tumor xenograft model. Furthermore, Phen and Met were associated with the increased level of ROS of cell mitochondrial, and ROS inhibitor NAC could significantly rescue the cell death induced by Phen and Met. Conclusion Phen and Met displayed powerful antitumor effects of LN229, and our findings powerfully suggest the possibility of Phen and Met being used as an adjuvant agent in the treatment of glioma patients.
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Affiliation(s)
- Yanmin Wang
- Department of Cerebral Surgery, Tianjin Beichen Hospital, Tianjin 300000, People's Republic of China,
| | - Yanli Meng
- Library, Tianjin Medical University, Tianjin 300000, People's Republic of China
| | - Shijun Zhang
- Department of Cerebral Surgery, Tianjin Beichen Hospital, Tianjin 300000, People's Republic of China,
| | - Huancheng Wu
- Department of Cerebral Surgery, Tianjin Beichen Hospital, Tianjin 300000, People's Republic of China,
| | - Dawei Yang
- Department of Cerebral Surgery, Tianjin Beichen Hospital, Tianjin 300000, People's Republic of China,
| | - Chaohui Nie
- Department of Cerebral Surgery, Tianjin Beichen Hospital, Tianjin 300000, People's Republic of China,
| | - Qunliang Hu
- Department of Cerebral Surgery, Tianjin Beichen Hospital, Tianjin 300000, People's Republic of China,
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Maniar K, Singh V, Moideen A, Bhattacharyya R, Chakrabarti A, Banerjee D. Inhalational supplementation of metformin butyrate: A strategy for prevention and cure of various pulmonary disorders. Biomed Pharmacother 2018; 107:495-506. [PMID: 30114633 DOI: 10.1016/j.biopha.2018.08.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 07/22/2018] [Accepted: 08/06/2018] [Indexed: 12/27/2022] Open
Abstract
The management of chronic lung diseases such as cancer, asthma, COPD and pulmonary hypertension remains unsatisfactory till date, and several strategies are being tried to control the same. Metformin, a popular anti-diabetic drug has shown promising effects in pre-clinical studies and has been subject to several trials in patients with debilitating pulmonary diseases. However, the clinical evidence for the use of metformin in these conditions is disappointing. Recent observations suggest that metformin use in diabetic patients is associated with an increase in butyrate-producing bacteria in the gut microbiome. Butyrate, similar to metformin, shows beneficial effects in pathological conditions found in pulmonary diseases. Further, the pharmacokinetic data of metformin suggests that metformin is predominantly concentrated in the gut, even after absorption. Butyrate, on the other hand, has a short half-life and thus oral supplementation of butyrate and metformin is unlikely to result in high concentrations of these drugs in the lung. In this paper, we review the pre-clinical studies of metformin and butyrate pertaining to pathologies commonly encountered in chronic lung diseases and underscore the need to administer these drugs directly to the lung via the inhalational route.
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Affiliation(s)
- Kunal Maniar
- Department of Pharmacology, Postgraduate Institute of Medical Education and Research, India
| | - Vandana Singh
- Department of Experimental Medicine and Biotechnology, Postgraduate Institute of Medical Education and Research, India
| | - Amal Moideen
- Department of Pharmacology, Postgraduate Institute of Medical Education and Research, India
| | - Rajasri Bhattacharyya
- Department of Experimental Medicine and Biotechnology, Postgraduate Institute of Medical Education and Research, India
| | - Amitava Chakrabarti
- Department of Pharmacology, Postgraduate Institute of Medical Education and Research, India
| | - Dibyajyoti Banerjee
- Department of Pharmacology, Postgraduate Institute of Medical Education and Research, India.
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18
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Wang Y, Wu Z, Hu L. The regulatory effects of metformin on the [SNAIL/miR-34]:[ZEB/miR-200] system in the epithelial-mesenchymal transition(EMT) for colorectal cancer(CRC). Eur J Pharmacol 2018; 834:45-53. [PMID: 30017802 DOI: 10.1016/j.ejphar.2018.07.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 06/22/2018] [Accepted: 07/09/2018] [Indexed: 01/26/2023]
Abstract
The epithelial-mesenchymal transition (EMT) plays a critical role in cancer progression, metastasis and drug resistance. The transcription factor(TF) and microRNA (miR) chimeric [SNAIL/miR-34]:[ZEB/miR-200] unit is the core regulatory system for the EMT process. Here, we proposed to assess the anti-EMT abilities and explore the inherent pharmacological mechanisms of the classic hypoglycaemic agent metformin for colorectal cancer(CRC). For the EMT model, the TGF-β-induced CRC cell lines SW480 and HCT116 were treated with metformin. The viability, migration and invasion abilities of the cells were evaluated with the Cell Counting Kit-8, wound-healing and trans-well assay. The alterations of the [SNAIL/miR-34]:[ZEB/miR-200] system and the EMT markers E-cadherin and vimentin were detected by western blot, qPCR and immunofluorescent staining. Metformin exhibited inhibitory effects on the proliferation, migration and invasion of the CRC SW480 cells. The up-regulation of E-cadherin and the down-regulation of vimentin for both SW480 and HCT116 cells revealed the anti-EMT abilities of metformin. For the [SNAIL/miR-34]:[ZEB/miR-200] system, metformin increased miR-200a, miR-200c and miR-429 levels and decreased miR-34a, SNAIL1 and ZEB1 levels in the TGF-β-induced EMT. From immunofluorescence, we observed increased E-cadherin and ZEB1 co-expression in metformin-treated cells. Metformin may perform bidirectional regulations of the [SNAIL/miR-34]:[ZEB/miR-200] system in the EMT process for colorectal cancer. Such regulation is expressed as the inhibition of EMT in general as well as an increased higher proportion of E/M hybrid cells in the total population.
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Affiliation(s)
- Yaodu Wang
- Cancer Center, Shandong University Qilu Hospital, West Wenhua Road 107, Jinan 250012, Shandong Province, PR China
| | - Zhiyang Wu
- Intensive Care Unit, Shandong University Qilu Hospital(Qingdao), Hefei Road 758, Qingdao 266035, Shandong Province, PR China
| | - Likuan Hu
- Cancer Center, Shandong University Qilu Hospital, West Wenhua Road 107, Jinan 250012, Shandong Province, PR China.
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Zhong S, Wu Y, Yan X, Tang J, Zhao J. Metformin use and survival of lung cancer patients: Meta-analysis findings. Indian J Cancer 2018; 54:63-67. [PMID: 29199666 DOI: 10.4103/0019-509x.219582] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Previous studies on the association between metformin use and lung cancer survival have yielded mixed results. We aimed to perform a metaanalysis to assess the association with all available studies. Relevant studies were identified by searching PubMed and EMBASE to July 2016. We calculated the summary hazard ratios (HRs) and 95% confidence intervals (CIs) using randomeffects models. Twelve cohort studies involving 124,533 participants were included in this study. The results showed that metformin use was not associated with the overall survival of lung cancer patients (HR = 0.79, 95% CI: 0.62-1.02). In the subgroup analyses by country or subtype of lung cancer, although a beneficial effect of metformin use on overall survival was found in patients with smallcell lung cancer or in lung patients from China, it may be inappropriate draw a final conclusion considering small sample size, low study quality, and the limited number of studies in the subgroups. Further analyses found that metformin use after diagnosis showed a beneficial effect on both over survival (HR = 0.79, 95% CI: 0.72-0.87) and progressionfree survival (PFS; HR = 0.62, 95% CI: 0.39-0.96) of lung cancer patients. In conclusion, metformin use after diagnosis is associated with improved overall survival and PFS of lung cancer patients. Nevertheless, this effect of metformin use is needed for further assessment.
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Affiliation(s)
- S Zhong
- Center of Clinical Laboratory Science, Jiangsu Cancer Hospital Affiliated to Nanjing Medical University, Nanjing 210009, China
| | - Y Wu
- Department of Rheumatology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - X Yan
- Institute of Laboratory Medicine, Jinling Hospital of Nanjing University, Nanjing 210002, China
| | - J Tang
- Department of General Surgery, Jiangsu Cancer Hospital Affiliated to Nanjing Medical University, Nanjing 210009, China
| | - J Zhao
- Center of Clinical Laboratory Science, Jiangsu Cancer Hospital Affiliated to Nanjing Medical University, Nanjing 210009, China
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Xin WX, Fang L, Fang QL, Zheng XW, Ding HY, Huang P. Effect of hypoglycemic agents on survival outcomes of lung cancer patients with diabetes mellitus: A meta-analysis. Medicine (Baltimore) 2018; 97:e0035. [PMID: 29489653 PMCID: PMC5851744 DOI: 10.1097/md.0000000000010035] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND To assess the association between hypoglycemic agents and prognosis of lung cancer patients with diabetes. METHODS A comprehensive literature search was performed in PubMed, Web of Science, Embase, and Cochrane Library until May 2017. The search yielded 2593 unique citations, of which 18 articles met inclusion criteria. The hazard ratios (HRs) and 95% confidence intervals (95% CIs) were calculated by a fixed-effects or random-effects model. RESULTS The pooled HRs favoring metformin users were 0.77 for overall survival (OS) (n = 15, 95% CI: 0.68-0.86) and 0.50 for disease-free survival (n = 5, 95% CI: 0.39-0.64). One study assessed the relationship between metformin and cancer-specific survival (CSS), reporting no significant results. No significant association between insulin and OS (n = 2, HR: 0.95, 95% CI: 0.79-1.13) or CSS (n = 2, HR: 1.03, 95% CI: 0.76-1.41) was noted. One study evaluated association of sulfonylureas with lung cancer survival and reported no clinical benefit (HR: 1.10, 95% CI: 0.87-1.40). One study reported no association of thiazolidinediones with lung cancer survival (HR: 1.04, 95% CI: 0.65-1.66). CONCLUSIONS This meta-analysis demonstrated that metformin exposure might improve survival outcomes in lung cancer patients with diabetes.
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Affiliation(s)
- Wen-Xiu Xin
- Laboratory of Clinical Pharmacy
- Key Laboratory of Head and Neck Translational Research of Zhejiang Province
| | - Luo Fang
- Zhejiang Key Laboratory of Diagnosis and Treatment Technology on Thoracic Oncology (Lung and Esophagus), Zhejiang Cancer Hospital, Hangzhou, P.R. China
| | | | | | | | - Ping Huang
- Laboratory of Clinical Pharmacy
- Key Laboratory of Head and Neck Translational Research of Zhejiang Province
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Yu WS, Lee CY, Park SY, Suh JW, Narm KS, Kim DJ, Chung KY, Lee JG. Prognostic factors for resected non-small cell lung cancer in patients with type 2 diabetes mellitus. J Surg Oncol 2018; 117:985-993. [PMID: 29409112 DOI: 10.1002/jso.24989] [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: 09/19/2017] [Accepted: 12/20/2017] [Indexed: 11/09/2022]
Abstract
BACKGROUND For diabetic patients with lung cancer, blood glucose levels and medications such as metformin and statins may influence survival. OBJECTIVES This study aimed to determine prognostic survival factors for diabetic patients with resected non-small cell lung cancer. PATIENTS AND METHODS Between January 2005 and December 2013, 301 patients with type 2 diabetes mellitus who underwent curative resection for non-small cell lung cancer were identified and reviewed retrospectively. RESULTS The median follow-up period was 48 months. In multivariate analysis for lung cancer-specific survival, older age, forced expiratory volume in 1 s (FEV1) <80% predicted, and advanced pathologic stage were significant negative prognostic factors; statin use was a positive prognostic factor (hazard ratio (HR), 0.468). In multivariate analysis for overall survival, male sex, older age, comorbidity index, and advanced pathologic stage were significant negative prognostic factors and proper glycemic control (HR, 0.621) and statin use (HR, 0.585) were positive prognostic factors. CONCLUSIONS Proper glycemic control (glycated hemoglobin A1c <7%) is recommended for diabetic patients undergoing lung cancer operations. Further studies are required to elucidate associations between type 2 diabetes mellitus and antineoplastic effects of statins and to evaluate statins as a novel adjuvant treatment for lung cancer.
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Affiliation(s)
- Woo Sik Yu
- Department of Medicine, The Graduate School of Yonsei University, Seoul, Republic of Korea.,Department of Thoracic Surgery, Armed Forces Capital Hospital, Seongnam-si, Gyunggi-do, Republic of Korea
| | - Chang Young Lee
- Department of Thoracic and Cardiovascular Surgery, College of Medicine, Yonsei University, Seoul, Republic of Korea
| | - Seong Yong Park
- Department of Thoracic and Cardiovascular Surgery, College of Medicine, Yonsei University, Seoul, Republic of Korea
| | - Jee Won Suh
- Department of Thoracic and Cardiovascular Surgery, College of Medicine, Yonsei University, Seoul, Republic of Korea
| | - Kyoung Shik Narm
- Department of Thoracic and Cardiovascular Surgery, College of Medicine, Yonsei University, Seoul, Republic of Korea
| | - Dae Joon Kim
- Department of Thoracic and Cardiovascular Surgery, College of Medicine, Yonsei University, Seoul, Republic of Korea
| | - Kyung Young Chung
- Department of Thoracic and Cardiovascular Surgery, College of Medicine, Yonsei University, Seoul, Republic of Korea
| | - Jin Gu Lee
- Department of Thoracic and Cardiovascular Surgery, College of Medicine, Yonsei University, Seoul, Republic of Korea
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Cao X, Wen ZS, Wang XD, Li Y, Liu KY, Wang X. The Clinical Effect of Metformin on the Survival of Lung Cancer Patients with Diabetes: A Comprehensive Systematic Review and Meta-analysis of Retrospective Studies. J Cancer 2017; 8:2532-2541. [PMID: 28900491 PMCID: PMC5595083 DOI: 10.7150/jca.19750] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 05/30/2017] [Indexed: 01/06/2023] Open
Abstract
Preclinical investigations have revealed an anti-cancer effect of metformin. Several studies of metformin treatment have demonstrated the improved clinical outcomes of lung cancer patients with diabetes; however, the results have been inconsistent among studies. Our systematic review and meta-analysis aimed to summarize the up-to-date effects of metformin on diabetic lung cancer patients. A systematic search was performed for studies published. Then, these studies were evaluated for inclusion, and relevant data was extracted. The summary risk estimates for the associations of metformin treatment with overall survival (OS) and progression-free survival (PFS) were analyzed using random/fixed-effects models. Analyses stratified by histological type were also conducted. Based on the 10 studies included in our analysis, metformin treatment was found to significantly improve survival, corresponding to reductions of 23% and 47% in OS [hazard ratio (HR)=0.77, 95% confidence interval (95%CI)=0.66-0.9, p=0.001] and PFS (HR=0.53, 95%CI=0.41-0.68, p<0.001), respectively. In addition, significant improvements in the OS for non-small cell lung cancer (NSCLC) (HR=0.77, 95%CI=0.71-0.84, p=0.002) and small cell lung cancer (SCLC) (HR=0.52, 95%CI=0.29-0.91, p=0.022) were observed in association with metformin treatment in analysis stratified by histological type. This stratified analysis also revealed a significant improvement in PFS for both NSCLC (HR=0.53, 95%CI=0.39-0.71, p<0.001) and SCLC (HR=0.54, 95%CI=0.34-0.84, p=0.007). We found that metformin treatment significantly improved the OS and PFS of diabetic lung cancer patients, and our findings suggest that metformin might be an effective treatment option for diabetic patients with lung cancer.
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Affiliation(s)
- Xun Cao
- Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, Guangdong, China
| | - Zhe-Sheng Wen
- Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, Guangdong, China
- Department of Thoracic Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, China
| | - Xu-Dong Wang
- Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, Guangdong, China
| | - Yong Li
- Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, Guangdong, China
| | - Kui-Yuan Liu
- Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, Guangdong, China
- Department of Thoracic Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, China
| | - Xin Wang
- Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, Guangdong, China
- Department of Thoracic Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, China
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Menter AR, Carroll NM, Sakoda LC, Delate T, Hornbrook MC, Jain RK, Kushi LH, Quinn VP, Ritzwoller DP. Effect of Angiotensin System Inhibitors on Survival in Patients Receiving Chemotherapy for Advanced Non-Small-Cell Lung Cancer. Clin Lung Cancer 2016; 18:189-197.e3. [PMID: 27637408 DOI: 10.1016/j.cllc.2016.07.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 07/19/2016] [Accepted: 07/29/2016] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Preclinical studies suggest that angiotensin system inhibitors (ASI) and bevacizumab improve tumor perfusion and chemotherapy efficacy. We performed a retrospective study to examine whether concomitant ASI use during carboplatin and paclitaxel (CP) without or with bevacizumab (CPB) was associated with improved overall survival (OS) in patients with advanced nonsquamous, non-small-cell lung cancer (NS-NSCLC). PATIENTS AND METHODS In a retrospective cohort study, adult patients diagnosed with stage IIIB or IV NS-NSCLC between 2005 and 2011 were identified from tumor registries at 1 of 4 Kaiser Permanente regions. Survival differences between those who did and did not receive ASIs concomitant with chemotherapy (CP or CPB) were assessed using propensity score-matched proportional hazard models. OS was measured from the initiation of chemotherapy until death, disenrollment, or December 31, 2012. RESULTS Of the 1465 CP and 348 CPB patients included, 273 (19%) and 78 (22%), respectively, received concomitant ASI. For CP patients with and without concomitant ASI exposure, median OS was 12.0 and 8.4 months, respectively (crude hazard ratio [HR], 0.72; 95% confidence interval [CI], 0.63-0.84). For CPB patients, the comparable median OS was 14.9 and 11.9 months, respectively (crude HR, 0.77; 95% CI, 0.57-1.02). Using propensity score-matched cohorts, the HR for concomitant ASI use was 0.73 (95% CI, 0.61-0.88) for CP patients and 0.79 (95% CI, 0.51-1.21) for CPB patients. CONCLUSION Concomitant ASI receipt during CP or CPB therapy for NS-NSCLC was associated with improved survival, although the association was only statistically significant in the CP group.
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Affiliation(s)
- Alex R Menter
- Oncology Department, Kaiser Permanente Colorado, Lone Tree, CO.
| | - Nikki M Carroll
- Institute for Health Research, Kaiser Permanente Colorado, Denver, CO
| | - Lori C Sakoda
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Thomas Delate
- Pharmacy Department, Kaiser Permanente Colorado, Aurora, CO
| | - Mark C Hornbrook
- The Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | - Rakesh K Jain
- Edwin L. Steele Laboratory, Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Lawrence H Kushi
- Division of Research, Kaiser Permanente Northern California, Oakland, CA; Division of Hematology and Oncology, Department of Internal Medicine, University of California Davis School of Medicine, Sacramento, CA
| | - Virginia P Quinn
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
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24
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Kim S. Role of metformin in lung cancer treatment and prevention: Are we any closer to the answer? J Thorac Cardiovasc Surg 2016; 152:62-3. [DOI: 10.1016/j.jtcvs.2016.03.072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Accepted: 03/30/2016] [Indexed: 01/22/2023]
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25
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Zhang J, Luo Y, Zhao X, Li X, Li K, Chen D, Qiao M, Hu H, Zhao X. Co-delivery of doxorubicin and the traditional Chinese medicine quercetin using biotin–PEG2000–DSPE modified liposomes for the treatment of multidrug resistant breast cancer. RSC Adv 2016. [DOI: 10.1039/c6ra24173e] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
At present, multidrug resistance (MDR) in cancer therapy is an international problem, which is caused mostly by the overexpressed P-glycoprotein (P-gp) efflux pump.
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Affiliation(s)
- Jiulong Zhang
- Department of Traditional Chinese Materia Medica
- Shenyang Pharmaceutical University
- Shenyang
- P. R. China
| | - Yue Luo
- Department of Pharmaceutics
- Shenyang Pharmaceutical University
- Shenyang
- P. R. China
| | - Xiufeng Zhao
- Department of Pharmaceutics
- Shenyang Pharmaceutical University
- Shenyang
- P. R. China
| | - Xiaowei Li
- Department of Pharmaceutics
- Shenyang Pharmaceutical University
- Shenyang
- P. R. China
| | - Kexin Li
- Department of Pharmaceutics
- Shenyang Pharmaceutical University
- Shenyang
- P. R. China
| | - Dawei Chen
- Department of Pharmaceutics
- Shenyang Pharmaceutical University
- Shenyang
- P. R. China
| | - Mingxi Qiao
- Department of Pharmaceutics
- Shenyang Pharmaceutical University
- Shenyang
- P. R. China
| | - Haiyang Hu
- Department of Pharmaceutics
- Shenyang Pharmaceutical University
- Shenyang
- P. R. China
| | - Xiuli Zhao
- Department of Pharmaceutics
- Shenyang Pharmaceutical University
- Shenyang
- P. R. China
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26
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Rusch VW. Perioperative pharmacotherapy for lung resection: "Going for the gold"? J Thorac Cardiovasc Surg 2015; 151:18-9. [PMID: 26519242 DOI: 10.1016/j.jtcvs.2015.09.092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 09/23/2015] [Indexed: 11/17/2022]
Affiliation(s)
- Valerie W Rusch
- Department of Surgery, Thoracic Service, Memorial Sloan-Kettering Cancer Center, New York, NY.
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