Metformin and Pathologic Complete Responses to Neoadjuvant Chemotherapy in Diabetic Patients With Breast Cancer
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- 10 July 2009
- journal article
- research article
- Published by American Society of Clinical Oncology (ASCO) in Journal of Clinical Oncology
- Vol. 27 (20), 3297-3302
- https://doi.org/10.1200/jco.2009.19.6410
Abstract
Purpose: Population studies have suggested that metformin use in diabetic patients decreases cancer incidence and mortality. Metformin inhibits the growth of cancer cells in vitro and tumors in vivo. However, there is little clinical data to support this. Our purpose was to determine whether metformin use was associated with a change in pathologic complete response (pCR) rates in diabetic patients with breast cancer receiving neoadjuvant chemotherapy. Patients and Methods: We identified 2,529 patients who received neoadjuvant chemotherapy for early-stage breast cancer between 1990 and 2007. Patients were compared by groups: 68 diabetic patients taking metformin, 87 diabetic patients not taking metformin, and 2,374 nondiabetic patients. pCR rates were compared between the three groups using χ2 tests of independence and compared pair- wise using a binomial test of proportions. Factors predictive of pCR were assessed using a multivariate logistic regression model. Results: The rate of pCR was 24% in the metformin group, 8.0% in the nonmetformin group, and 16% in the nondiabetic group (P = .02). Pairwise comparisons between the metformin and nonmetformin groups (P = .007) and the nonmetformin and nondiabetic groups (P = .04) were significant. Comparison of the pCR rates between the metformin and nondiabetic groups trended toward but did not meet significance (P = .10). Metformin use was independently predictive of pCR (odds ratio, 2.95; P = .04) after adjustment for diabetes, body mass index, age, stage, grade, receptor status, and neoadjuvant taxane use. Conclusion: Diabetic patients with breast cancer receiving metformin and neoadjuvant chemotherapy have a higher pCR rate than do diabetics not receiving metformin. Additional studies to evaluate the potential of metformin as an antitumor agent are warranted.Keywords
This publication has 42 references indexed in Scilit:
- Important role of the LKB1–AMPK pathway in suppressing tumorigenesis in PTEN-deficient miceBiochemical Journal, 2008
- Body-mass index and incidence of cancer: a systematic review and meta-analysis of prospective observational studiesThe Lancet, 2008
- Preoperative Chemotherapy: Updates of National Surgical Adjuvant Breast and Bowel Project Protocols B-18 and B-27Journal of Clinical Oncology, 2008
- The potential of antidiabetic thiazolidinediones for anticancer therapyExpert Opinion on Investigational Drugs, 2006
- Factors Affecting Sensitivity and Specificity of Screening Mammography and MRI in Women with an Inherited Risk for Breast CancerBreast Cancer Research and Treatment, 2006
- Metabolic syndrome as a prognostic factor for breast cancer recurrencesInternational Journal of Cancer, 2006
- Prognostic Value of Pathologic Complete Response After Primary Chemotherapy in Relation to Hormone Receptor Status and Other FactorsJournal of Clinical Oncology, 2006
- Overweight, obesity and cancer: epidemiological evidence and proposed mechanismsNature Reviews Cancer, 2004
- Insulin-like growth factors and neoplasiaNature Reviews Cancer, 2004
- Overweight, Obesity, and Mortality from Cancer in a Prospectively Studied Cohort of U.S. AdultsThe New England Journal of Medicine, 2003