Survival of Patients with Stage IV Lung Cancer with Diabetes Treated with Metformin
- 15 February 2015
- journal article
- research article
- Published by American Thoracic Society in American Journal of Respiratory and Critical Care Medicine
- Vol. 191 (4), 448-454
- https://doi.org/10.1164/rccm.201407-1395oc
Abstract
Prior studies have shown an anticancer effect of metformin in patients with breast and colorectal cancer. It is unclear, however, whether metformin has a mortality benefit in lung cancer. To compare overall survival of patients with diabetes with stage IV non-small cell lung cancer (NSCLC) taking metformin versus those not on metformin. Using data from the Surveillance, Epidemiology, and End Results registry linked to Medicare claims, we identified 750 patients with diabetes 65-80 years of age diagnosed with stage IV NSCLC between 2007 and 2009. We used propensity score methods to assess the association of metformin use with overall survival while controlling for potential confounders. Overall, 61% of patients were on metformin at the time of lung cancer diagnosis. Median survival in the metformin group was 5 months, compared with 3 months in patients not treated with metformin (P < 0.001). Propensity score analyses showed that metformin use was associated with a statistically significant improvement in survival (hazard ratio, 0.80; 95% confidence interval, 0.71-0.89), after controlling for sociodemographics, diabetes severity, other diabetes medications, cancer characteristics, and treatment. Metformin is associated with improved survival among patients with diabetes with stage IV NSCLC, suggesting a potential anticancer effect. Further research should evaluate plausible biologic mechanisms and test the effect of metformin in prospective clinical trials.Keywords
This publication has 48 references indexed in Scilit:
- Molecular mechanism of action of metformin: old or new insights?Diabetologia, 2013
- The effect of metformin and thiazolidinedione use on lung cancer in diabeticsBMC Cancer, 2012
- Prognostic impact of insulin receptor expression on survival of patients with nonsmall cell lung cancerCancer, 2011
- Metformin Decreases the Dose of Chemotherapy for Prolonging Tumor Remission in Mouse Xenografts Involving Multiple Cancer Cell TypesCancer Research, 2011
- Clinically Defined Type 2 Diabetes Mellitus and Prognosis in Early-Stage Breast CancerJournal of Clinical Oncology, 2011
- Metformin Prevents Tobacco Carcinogen–Induced Lung TumorigenesisCancer Prevention Research, 2010
- Metformin Selectively Targets Cancer Stem Cells, and Acts Together with Chemotherapy to Block Tumor Growth and Prolong RemissionCancer Research, 2009
- Does pre-existing diabetes affect prostate cancer prognosis? A systematic reviewProstate Cancer and Prostatic Diseases, 2009
- Long-term All-Cause Mortality in Cancer Patients With Preexisting Diabetes MellitusJAMA, 2008
- Adapting a clinical comorbidity index for use with ICD-9-CM administrative databasesJournal of Clinical Epidemiology, 1992