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Does the Use of Metformin Improve Outcomes in Patients With Non–Small Cell Lung Cancer?

By: Myles Starr
Posted: Monday, August 23, 2021

The addition of the oral diabetes medicine metformin to the treatment of nondiabetic patients with stage III non–small cell lung cancer who are receiving chemoradiation therapy does not appear to improve outcomes. Jeffrey D. Bradley, MD, of the Winship Cancer Institute at Emory University, Atlanta, and colleagues reported in JAMA Oncology that adding metformin to concurrent chemoradiation appeared to be well tolerated “but did not improve survival among patients with unresectable stage III NSCLC.” 

The study, which took place from August 2014 to December 2016, included 97 men and 70 women, with a median age of 64, from institutions in the United States, Canada, and Israel. There were 81 individuals in the control group and 86 in the experimental group treated with metformin. All individuals received 60 Gy, in 2-Gy daily fractions, over 30 treatments using either three-dimensional conformal or intensity-modulated radiation therapy. During radiotherapy, all patients were administered paclitaxel and carboplatin. After a 2-week dose escalation, the metformin group received 2,000 mg (orally) of the medication daily, 500 mg in the morning and evening, and 1,000 mg at midday. Treatment was followed by CT or MRI scans of the chest and upper abdomen every 3 months (for 2 years) and every 6 months (for 3 to 5 years).

Despite better-than-expected overall outcomes, there was found to be little difference in the outcomes between the two study groups. The variable most affecting progression-free survival was the stage of cancer at the time of treatment. The median follow-up was at 27.7 months. In the control group, the 1-year progression free survival rate was 60.4%; in the metformin group, it was 51.3%. After 1 year, the overall survival rate was 80.2% in the control arm and 80.8% in the metformin arm. 

Disclosures: For full disclosures of the study authors visit jamanetwork.com.



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