Advanced Prostate Cancer

ASCO Genitourinary Cancers Symposium (postdiagnostic Metformin and Statin use & PCa mortality)

Note that one should be clear that Metformin users & Statin users represent populations that may have PCa risks quite different from the general PCa population. For instance, while diabetics have a reduced risk of PCa, they have increased PCa mortality risk, albeit lowered in Metformin users.

Studies that refer to Metformin use often fail to mention the dose. Similarly, statin use studies may lump all brands & doses together.

We lack an intervention study involving the two drugs.

Having said that:

"Based on 12,700 patients, post-diagnostic use of statin and metformin was associated with a substantial reduction in CaP mortality (Table), with more pronounced effects in patients with obesity (HR=0.32) or M1 disease (HR=0.54)."

"Effects of statins vary widely by brand, with atorvastatin being associated with the largest reduction in CaP mortality (HR=0.18 ...)"

"CaP mortality was substantially lower in post-diagnostic users of statin with high-risk CaP within 6 years of follow-up. Synergistic effect of statin and metformin was observed in M1 disease only."

-Patrick

202 Poster Session (Board #J22), Thu, 11:30 AM-1:00 PM and

5:15 PM-6:15 PM

Individual and joint effect of postdiagnostic metformin and statin use on prostate cancer mortality among patients with high-risk prostate cancer.

Grace L. Lu-Yao, Jian-Yu E, Yong Lin, Timothy Rebbeck, Shou-En Lu, William Kevin Kelly, Anthony Victor D’Amico, Mark N. Stein, Lanjing Zhang, Isaac Kim, Kitaw Demissie, Anna C. Ferrari, Xiang-Lin Tan; Sidney Kimmel Cancer Center at Jefferson, Philadelphia, PA; Rutgers Cancer Institute of New Jersey, Piscataway, NJ; Rutgers School of Public Health, Piscataway, NJ; Dana- Farber Cancer Institute/ Harvard Medical School, Boston, MA; Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, PA; Dana-Farber Cancer Institute/ Brigham and Women’s Hospital, Boston, MA; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ

Background: Metformin and statin together may delay prostate cancer (CaP) metastasis. However, the joint effects on CaP mortality remain unknown. This study is to quantify individual and joint effects of post diagnostic statin and metformin use on CaP mortality in survivors with high-risk CaP. Methods: This population-based study includes patients identified from the SEER database linked with Medicare files diagnosed with high-risk CaP (T category $T2c or prostate specific antigen level $20 or Gleason score $8) in 2008-2011. Comparators did not have documented use of statin or metformin. Hazard ratios (HR) and 95% were calculated using a time-varying Cox proportional hazard model with competing causes of death.

Results: Based on 12,700 patients, post-diagnostic use of statin and metformin was associated with a substantial reduction in CaP mortality (Table), with more pronounced effects in patients with obesity (HR=0.32) or M1 disease (HR=0.54). Effects of statins vary widely by brand, with atorvastatin being associated with the largest reduction in CaP mortality (HR=0.18, 95% 0.07-0.50).

Conclusions: CaP mortality was substantially lower in post-diagnostic users of statin with high-risk CaP within 6 years of follow-up. Synergistic effect of statin and metformin was observed in M1 disease only. Randomized trials are warrant to confirm the findings.

{Table would not copy. See: gucasym.org/sites/gucasym.o...}

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Thank You Patrick!

😊Jackie

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