The Impact of Metformin Use with Survival Outcomes.

[pjoshea13]

New meta-analysis below [1].

"27 eligible studies were identified, including 123,212 participants.

"In prostate cancer, patients using metformin have significant benefits for:

... recurrence (HR = 0.74 ...),

...{cancer-specific survival} (HR = 0.74 ...), and

... {overall survival} (HR = 0.76 ...).

"Moreover, further subgroup analysis showed that the beneficial effects of metformin may be more significant for patients receiving radical radiotherapy."

***

Bear in mind that in almost all Metformin studies at this point, Metformin was prescribed for diabetes - not PCa.

However, insulin resistance - a pre-diabetes state - has been associated with more serious PCa, (and castration therapy is associated with increased insulin resistance.)

-Patrick

[1] pubmed.ncbi.nlm.nih.gov/346...

Review Biomed Res Int

. 2021 Oct 8;2021:5311828. doi: 10.1155/2021/5311828. eCollection 2021.

The Impact of Metformin Use with Survival Outcomes in Urologic Cancers: A Systematic Review and Meta-Analysis

Xiangyang Yao 1 , Haoran Liu 2 , Hua Xu 1

Affiliations collapse

Affiliations

1 Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.

2 Department of Urology, The First Affiliated Hospital of Anhui Medical University, Institute of Urology, Anhui Medical University, Hefei, China.

PMID: 34660791 PMCID: PMC8519697 DOI: 10.1155/2021/5311828

Abstract

Background: Conflicting results exist between the potential protective effects of metformin and the prognosis of urologic cancers. This meta-analysis summarized the effects of metformin exposure on the recurrence, progression, cancer-specific survival (CSS), and overall survival (OS) of the three main urologic cancers (kidney cancer, bladder cancer, and prostate cancer).

Methods: We systematically searched PubMed, Embase, Web of Science, Wanfang, and China National Knowledge Infrastructure databases (January 2010 to December 2019), which identified studies regarding metformin users and nonusers with urologic cancers and extracted patient data. A random effect model or fixed effect model was used to analyze hazard ratios (HRs) and 95% confidence intervals (CIs).

Results: Among the 1883 confirmed studies, 27 eligible studies were identified, including 123,212 participants. In prostate cancer, patients using metformin have significant benefits for recurrence (HR = 0.74; 95% CI: 0.61-0.90; P = 0.007; I 2 = 56%), CSS (HR = 0.74; 95% CI: 0.61-0.91; P = 0.002; I 2 = 79%), and OS (HR = 0.76; 95% CI: 0.65-0.90; P < 0.001; I 2 = 86%). Moreover, further subgroup analysis showed that the beneficial effects of metformin may be more significant for patients receiving radical radiotherapy. For kidney cancer, metformin was beneficial for progression (HR = 0.80; 95% CI: 0.65-0.98; P = 0.14; I 2 = 46%). Analysis revealed that the effect of metformin on the overall survival of kidney cancer patients may be related to nationality (American: HR = 0.76; 95% CI: 0.59-0.98; P = 0.88; I 2 = 0%). For bladder cancer, no obvious benefits of metformin use were identified. However, subgroup analysis indicated that metformin may improve the recurrence of bladder cancer, but this improvement was only found in patients with a median follow-up time of more than 4 years (HR = 0.43; 95% CI: 0.28-0.67; P = 0.61; I 2 = 0%).

Copyright © 2021 Xiangyang Yao et al.

Conflict of interest statement

The authors have declared that there is no competition of interests.

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[dockam]

That's an awesome finding and reinforces what I'm taking! My MO gave me an Rx for Metformin 2gm/day in 2016, along with Lipitor. PSA was 0.7 at the end of 2015, after 15 Taxotere sessions. Hit a nadir of 0.1 in the Summer of 2017. But, now there's a progression necessitating Cabazitaxel starting on 10/29. But, maybe the Metformin got me to 6 1/2 years with the PCa

mdedge.com/hematology-oncol...

nature.com/articles/s41598-...

Fight on y'all

[Spyder54]

Thanks Patrick,One more piece of the puzzle. Man this puzzle has a lot of pieces😳. I already feel like a walking Pharma container. This is the 3rd time I have read about advantages of Metformin for Advanced PCa.

Always appreciate how you and TA back their discussion with research and clinical trials.

Mike

[Hidden]

Might be good for non-diabetics. Might not do much. Some more RCTs would be nice. In the meantime I'll take it unless I don't :)Usually I take 1000 mg a day. Sometimes I take 1500 mg for a few days and then none for a day or two.

ncbi.nlm.nih.gov/pmc/articl...

[dhccpa]

Some say that if you can't get a doc to prescribe metformin, take Berberine instead. Any thoughts on that?

[pjoshea13 in reply to dhccpa]

5 years old, but ...

healthunlocked.com/advanced...

-Patrick

[BILIE]

THANKS PJ !!

[latvis]

Oral route should be the worse option.

[Don_1213]

Interesting. This paper took me to another paper ncbi.nlm.nih.gov/pmc/articl... - "Metformin: current clinical applications in nondiabetic patients with cancer" - recent 2020 paper that reinforced what the first article said and specifically address the numbers for PCa besides other gero-urinary cancers.

I had been on metformin since almost when my PCa was diagnosed. And for some reason I discontinued it about 6 months ago. Periodically I try to review my meds and decide if they're all necessary due to a current paper posted here (? possibly somewhere else) that questioned if metformin helped with PCa, or if it was neutral or even a negative.

Thanks to this paper and the other one I found - I contacted my GP and asked him to send a new prescription in for metformin. I have that by next week. Meanwhile, I still have half a bottle kicking around in the spare-pharma plastic container in my closet.. so guess I'll start it tonight.

[cigafred in reply to Don_1213]

The part on PCa did not seem that supportive of metformin: A multicenter phase 2 trial enrolled forty-four men with progressive metastatic castration-resistant prostate cancer. Patients received metformin 1000 mg twice daily until disease progression. Metformin was safe and showed modest activity, which only had some influence on prostate-specific antigen level in nondiabetic patients [56]. As a combination therapy, the addition of metformin to abiraterone for patients with metastatic castration-resistant prostate cancer showed no meaningful clinical benefit. Metformin was also given at 1000 mg twice daily in this study [57]. However, these studies were limited by small sample sizes. A larger trial in which metformin is added to androgen-deprivation therapy in patients with castration-sensitive locally advanced or metastatic patients is recruiting (NCT00268476) [58]. The estimated study completion date will be 2024.

The study referred to is STAMPEDE.