Metformin to Prevent Anthropometric and Metabolic Complications of ADT in Men With Prostate Cancer Receiving Radical Radiotherapy.

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This phase II randomized controlled trial evaluated the preventive impact of the addition of metformin versus placebo to androgen deprivation therapy (ADT) on ADT-induced metabolic and anthropometric complications in 79 men with locally advanced prostate cancer who received radical radiotherapy. At 1 year, weight, waist circumference, HbA1c, fasting lipid profile, the prevalence of metabolic syndrome, and biochemical response were similar in both groups.

Metformin did not have a preventive impact on the anthropometric and metabolic complications of ADT in patients with locally advanced prostate cancer receiving radiotherapy.

– Charles Gaulin, MBBS

Abstract

This abstract is available on the publisher's site.

BACKGROUND

Prostate cancer patients undergoing treatment with radical radiotherapy (RT) plus androgen deprivation therapy (ADT) experience a constellation of deleterious metabolic and anthropometric changes related to hypogonadism that are associated with increased morbidity and mortality. We assessed the impact of metformin versus placebo to blunt the adverse impact of ADT on body weight, waist circumference, and other metabolic parameters.

METHODS AND MATERIALS

This phase 2, multicenter, randomized controlled trial (RCT) randomized normoglycemic men with locally advanced prostate cancer receiving radical RT and ADT (18 to 36 months) in a 1:1 ratio to receive Metformin 500mg by mouth three times a day (for 30 to 36 months) versus identical placebo.

RESULTS

From December 2015 to October 2019, 83 men were randomized with median follow-up of 23 months. Baseline mean body mass Index (BMI) of the cohort was 30.2 (range 22.2-52.5). Change in mean weight relative to baseline was lower amongst men who received metformin compared to placebo at 5 months (-1.80 kg, p=0.038), but was not significant with longer follow-up (1 year: +0.16 kg, p=0.874). Although participants on ADT had increases in waist circumference in both study arms, metformin did not significantly reduce these changes (1 year: +2.79 cm (placebo) vs. +1.46 cm (metformin), p=0.336). LDL cholesterol was lower in the metformin arm (-0.32 mmol/L) when compared to the placebo arm (-0.03 mmol/L) at 5 months (p=0.022), but these differences were not significant with longer follow-up (1 year: -0.17 mmol/L vs -0.19 mmol/L, p=0.896). There were no differences in HbA1C, triglyceride, HDL, and total cholesterol by study arm.

CONCLUSIONS

Men receiving radical RT and ADT gained weight and had increases in waist circumference over time, which metformin did not significantly mitigate. Although this study did not observe any preventative impact of metformin on the anthropometric and metabolic complications of ADT, metformin continues to be studied in phase 3 RCTs in this patient population to assess its potential anti-neoplastic effects.

Copyright © 2022 Elsevier Inc. All rights reserved.

International Journal of Radiation Oncology, Biology, Physics

Metformin for Prevention of Anthropometric & Metabolic Complications of Androgen Deprivation Therapy in Prostate Cancer Patients Receiving Radical Radiotherapy: A Phase II Randomized Controlled Trial

Int. J. Radiat. Oncol. Biol. Phys 2022 Jul 27;[EPub Ahead of Print], N Usmani, S Ghosh, KP Sanghera, AD Ong, R Koul, A Dubey, S Ahmed, H Quon, D Yee, M Parliament, G Sivananthan, W Hunter, B Danielson, L Rowe, M McDonald, JO Kim

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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"Although this study did not observe any preventative impact of metformin on the anthropometric and metabolic complications of ADT, "

That's the whole reason to take it.

And if you are getting radiation treatment, how can you not be a concurrent ADT????

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I now take metformin, both to reduce my A1C which was getting borderline high, and to slow down the growth of my prostate cancer. Since starting on metformin my PSA, which had been growing very slowly, has stabilized at 1.8, knock on wood. I am not on ADT and haven't been for five years. My BMI is 25.1; yeah I could afford to lose at least 10 lbs.