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Concurrent Nivolumab and Metformin in Diabetic Cancer Patients: Is It Safe and More Active?

Chiara Ciccarese1,2, Roberto Iacovelli3, Sebastiano Buti4

  • 1Department of Medical Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.

Anticancer Research
|February 27, 2022
PubMed
Abstract

Insights

The combination of nivolumab and metformin is safe for diabetic cancer patients. Higher metformin doses correlate with improved progression-free survival, overall survival, and response rates, suggesting potential antitumor synergy.

Area of Science:

  • Oncology
  • Immunotherapy
  • Pharmacology

Background:

  • Emerging evidence suggests programmed death-1 (PD-1)/programmed death-ligand 1 (PD-L1) inhibitors may synergize with metformin.
  • Metformin is an oral hypoglycemic agent with potential anticancer properties.

Purpose of the Study:

  • To investigate the safety and activity of combining nivolumab (a PD-1 inhibitor) with metformin.
  • To evaluate this combination in diabetic patients with advanced cancers.

Main Methods:

  • Retrospective collection of 40 patients with advanced melanoma, renal cell carcinoma, or lung cancer.
  • Patients received nivolumab with concurrent diabetes treated with metformin.
  • Primary endpoint was the safety of the nivolumab plus metformin combination.

Main Results:

  • The combination was well-tolerated, with 75% experiencing any-grade adverse events (fatigue, pruritus, rash, asthenia).
  • Grade 3 adverse events occurred in 20% of patients; no Grade 4 adverse events were observed.
  • Higher metformin doses (>1,000 mg daily) correlated with significantly longer progression-free survival (p=0.021) and overall survival (p=0.037), and higher overall response rates.

Conclusions:

  • Nivolumab and metformin combination is safe in diabetic cancer patients.
  • The combination demonstrated potential antitumor activity.
  • Further research into the synergistic antitumor effects is warranted.
Keywords:
Immunotherapydiabetic cancer patientsimmune checkpoint inhibitormetforminnivolumabsafety

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