Glycemic variability and disease progression in patients with metastatic colorectal cancer: a pilot cohort study

Introduction: altered glucose metabolism plays a pivotal role in cancer cell proliferation and disease progression. However, there is limited information regarding the role of glycemic variability in metastatic colorectal cancer (mCRC). Objective: to analyze the association between glycemic variability and tumor response in patients with mCRC. Method: a prospective pilot cohort study was conducted in patients with newly diagnosed mCRC. Patients were excluded if they had a previous chronic corticosteroid use, prior cancer treatment, or infection. At baseline and after a four-month follow-up, the glycemic coefficient of variation (CV %) was measured by the Free Style Libre sensor over a 15-day period. The outcome was disease control rate (DCR) according to RECIST version 1.1. Disease control rate was defined as the proportion of patients achieving complete response, partial response, or stable disease. Progressive disease was defined as the appearance of new lesions or tumor growth. Results: among the eleven patients included, 63.6 % achieved DCR. Patients with a glycemic CV % above the 75th percentile had a higher proportion of patients aged ≥ 65 years, a diagnosis of type 2 diabetes mellitus, and progression events (75 %), showing a trend to significance. Conclusion: this pilot study suggests that glycemic variability may be associated with tumor response in patients with mCRC. However due to the exploratory design, larger prospective studies are needed to confirm the potential role of glycemic variability as a metabolic biomarker in mCRC.