Metformin

Living with secondary breast cancer Treatments and medical issues
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Just to share. This page has been converted from Chinese to English by google translate.

ps. I am a diabetic and have been prescribed metformin for 15 years since my daughter was born. 1000mg daily. Honestly, I did not take it regularly, maybe, <10 in a month until my second diagnosis. I am not sure whether it has helped in my cancer treatment journey. My experience there is no adverse effect of this med but it has to be administered by medical professionals as it may cause low blood sugar which is dangerous. 

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Liao Zhiying, MD    2019/9 Updated

Director of Radiation Oncology, Taichung Hospital, Weifu Department
New York MSKCC Cancer Integrated Medicine training
Houston MD ANDERSON Cancer Integrated Medicine training

 

Old drug new role

Metformin, an old diabetes drug, has been researched in cancer prevention and treatment in recent years. In general, people with diabetes have a twice-risk chance of developing cancer, but epidemiology has found that cancer patients have diabetes. Among people, those who use Metformin have a cancer mortality rate of 15-57%, through the possible regulation of insulin (increased sensitivity), gradually reduce blood sugar, reduce inflammation, reduce cancer cell division and angiogenesis. To reduce the deterioration of cancer cells.

 

Research mechanism 

Metformin affects the growth and reproduction of cancer cells through:

  1. Reduce blood glucose in the blood by reducing glycogen breakdown, and increase the insulin sensitivity of the cells (reduce insulin resistance)
  2. Reduce blood insulin, reduce the Ras/Raf/MEK/ ERK and PI3K/AKT/mTOR signal transmission pathway stimulated by lysin in cancer cells, reduce cancer cell division and growth
  3. Metformin directly stimulates the AMP-activated protein kinase pathway to inhibit cancer cell mTOR (some target drugs also inhibit mTOR).

Retrospective literature:

A.cancer prevention Meta-Analysis

18 studies analyzing 560,000 people, reducing the incidence of cancer by 27%

B. Retrospective study of cancer treatment

  1. Prospective cohort in the Netherlands -1353 Diabetes cancer patients use metformin to reduce 57% of cancer deaths
  2. Canada 10309 retrospective observations (retrispective) reduce cancer death by 20%
  3. Systematic review (Meta-Analysis) 28,671 people, observational studies reduced 35% of deaths, clinical trials did not.

 

Clinical Trials:

At present, clinical trials (lung, endometrium, breast cancer, etc.) are still in the test.

Can query : ClinicalTrials.gov  multiple bundles combined with other target treatment, chemotherapy and radiation therapy, and is a potential radiotherapy sensitizer.

 

Breast cancer:

  1. Two-day randomized study before surgery, 47/39 patients, using metformin before surgery,  post-operative examination shows Ki67 split index significantly reduced. (General Ki67 is used to observe the rate of cancer cell division, the higher the score, the faster the division.
  2. Non-diabetic breast cancer patients, HOMA (insulin resistance index) > 2.8 use metformin, can reduce Ki67 tumor division coefficient
  3. Blood sugar drugs reduce breast cancer  ki67 35–>29 from biopsy to surgery, slowing the growth of cancer cells.
  4. Celebrex (anti-inflammatory drugs) also slowed down the cancer cell division index ki67 by 29% before surgery

Endometrial cancer:

1.Metformin blood glucose drug reduces the cancer cell division index to 67% from biopsy to surgery.

 

Lung cancer:

  1. JAMA Phase II Clinical Trial Lung Cancer Target TKI combined with blood glucose (metformin 1000mg) to prolong Median OS survival (31.7 months vs. 17.5 months)

         The latest JAMA study in 2019~Hot

 

to sum up:

Metformin is the first line of diabetes medicine, which may prevent cancer or adjuvant treatment of cancer by reducing blood sugar, reducing insulin secretion and AMPK/mTOR. Currently, preliminary clinical human studies can slow the growth of cancer cells (using the Ki67 indicator). Especially in the insulin resistance but not in the diagnosis of diabetes patients, the use of target drugs for lung cancer, combined with the use of metformin in the initial study, there is an increase in survival, and in the future, a larger randomized clinical trial test is needed to confirm the effect.

Reference

MD ANDERSON

Metformin in Cancer Treatment and Prevention Annual Review

JCO 2014
Annals of Oncology 2016
Celebrex breast cancer trial
2018ASCO Lung Cancer

2

Thanks for post this lovemama

 

I’m on metformin 500mg to 1000mg daily

 

I had just started 500mg twice daily before diagnosis, during surgery and since and I just taken 500mg daily but I am thinking I need to resettle into my normal self care routine.

 

Its been difficult for me I had the op diagnosed triple neg, decided against chemo and now facing decision about radiotherapy.  just concerned the treatment is going to cause me other health issues, with already damaged lungs and rad consultant said there would be damage to lung 1cm top to bottom unsure how deep with whole breast radiation.

 

in my favour is no cancer in lymph, clear margins and stage 1 and as far as is known I no longer have cancer since the lumpectomy.

not so good is its grade 3 invasive cancer.