Metformin + ADT in treatment of advanced prostate cancer


Yet another study, just published in the Journal of Urology, has indicated a clear association between the use of metformin along with androgen deprivation therapy (ADT) in the treatment of advanced forms of prostate cancer.

The study by Richards et al. reports findings from a retrospective analysis of data from > 87,000 US Veterans, all treated with ADT for advanced forms of prostate cancer between 2000 and 2008. The study cohort was divided into three groups:

    • Group A: Men treated with ADT who did not have diabetes (61 percent of the cohort)
    • Group B: Men treated with ADT who also had diabetes but who did not receive metformin (22 percent of the cohort)
    • Group C: Men treated with ADT who also had diabetes and who did receive metformin (17 percent of the cohort)

The study excluded patients who were on ADT for < 6 months or who only received ADT in combination with radiotherapy for treatment of localized prostate cancer.

The research team found the following results:

  • Compared to the men in Group A
    • Men in Group C had better overall survival (OS) (hazard ratio [HR] = 0.82) than men in Group B  (HR = 1.03)
    • Men in Group C had better cancer-specific survival (CSS) (hazard ratio [HR] = 0.70) than men in Group B (HR = 0.93)
    • Men in Group C had a noticeable reduction in risk for skeletal-related events (SREs)

Richards et al. conclude that:

Metformin use in Veterans with [prostate cancer] receiving ADT is associated with improved oncologic outcomes. This association should be evaluated in a prospective clinical trial.

Given that this was a study based on VA data, and would therefore have included a relatively high percentage of non-Caucasian patients, it might have been interesting to know whether similar results were identified in the different racial/ethnic groups of patients (even if these data groups were not large enough to demonstrate statistical significance).

The “New” Prostate Cancer InfoLink agrees with Richards et al. It is high time that a large, prospective clinical trial studied the combination of metformin + ADT in first-line treatment of advanced prostate cancer among men who do and do not have diabetes.

 

3 Responses

  1. Any form of ADT? I’m getting ready to make life choices: 66 years old, Gleason score 4 + 3 = 7 (grade group 3); tumor in transition zone; already take metformin 1000 mg per day.

    Just adding ADT sounds better than what I’m about to do: RT or RP.

    Ed

  2. Dear Ed:

    You may be ignoring two things.

    The first is that long-term ADT can also come with a whole series of adverse effects that can vary enormously (and unpredictably) from person to person.

    The second is that ADT is not a curative form of treatment. Sooner or later, everyone progresses on ADT, and then you are on to a whole series of other drugs that all come with their own lists of complications and side effects. Starting ADT early is not usually a recommended therapeutic strategy here in the US.

    Futhermore, it doesn’t sound to me as the RT and RP are your only options in the first place. However, they may be the only ones your insurance provider is willing to pay for.

  3. OK. Thanks. My insurance is the VA. Trying to get OK right now to do BBT at UC Davis or Stanford.

    Ed

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google+ photo

You are commenting using your Google+ account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

w

Connecting to %s

This site uses Akismet to reduce spam. Learn how your comment data is processed.

%d bloggers like this: