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P1.04 - Immunooncology (Not CME Accredited Session) (ID 936)
- Event: WCLC 2018
- Type: Poster Viewing in the Exhibit Hall
- Presentations: 1
- Coordinates: 9/24/2018, 16:45 - 18:00, Exhibit Hall
P1.04-30 - A Potential Effect of Diabetes Mellitus and Metformin Use on Efficacy of Immune Checkpoint Inhibitors (ICI) (ID 14072)
16:45 - 18:00 | Author(s): Yosef Landman
Numerous studies have demonstrated metformin use is associated with decreased cancer risk in the general population, as well as improved overall response rate (ORR), progression free survival (PFS) and overall survival (OS) in cancer patients undergoing chemotherapy.Recent in-vitro studies found several new mechanisms which granted metformin the potential to increase cancer patients' response to immune checkpoint inhibitors (ICI).a9ded1e5ce5d75814730bb4caaf49419 Method
In this study we aim to explore the correlation between the daily use of metformin and benefit from ICI in patients with lung cancer and other solid malignancies.
We retrospectively evaluated all consecutive patients with metastatic solid malignancies treated with ICI therapy in a single institution between February 2015 and June 2017. Patients' clinical data was obtained from electronic medical records. Cox proportional hazards model and chi squared test were used to determine the associations between metformin use and ORR, median PFS (mPFS) and median OS.4c3880bb027f159e801041b1021e88e8 Result
Of 218 patients included in the analysis (202 NSCLC, 16 non lung cancers), 49 (22.5%) suffered from type 2 diabetes mellitus (T2DM). Of them 33 (15.1%) were treated with metformin and 16 (7.3%) received other, non-metformin therapy for T2DM. Comparison between non-diabetic and diabetic cancer patient groups demonstrated that mPFS was found to be significantly higher in the non-diabetic patients – 6.0 vs. 4.0 months (HR=1.47 [1.03-2.09], p=0.036). ORR was comparable (35.5% vs. 30.6%, p=0.52).8eea62084ca7e541d918e823422bd82e Conclusion
In the T2DM subgroup - mPFS and HR suggested increased efficacy in the metformin group compared to non-metformin, but the numbers were too small to reach significance 8.0 vs. 3.2 months (HR=0.63 [0.32-1.23], p=0.17). ORR was also numerically higher (36.4% vs. 18.8%, p=0.21).
In both comparisons, no significant differences were found in OS.
This data suggests T2DM might be associated with decreased efficacy of ICI.
While several studies demonstrated that diabetic cancer patients receiving chemotherapy gained much benefit with metformin use, the trend we observed regarding metformin use with ICI therapy was milder and should be further explored in larger prospective cohorts.6f8b794f3246b0c1e1780bb4d4d5dc53
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