Clinical outcomes in non-small-cell lung cancer patients receiving concurrent metformin and immune checkpoint inhibitors

Muhammad Z Afzal; Konstantin Dragnev; Tayyaba Sarwar; Keisuke Shirai

doi:10.2217/lmt-2018-0016

Clinical outcomes in non-small-cell lung cancer patients receiving concurrent metformin and immune checkpoint inhibitors

Lung Cancer Manag. 2019 May 7;8(2):LMT11. doi: 10.2217/lmt-2018-0016. eCollection 2019 Oct.

Authors

Muhammad Z Afzal^{1

1}, Konstantin Dragnev^{2

2}, Tayyaba Sarwar^{3

3}, Keisuke Shirai^{2

2}

Affiliations

¹ Hospital Medicine Dartmouth-Hitchcock Medical Center, One Medical Center Dr, Lebanon, NH 03756, USA.
² Hematology-Oncology Norris Cotton Cancer Center, One Medical Center Dr, Lebanon, NH 03756, USA.
³ The DartLab at Dartmouth College, Norris Cotton Cancer Center, One Medical Center Dr, Lebanon, NH 03756, USA.

Abstract

Aim: To study the clinical benefits of concurrent metformin and immune checkpoint inhibitors (ICIs) in non-small-cell lung cancer patients.

Materials & methods: This is a retrospective review of 50 non-small-cell lung cancer patients receiving ICIs with metformin (cohort A) or without metformin (cohort B). Patients were also stratified by ICIs as second-/third-line therapy.

Results: Overall response rate and disease control rate were higher in cohort A (41.1 vs 30.7%, p = 0.4 and 70.5 vs 61.6%, p = 0.5, respectively). Median overall survival and progression-free survival were also higher in cohort A (11.5 vs 7.6 months, p = 0.5 and 4.0 vs 3.0 months, p = 0.6, respectively). On subset analysis (second-/third-line ICIs), overall response rate, disease control rate, median overall survival, progression-free survival were also higher in cohort A.

Conclusion: Despite the small-sample size, we observed improved clinical outcomes in patients who received ICIs in combination with metformin.

Keywords: anti-PD-1/anti-PD-L1; atezolizumab; metformin; nivolumab; non-small-cell lung cancer; pembrolizumab; second-line ICI; third-line ICI.