title: Association of Metformin Use with Outcomes in Advanced Endometrial Cancer Treated with Chemotherapy.
abstract: There is increasing evidence that metformin, a commonly used treatment for diabetes, might have the potential to be repurposed as an economical and safe cancer therapeutic. The aim of this study was to determine whether stage III-IV or recurrent endometrial cancer patients who are using metformin during treatment with chemotherapy have improved survival. To test this we analyzed a retrospective cohort of subjects at two independent institutions who received chemotherapy for stage III-IV or recurrent endometrial cancer from 1992 to 2011. Diagnosis of diabetes, metformin use, demographics, endometrial cancer clinico-pathologic parameters, and survival duration were abstracted. The primary outcome was overall survival. The final cohort included 349 patients, 31 (8.9%) had diabetes and used metformin, 28 (8.0%) had diabetes but did not use metformin, and 291 (83.4%) did not have diabetes. The results demonstrate that the median overall survival was 45.6 months for patients with diabetes who used metformin compared to 12.5 months for patients with diabetes who did not use metformin and 28.5 months for patients without diabetes (log-rank test comparing the three groups P = 0.006). In a model adjusted for confounders, the difference in survival between the three groups remained statistically significant (P = 0.023). The improvement in survival among metformin users was not explained by better baseline health status or more aggressive use of chemotherapy. Overall, the findings in this retrospective cohort of endometrial cancer patients with stage III-IV or recurrent disease treated with chemotherapy indicate that patients with diabetes who were concurrently treated with metformin survived longer than patients with diabetes who did not use metformin.
authors.affiliation: Department of Medicine, University of Chicago, Chicago, Illinois, United States of America.
authors.forename: Obiageli
authors.initials: O
authors.lastname: Ezewuiro
authors.affiliation: Department of Medicine, University of Chicago, Chicago, Illinois, United States of America.
authors.forename: Tatyana A
authors.initials: TA
authors.lastname: Grushko
authors.affiliation: Department of Public Health Sciences, University of Chicago, Chicago, Illinois, United States of America.
authors.forename: Masha
authors.initials: M
authors.lastname: Kocherginsky
authors.affiliation: Department of Obstetrics and Gynecology, Gordon Center for Integrative Science, University of Chicago, Chicago, Illinois, United States of America.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Habis
authors.affiliation: Department of Obstetrics and Gynecology, NorthShore University Health System, Chicago, Illinois, United States of America.
authors.forename: Jean A
authors.initials: JA
authors.lastname: Hurteau
authors.affiliation: Department of Obstetrics and Gynecology, Gordon Center for Integrative Science, University of Chicago, Chicago, Illinois, United States of America.
authors.forename: Kathryn A
authors.initials: KA
authors.lastname: Mills
authors.affiliation: Department of Obstetrics and Gynecology, Gordon Center for Integrative Science, University of Chicago, Chicago, Illinois, United States of America.
authors.forename: Jessica
authors.initials: J
authors.lastname: Hunn
authors.affiliation: Department of Medicine, University of Chicago, Chicago, Illinois, United States of America.
authors.forename: Olufunmilayo I
authors.initials: OI
authors.lastname: Olopade
authors.affiliation: Department of Medicine, University of Chicago, Chicago, Illinois, United States of America.
authors.forename: Gini F
authors.initials: GF
authors.lastname: Fleming
authors.affiliation: Department of Obstetrics and Gynecology, Gordon Center for Integrative Science, University of Chicago, Chicago, Illinois, United States of America.
authors.forename: Iris L
authors.initials: IL
authors.lastname: Romero
mesh_terms: D018262:Adenocarcinoma, Clear Cell / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D000368:Aged; D002296:Carcinosarcoma / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D018284:Cystadenocarcinoma, Serous / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D016889:Endometrial Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D008687:Metformin / Q000627:therapeutic use*; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate
chemical_list: D007004:Hypoglycemic Agents; D008687:Metformin