title: Improved progression free survival for patients with diabetes and locally advanced non-small cell lung cancer (NSCLC) using metformin during concurrent chemoradiotherapy.
abstract: OBJECTIVE
  The aim was to investigate whether the use of metformin during concurrent chemoradiotherapy (cCRT) for locally advanced non-small cell lung cancer (NSCLC) improved treatment outcome.
  
  
  METHODS
  A total of 682 patients were included in this retrospective cohort study (59 metformin users, 623 control patients). All received cCRT in one of three participating radiation oncology departments in the Netherlands between January 2008 and January 2013. Primary endpoint was locoregional recurrence free survival (LRFS), secondary endpoints were overall survival (OS), progression-free survival (PFS) and distant metastasis free survival (DMFS).
  
  
  RESULTS
  No significant differences in LRFS or OS were found. Metformin use was associated with an improved DMFS (74% versus 53% at 2 years; p=0.01) and PFS (58% versus 37% at 2 years and a median PFS of 41 months versus 15 months; p=0.01). In a multivariate cox-regression analysis, the use of metformin was a statistically significant independent variable for DMFS and PFS (p=0.02 and 0.03).
  
  
  CONCLUSIONS
  Metformin use during cCRT is associated with an improved DMFS and PFS for locally advanced NSCLC patients, suggesting that metformin may be a valuable treatment addition in these patients. Evidently, our results merit to be verified in a prospective trial.
authors: Department of Radiation Oncology (MAASTRO), GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, The Netherlands. Electronic address: krista.wink@maastro.nl.
authors: Krista C J
authors: KC
authors: Wink
authors: Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands.
authors: José S A
authors: JS
authors: Belderbos
authors: Department of Radiation Oncology, Amsterdam Medical Centre, The Netherlands.
authors: Edith M T
authors: EM
authors: Dieleman
authors: Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands.
authors: Maddalena
authors: M
authors: Rossi
authors: Department of Radiation Oncology, Amsterdam Medical Centre, The Netherlands.
authors: Coen R N
authors: CR
authors: Rasch
authors: Department of Research, Netherlands Comprehensive Cancer Organization, Utrecht, The Netherlands.
authors: Ronald A M
authors: RA
authors: Damhuis
authors: Department of Radiation Oncology (MAASTRO), GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, The Netherlands.
authors: Ruud M A
authors: RM
authors: Houben
authors: Department of Radiation Oncology (MAASTRO), GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, The Netherlands; Institute of Radiooncology, Helmholtz Zentrum Dresden-Rossendorf, Germany; OncoRay, National Center for Radiation Research in Oncology, Dresden, Germany; Department of Radiation Oncology, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany.
authors: Esther G C
authors: EG
authors: Troost
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D016022:Case-Control Studies; D059248:Chemoradiotherapy / Q000379:methods* / Q000401:mortality; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000401:mortality; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D053208:Kaplan-Meier Estimate; D008297:Male; D008687:Metformin / Q000627:therapeutic use*; D008875:Middle Aged; D009367:Neoplasm Staging; D009426:Netherlands / Q000453:epidemiology; D011446:Prospective Studies; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D007004:Hypoglycemic Agents; D008687:Metformin
keywords: Chemotherapy; Diabetes; Metformin; NSCLC; Radiotherapy