Metformin and aspirin treatment could lead to an improved survival rate for Type 2 diabetic patients with stage II and III colorectal adenocarcinoma relative to non-diabetic patients

Abstract

Abstract. Metformin, the drug of choice in the treatment of type 2 diabetes mellitus (DM2), in addition to aspirin (ASA), the drug prescribed for cardioprotection of diabetic and non-diabetic patients, have an inhibitory effect on cancer cell survival. The present population-based study conducted in the province of Trieste (Italy), aimed to investigate the prevalence of DM2 in patients with colorectal adenocarcinoma (CRC) and survival for CRC in diabetic and nondiabetic patients. All permanent residents diagnosed with a CRC between 2004 and 2007 were ascertained through the regional health information system. CRC-specific and relative survival probabilities were computed for each group of patients defined by CRC stage, presence or absence of DM2 treated with metformin, and presence or absence of daily ASA therapy. A total of 515 CRC patients without DM2 and 156 with DM2 treated with metformin were enrolled in the study. At the time of CRC diagnosis, 71 (14%) nondiabetic and 39 (25%) diabetic patients were taking ASA daily. The five-year relative survival for stage III CRC was 101% [95% confidence interval (CI) =76-126] in the 18 patients with DM2 treated with metformin and ASA, 55% (95% CI=31-78) in the 23 without DM2 treated with ASA, 55% (95% CI=45-65) in the 150 without DM2 not taking ASA, and 29% (95% CI=13-45) in the 43 with DM2 treated with metformin, however not with ASA. The findings support the hypothesis of a possible inhibitory effect of metformin and ASA on CRC cells. Randomized controlled trials are required to verify this hypothesis.

A more physiological approach to lipid metabolism alterations in cancer: CRC-like organoids assessment

“…As well, metformin therapies have been proposed alone or in combination with other drugs, in CRC. For example, metformin has been recently combined with aspirin to treat middle stages in non-diabetic CRC patients (II and III stages) [39]. Furthermore, it exists a Phase 2 Trial for the study of metformin and 5-FU combination in metastatic CRC [40], concluded with longstanding cancer control.…”

Relevant Aspects of Combined Protocols for Prevention of N(M)AFLD and Other Non‐Communicable Diseases

“…[ 76 ] These comprise the assessment of the prevalence of T2DM in patients with colorectal adenocarcinoma (CRC) and survival for CRC in patients defined by CRC stage, presence or absence of T2DM treated with metformin, and presence or absence of daily aspirin therapy. [ 77 ] The five‐year relative survival for stage III CRC was 101% in the 18 patients with T2DM treated with metformin and aspirin, 55% in the 23 without T2DM treated with aspirin, 55% in the 150 without T2DM not taking aspirin, and 29% in the 43 with T2DM treated with metformin, but not with aspirin, supporting the hypothesis of a possible inhibitory effect of metformin plus aspirin on CRC cells. [ 77 ] However, randomized PCCT trials are required to verify this hypothesis.…”

The impact of metformin on survival in diabetes patients with operable colorectal cancer: A nationwide retrospective cohort study

“… 17 , 35 One study has shown that metformin and acetylsalicylic acid can act synergistically to supress cancer formation, but randomized controlled trials are required to verify this hypothesis. 36 Because of its tumour suppressor effects, it has been suggested that metformin may prevent certain types of cancer as well as being useful in radiotherapy, chemotherapy and androgen deprivation therapy (ADT). 35 …”