Lung cancer survival higher in SGLT2 users

3 minute read

Diabetes patients taking the common medication had better non-small cell lung cancer survival, early research has found.

Taking sodium-glucose cotransporter 2 inhibiters has been linked to better survival rates in people with non-small cell lung cancer, research suggests.

The US study of 2400 patients (aged over 65) with both lung cancer and pre-existing diabetes also found a dose-response relationship, with survival better among those who took SGLT2 inhibitors for a longer duration.

Over an average follow-up of 21 months, those who were taking SGLT2 inhibitors had a 32% lower risk of dying compared to those who were not taking the medication.

The benefits remained regardless of demographics, tumour characteristics and type of cancer treatment.

“This study is among the first epidemiological evaluation of the association between SGLT2 inhibitors and cancer survival using large nationally representative datasets,” the researchers wrote in British Journal of Cancer.

The study findings support previous research that has suggested this class of drugs may be of benefit in a broad range of cancers.

“Early clinical evidence indicates SGLT2 inhibitors may have anti-cancer benefits for gastrointestinal, lung, pancreas, prostate and liver cancers,” the study authors said.

The researchers said further studies were needed to determine the mechanisms, but they could include glycaemic-dependent pathways.

“Glucose is required for cancer cell survival and growth,” they said. “Lung cancer cells show increased glucose uptake and utilisation compared to normal lung cells.”

Previous research has shown that the inhibition of glucose uptake and glucose deprivation have induced apoptosis, they said. “It may be possible to induce apoptosis of tumour cells by inhibiting glucose uptake.”

Commenting on the study, respiratory researcher Professor Brian Oliver told TMR more research was needed to determine which cancer patients would benefit.

“I would be amazed if this becomes a frontline treatment for lung cancer,” said Professor Oliver, head of the respiratory cellular and molecular biology group at the Woolcock Institute of Medical Research.

“But maybe, with future research and more careful investigation as to who’s going to benefit the most, maybe it would become a therapeutic option for the treatment of lung cancer.”

Professor Oliver said previous research had shown a benefit of SGLT2 inhibitors in other cancers, but this was the first in lung cancer.

“There’s a lot of evidence in animal models. It’s the first time it’s been shown in lung cancer, which is, from a lung cancer perspective, very interesting.

“This is very exciting, but it’s early-stage research.”

Professor Oliver said the mechanism was unknown, but agreed that the SGLT2 inhibitors could quell cancer growth by controlling blood glucose levels.

“Because cancer cells are so metabolically active, if you reduce blood glucose, the theory is that that would inhibit cancer cell proliferation.

“The other possibility is that those drugs are acting directly on the tumour cells and causing an anti-tumour effect. And in in vitro studies, there is evidence of that with various tumours.”

British Journal of Cancer 2023, online 10 February

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