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ORIGINAL RESEARCH article
Front. Oncol.
Sec. Thoracic Oncology
Volume 15 - 2025 |
doi: 10.3389/fonc.2025.1498927
This article is part of the Research Topic Obesity, Diabetes, and Their Impact on Cancer View all 4 articles
Efficacy of three modern anti-diabetic drugs on survival outcomes of lung cancer patients with type 2 diabetes in China
Provisionally accepted- 1 China Academy of Chinese Medical Sciences, Beijing, China
- 2 Hengshui Hospital of Traditional Chinese Medicine, Hebei, Hebei Province, China
- 3 Maastricht University Medical Centre, Maastricht, Limburg, Netherlands
- 4 Air Force General Hospital PLA, Beijing, Beijing Municipality, China
Background: Some anti-diabetic drugs have been proved to be a tumor suppressor or activator. The associations of three relatively new classes of anti-diabetic medications-glucagon-like peptide-1 receptor agonists (GLP-1RA), dipeptidyl peptidase 4 inhibitors (DPP-4I), and sodium-glucose cotransporter 2 inhibitors (SGLT-2I) with lung cancer prognosis remain unclear.The electronic medical data from the National Healthcare Big Data (East)Center was retrospectively analyzed. We included 11,357 newly diagnosed lung cancer patient with type 2 diabetes (T2D) between January 1st, 2020 and July 1 st , 2023. Patients were categorized into eight groups according to the mono-orcombination therapy of GLP-1RA, DPP-4I and SGLT-2I. Disease progression and mortality risk were evaluated by cox proportional hazards analysis. Progression-free survival (PFS) and overall survival (OS) were assessed by the Kaplan-Meier (logrank) method.Results: Lung cancer patients with T2D who were treated with SGLT-2I & GLP-1RA exhibited the lowest progression (hazard ratio [HR]: 0.37; 95% confidence interval [CI]: 0.18, 0.78) and mortality risks (HR: 0.34; 95% CI: 0.14, 0.82) as well as prolonged median PFS (1.55 years) and OS (1.62 years) among all groups. In contrast, DPP-4I monotherapy did not show benefit for progression (HR: 1.09; 95% CI: 0.98, 1.22. Median PFS: 1.41 years) and mortality risks (HR: 0.96, 95%CI: 0.84, 1.09.Median OS: 1.48 years). However, when DPP-4I was used in combination with SGLT-2I or GLP-1RA, it caused reductions in both progression and mortality risks.prognosis for lung cancer patients with concurrent T2D. DPP-4I transits from a tumor activator to suppressor when combined with other anti-diabetic drugs. Future studies are needed to examine the underlying biological mechanisms.Full Name-1RA Glucagon-like peptide-1 receptor agonists DPP-4I Dipeptidyl peptidase-4 inhibitor SGLT-2I Sodium-glucose cotransporter-2 inhibitor T2D Type 2 diabetes PFS Progression-free survival OS Overall survival ICD-10 International classification of diseases 10th revision HbA1c HemoglobinA1c CYFRA21-1 Cytokeratin fragment 21-1 CA-125 Carbohydrate antigen 125 CEA Carcinoembryonic antigen
Keywords: lung cancer, type 2 diabetes, Real world study, anti-diabetic drugs, Survival
Received: 19 Sep 2024; Accepted: 28 Jan 2025.
Copyright: © 2025 Chen, Sun, Zhang, Lei, Ren, Di and Zhifei. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Yupeng Di, Air Force General Hospital PLA, Beijing, 100142, Beijing Municipality, China
Wang Zhifei, China Academy of Chinese Medical Sciences, Beijing, China
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