El-Khayat Shaimaa M, Abouegylah Mohamed, Abdallah Dina, Geweil Ahmed Gaber, Elenbaby A M, Zahra Omar Shebl
Clinical Oncology Department, Medical Research Institute, Alexandria University, 169 El-hureya Street, Qism Bab Sharqi, Alexandria, Alexandria Governorate, Egypt.
Clinical Oncology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
Med Oncol. 2021 Nov 5;39(1):1. doi: 10.1007/s12032-021-01599-3.
Metformin has been used to treat type 2 Diabetes Mellitus since long time. It has two proposed anti-neoplastic mechanisms, direct (insulin-independent) and indirect (insulin-dependent) actions. To assess the effect of Metformin on pathological response when combined with neoadjuvant chemotherapy in breast cancer. A prospective study included stage II, III non-diabetic breast cancer patients who received neoadjuvant chemotherapy in our center during the period from May 2017 to March 2019. 59 patients met our inclusion criteria and completed the study, 27 patients received 850 mg Metformin every 12 h with chemotherapy (group A), and 32 patients received chemotherapy without Metformin (group B). Pathological response was assessed by Chevallier classification and residual cancer burden score (RCB). Both groups were well balanced regarding baseline characteristics. The results of our study showed that the rate of pathological complete response (pCR) was 14.8% in group (A) vs. 6.3% in group (B) with a P value of 0.39. RCB class 3 was 40.7% in group (A) vs. 68.8% in group (B) which was statistically significant with a (P value of 0.031). Patients with triple-positive histology who had RCB class 3 were only (14.3%) in group (A) versus (60%) in group B. Patients with body mass index (BMI) ≥ 25 who had RCB 3 were 40% and 66.7% in group (A) and (B), respectively. Metformin may increase the pCR especially in patients with BMI ≥ 25 and patients with triple-positive histology, a larger phase III study is needed to confirm this finding.
长期以来，二甲双胍一直用于治疗2型糖尿病。它有两种抗肿瘤机制，即直接（不依赖胰岛素）和间接（依赖胰岛素）作用。为评估二甲双胍与新辅助化疗联合应用时对乳腺癌病理反应的影响。一项前瞻性研究纳入了2017年5月至2019年3月期间在本中心接受新辅助化疗的II期、III期非糖尿病乳腺癌患者。59例患者符合纳入标准并完成研究，27例患者每12小时接受850毫克二甲双胍联合化疗（A组），32例患者仅接受化疗（B组）。通过Chevallier分类和残余癌负担评分（RCB）评估病理反应。两组在基线特征方面均衡良好。我们的研究结果显示，A组的病理完全缓解（pCR）率为14.8%，B组为6.3%，P值为0.39。A组RCB 3级为40.7%，B组为68.8%，差异具有统计学意义（P值为0.031）。组织学三阳性且RCB 3级的患者在A组仅占（14.3%），而在B组占（60%）。体重指数（BMI）≥25且RCB 3级的患者在A组和B组分别为40%和66.7%。二甲双胍可能会提高pCR率，尤其是在BMI≥25的患者和组织学三阳性的患者中，需要更大规模的III期研究来证实这一发现。
