The effect of metformin or dipeptidyl peptidase 4 inhibitors on clinical outcomes in metastatic non‐small cell lung cancer treated with immune checkpoint inhibitors

• Published in: Thoracic cancer Vol. 14; no. 1; pp. 52 - 60
• Main Authors: Yang, Jieun, Kim, Se Hyun, Jung, Eun Hee, Kim, Sang‐A, Suh, Koung Jin, Lee, Ji Yun, Kim, Ji‐Won, Kim, Jin Won, Lee, Jeong‐Ok, Kim, Yu Jung, Lee, Keun‐Wook, Kim, Jee Hyun, Bang, Soo‐Mee, Lee, Jong Seok
• Format: Journal Article
• Language: English
• Published: Melbourne John Wiley & Sons Australia, Ltd 01.01.2023; John Wiley & Sons, Inc; Wiley
• Subjects: Antidiabetics; Antineoplastic Agents, Immunological - therapeutic use; Cancer therapies; Carcinoma, Non-Small-Cell Lung - pathology; Chemotherapy; Clinical outcomes; Diabetes; dipeptidyl peptidase 4 inhibitor; Dipeptidyl-Peptidase IV Inhibitors - pharmacology; Dipeptidyl-Peptidase IV Inhibitors - therapeutic use; Humans; immune checkpoint inhibitor; Immune Checkpoint Inhibitors - therapeutic use; Kinases; Ligands; Lung cancer; Lung Neoplasms - pathology; Metastasis; metformin; Metformin - pharmacology; Metformin - therapeutic use; non‐small cell lung cancer; Original; Patients; Proteins; Survival analysis; Tumors; non-small cell lung cancer; dipeptidyl peptidase 4 inhibitor; metformin; immune checkpoint inhibitor
• ISSN: 1759-7706; 1759-7714
• DOI: 10.1111/1759-7714.14711

Background Preclinical data have shown the immunomodulatory effects of metformin and dipeptidyl peptidase 4 (DPP4) inhibitors in patients with diabetes. However, its clinical impact remains unclear in lung cancer. Methods Between 2017 and 2021, 466 patients received ICI monotherapy. Patients were categorized into concurrent (MET; metformin or combination of metformin and DPP4 inhibitor) and without concomitant (NMET; nonmetformin/DPP4 inhibitors) administration of metformin and DPP4 inhibitors groups at least 8 weeks before and during ICI therapy. The primary objectives were the objective response rate (ORR) and progression‐free survival (PFS). The second objective was to evaluate the overall survival (OS) and the occurrence of immune‐related adverse events (irAEs). Results Among 466 patients, 89 (19.0%) and 377 (81%) were categorized into the MET and NMET groups, respectively. MET group had a significantly higher ORR (MET group: 24.7% vs. NMET group: 14.8%, p = 0.025) and longer PFS than those in the NMET group (MET group 5.1 month vs. NMET group 2.8 months, p = 0.018). After patients were stratified based on the prior line of therapy and PD L1 expression status, the PFS of the second‐line therapy and PD L1 ≥50 was significantly higher in the MET than in the NMET group. The proportion of patients experiencing all‐grade irAEs was numerically higher in the MET group (19.1%) than in the NMET group (14.3%), without statistical significance (p = 0.382). Conclusions Concurrent use of metformin and DPP4 inhibitors with ICIs significantly improved the clinical outcomes without increasing the incidence of irAEs in NSCLC.