A Pharmacist’s Perspective on Metformin Use and Cancer Outcomes
Abstract
Having grown into the diabetes gold standard treatment, metformin trails an unsurpassed legacy of inexpensive safety and efficacy. This fact remains unaltered by the anecdotal risk of lactic acidosis, history of a feared and deadly outcome inherited from its medicinally engineered counterpart, phenformin. Upon this soon to be centennial of metformin’s published evidence (1922-2022), the mechanisms and interplays of its beneficial effects, noticed rather recently by the oncology community, are yet to be fully elucidated. With a 1 in 2 lifetime chance of developing cancer among the sons and daughters of the obesity pandemic, metformin’s unintended benefits in cancer have reached a rather difficult to ignore moment in time: a serendipitous ‘‘metformin age’’ for clinical oncology. Despite dramatic societal need for a safe, effective, and inexpensive cancer drug, naysayers, driven by myriads of confounders pledging proven shortcomings in any retrospective studies reporting a cancer-related benefit in metformin users, convincingly promote the evidence of our inability to indicate who may benefit or suffer most from metformin treatment. Facing continued inconsistency in understanding its benefits in cancer, metformin stars in the clinical trials arena as the first antitumor agent tested simultaneously by the greatest number of clinical trials in cancer history: 102 in North America, 61 in Europe, and 50 throughout the rest of the world over the last 5 years alone. Awaiting for the…
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