Impact of metformin on outcomes with immune checkpoint inhibitors in renal cell carcinoma: A large-scale retrospective analysis
Abstract
e16558
Background:
Immune checkpoint inhibitors (ICIs) are a mainstay in the treatment of renal cell carcinoma (RCC). Metformin, a commonly used biguanide for type 2 diabetes, has demonstrated anti-tumor and immunomodulatory effects that may enhance ICI efficacy. However, the clinical impact of concurrent metformin use on outcomes in patients with RCC treated with ICIs remains unclear.
Methods:
We conducted a retrospective cohort study using the TriNetX Global Collaborative Network, a database of electronic medical records from 158 healthcare organizations. We identified patients with RCC using ICD-10-CM C64 who were initiated on ICIs ( nivolumab, pembrolizumab and avelumab) and were divided into two cohorts: those receiving concurrent metformin and those who were not. Propensity score matching (PSM) was performed in 1:1 ratio to balance the cohorts for age, sex, race, comorbidities, and concomitant medications. The primary outcome was overall survival (OS) over a 3-year follow-up period. Secondary outcomes included Major Adverse Cardiovascular Events (MACE) and immune-related adverse events (irAEs) including pneumonitis, colitis, thyroiditis, and skin eruptions.
Results:
A total of 12,271 patients with RCC treated with ICIs were identified: 1,321 in the Metformin cohort and 10,950 in non-metformin cohort. After 1:1 PSM, two well-balanced cohorts of 1,132 patients each were analyzed. Baseline characteristics were statistically similar between both cohorts (p > 0.05; Table…
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 12,271 participants or records.
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