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Research Article| Volume 134, ISSUE 3, P607-614, September 2014

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Anti-diabetic doses of metformin decrease proliferation markers in tumors of patients with endometrial cancer

  • Ido Laskov
    Affiliations
    Division of Gynecologic Oncology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada

    Segal Cancer Center, Lady Davis Institute of Medical Research, McGill University, Montreal, Quebec, Canada
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  • Laura Drudi
    Affiliations
    Division of Gynecologic Oncology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada

    Segal Cancer Center, Lady Davis Institute of Medical Research, McGill University, Montreal, Quebec, Canada
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  • Marie-Claude Beauchamp
    Affiliations
    Division of Gynecologic Oncology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada

    Segal Cancer Center, Lady Davis Institute of Medical Research, McGill University, Montreal, Quebec, Canada
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  • Amber Yasmeen
    Affiliations
    Division of Gynecologic Oncology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada

    Segal Cancer Center, Lady Davis Institute of Medical Research, McGill University, Montreal, Quebec, Canada
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  • Alex Ferenczy
    Affiliations
    Department of Pathology, McGill University, Montreal, Quebec, Canada
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  • Michael Pollak
    Affiliations
    Segal Cancer Center, Lady Davis Institute of Medical Research, McGill University, Montreal, Quebec, Canada

    Department of Oncology, McGill University, Montreal, Quebec, Canada
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  • Walter H. Gotlieb
    Correspondence
    Corresponding author at: McGill University, 3755 Cote Ste., Catherine Road, Montreal, QC, Canada H3T 1E2.
    Affiliations
    Division of Gynecologic Oncology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada

    Segal Cancer Center, Lady Davis Institute of Medical Research, McGill University, Montreal, Quebec, Canada

    Department of Oncology, McGill University, Montreal, Quebec, Canada
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      Highlights

      • Pilot ‘window of opportunity’ trial of metformin, administered from diagnostic biopsy to surgery for endometrial cancer
      • Significant reduction in Ki-67 and pS6 in the endometrial cancer cells in vivo
      • Significant decrease of plasma insulin, IGF-1 and IGFBP-7

      Abstract

      Background

      Metformin has been associated with reduced cancer risk. The mechanisms underlying this cancer protective effect remain unknown.

      Methods

      “Window of opportunity” study of metformin in women with operable endometrial cancer (EC). Eleven newly diagnosed, untreated, non-diabetic patients with EC received metformin 500 mg tid from diagnostic biopsy to surgery. Fasting plasma insulin, insulin-like growth factor 1 (IGF-1), insulin-like growth factor binding protein 1 (IGFBP-1) and insulin-like growth factor binding protein 7 (IGFBP-7) measurements were taken before and after metformin treatment. Ki-67, pAMPK, and pS6 immunohistochemistry staining was performed on the endometrial cancer before and after metformin treatment and was compared to a control group of 10 women with EC who did not receive metformin.

      Results

      Metformin was administered for a mean of 36.6 days. None of the patients suffered side effects requiring withdrawal from the study. The study group comprised 8 patients with endometrioid EC, and 3 non-endometrioid EC, with a mean follow-up time of 57 months. Mean plasma insulin (p = 0.0005), IGF-1 (p = 0.001), and IGFBP-7 (p = 0.0098) were significantly reduced after metformin treatment. A clear reduction in ki-67 and pS6 expression was observed by both conventional light microscope analysis and digital image analysis with a significant mean reduction in percentage of cells staining for ki-67 (9.7%, P = 0.02) and pS6 (31%, P = 0.03). In the non-treated control group expression was similar between the biopsy and the surgical specimens.

      Conclusions

      This pilot trial presents biological evidence consistent with anti-proliferative effects of metformin in women with EC in the clinical setting.

      Keywords

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