肺癌、乳腺癌、结直肠癌、胰腺癌……二甲双胍抗癌的潜力究竟有多大？
学术经纬约 11 分钟二甲双胍抗癌的原理是什么？
二甲双胍降低癌症风险，不同研究证据并不一致
乳腺癌
发表于Journal of Clinical Pharmacy and Therapeutics的一项针对女性乳腺癌随机试验meta分析显示，增加二甲双胍作为辅助治疗与患者无进展生存期（HR=1.00，95%CI=0.70~1.43）和总生存期（HR=1.00，95%CI=0.71~1.39）改善无关。
肺癌
JAMA Oncology发表的包含54例未切除的局部晚期非小细胞肺癌2期临床试验发现，二甲双胍联合放化疗与较高的局部病情进展发生率（HR=2.42，95%CI=1.14~5.10）和死亡率（HR=3.80，95%CI=1.49~9.73）有关。
另外一项发表于Journal of Cancer Research and Clinical Oncology的非小细胞肺癌的荟萃分析也显示，二甲双胍并不能改善患者的总生存期（RR=0.86，95%CI=0.68~1.08）和无进展生存期（RR=0.92，95%CI=0.77~1.10）。
不过，另外一项发表于JAMA Oncology的研究提出，二甲双胍能否协同EGFR-TKIs发挥抗肺癌作用，这或许与患者体重指数（BMI）存在密切关联！这可能是因为BMI较高的患者对二甲双胍的抗肿瘤作用更为敏感，但是这项研究的结论仍需要开展更进一步前瞻性研究加以验证。（JAMA子刊：二甲双胍能否“助攻”肺癌治疗，关键或许在这个指标！）
此外，JAMA Oncology发表的另一项研究也曾带来“希望的曙光”，这项研究显示在晚期肺腺癌患者中，在 EGFR-TKI 靶向药治疗的基础上，加用二甲双胍治疗，可以显著提高疗效。（二甲双胍“神”助攻！配合肺癌靶向治疗，竟然明显提高了疗效！）
前列腺癌
发表于Urologic Oncology-Seminars and Original Investigations的一项临床随机试验，纳入了124例高风险局部晚期或转移性激素敏感性前列腺癌患者，随机接受标准治疗或是二甲双胍+标准治疗，结果显示相比于标准治疗的患者，二甲双胍+标准治疗的患者无前列腺癌生存期更长（29个月 vs. 20个月），但总生存期无差异。
结直肠癌
过往有研究显示，结直肠癌患者使用二甲双胍存在临床获益，如发表于Clinical Colorectal Cancer的一项针对转移性结直肠癌患者的研究发现，22%的接受二甲双胍+甲酰四氢叶酸钙治疗的患者，在治疗第8周到达疾病控制。但研究为单臂试验，无直接对照组，考虑到这类研究存在潜在的混杂因素和时间相关偏倚，对于这类结果的解释需要更为慎重。
胰腺癌
发表于Lancet Oncology的研究显示，添加二甲双胍作为辅助治疗并不能改善晚期胰腺癌患者结局（基础治疗方案为吉西他滨+厄洛替尼）。
为什么观察性研究和随机试验结果不一致？
二甲双胍抗癌前路漫漫，争议或将继续
欢迎投稿：学术成果、前沿进展、临床干货等主题均可，点此了解投稿详情。
参考资料（可上下滑动查看）
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