Anyone on metformin?

[Blondie]

Thank you to those who have been posting research on metformin- very interesting reading!

Has anyone discussed the use of metformin with their oncologists?? I realise research is still being completed to prove its effectiveness in treatment of cancer. However, I understand it is cost effective. Would some oncologists be open to their patients using it-if that is possible??

Otherwise, I suppose getting a glucose test may be an idea. I am thinking about asking my oncologist if it possible to go on metformin?? Has anyone done this without having type II diabetes??

Blondie

[CLTann]

Metaformin is almost no cost. For my husband's three month supply at 500 mg each day, the cost is $5. It is an old drug for diabetes type 2.

[Julie2]

Is it OK to use metformin even if you are not diabetic? Is there an easy way to get it without prescription?

Thanks,
Julie

[Trish]

My oncologist said not to take Metformin at this stage, not because I wasn't diabetic but because it can cause diahoerrea. Given I am on capcitabine(Xeloda) and lapatanib (Tykerb) she thinks it would be risky to add it in at present. She didn't rule it out in the future though. Would love to hear how you get on.
Trish

[jml]

I was given a prescription for Metformin after a year of treatment (2002-2003) and all the steriods, premeds, etc caused me to be insulin resistent. NOT pre-diabetic, just insulin resistent. It was prescribed by an endocrinologist.
I've been on/off the drug ever since, on occassion d/c'ing use because I've been on clinical trials the past year, and also because it can cause major diarrhea when you first start up the drug. If you're already have a problem with that, as I had, it's pretty hard to tolerate.
I'm hoping to return to using it, but since I've just started Halaven, I'd like to wait to settle into this regimen before starting up again. My oncologist is aware that I have taken Metformin in the past & is supportive of my continuing. I look forward to starting back on the drug because I believe (& have believed for a long time) that it should be a part of our regimen to control this disease.
I don't know that there are any oncs out there specifically writing scripts for Metformin, but maybe you can see an Endocrinologist for evaulation?

Good Luck & Keep the Faith!

Jml

[AlaskaAngel]

I originally suggested metformin in the nutrition column on this site before there was open discussion here about its possible helpful effect on cancer patients. I was suggesting it at that time only in the hope that it might help cancer patients who did treatment that included steroids as support drugs that were done in order to reduce their risk for recurrence, but then ended up with excessive weight gain that instead increases their risk, plus much more difficulty losing the weight due to menopause and aging (due to the loss of muscle mass, and testosterone and estrogen that results from treatment).

Since at that time there wasn't much info or active interest in it on the medical wavelengths and I had no substantiated basis for wanting it (other than the desperation of being someone who had never been overweight before in my life and suddenly was experiencing being overweight and doing increased exercise and diet with less and less effect over time as I continued to age), I documented my problem by getting a referral from my PCP to the Registered Dietitian at my cancer center in Seattle. At that time there was no focus AT ALL at the cancer center by oncology on doing anything to help manage the problems that patients like me were encountering with the increased risk from weight gain that was so obviously caused by treatment. It made no sense to me to put early stage patients thru such awful treatment for the purpose of reducing risk of recurrence, only to abandon the same patients to then have to struggle with weight gain that increased the risk.

I focused on coordinating the clinical basis for receiving treatment assistance for the problem. I made sure I got the formal referral from my PCP to the RD, and I made sure I copied their notes to each other. Eventually I did the same between both of them and an endocrinologist, in order to include authorized visits to an endocrinologist. None of this was done with any support whatsoever from any oncologist. I don't think the thought ever crossed their mind. Their focus has been primarily on other types of prescribed treatments that are generally more toxic.

I believe integrating endocrinologists into breast cancer care is very likely to be most helpful in finding more answers to many cancers that involve the endocrine system.

The medical system is archiac in this respect. Oncologists, whose training does not include much in the way of endocrinology, generally have failed to do any homework on its impact on cancers and progress in this regard continues to be very slow. I think that is one major reason why more answers to cancer have been so slow in coming. We are seen by PCPs, and then surgeons, and then oncologists, and then radiologists, and then packaged up with their conclusions without any input from the endocrine system portion of us that is being manipulated and changed by the treatment that these specialists collectively recommend.

At the very minimum, to make meaningful progress, endocrinologists will have to be trained to deal with cancers in the first place. Right now their schedule is full just with dealing with diabetes, thyroid disease, etc. Try getting an appointment with one if you don't have diabetes or thyroid disease. You will be lucky if you can.

I took my lab test results to the endocrinologist. I do not have diabetes or thyroid disease, and because endocrinologists have not had a background education in cancers in particular, there is little established connection for them to work with in our behalf. The endocrinologist gave me no further diagnosis. But eventually the endocrinologist did provide me with an Rx for metformin.

I am taking 500 mg a day (which is a small dose) and find it does help to at least not gain any more weight. I still have to exercise 7 days a week for a full hour and I still have to eat a very monitored diet (about half of what I ate prior to treatment with less exercise).

If we are going to get some answers about this on a wider basis, it would probably be best if you get your situation documented by visits with your PCP and a Registered Dietitian, to support any future referral for the visit with an endocrinologist.

AlaskaAngel

[Rich66]

Mom is taking low dose (500mg) along with metronomic Xeloda, Tykerb and Cytoxan.
Diarrhea no longer a problem once getting aggressive with florastor probiotics. Also..perusing diabetes forums suggested branded Glucophage seems to provide more consistent control, possibly less diarrhea. Costs more..about $45/mo without insurance. (medicare D won't cover since generics are available)
From what I'm gathering, doubling the dose might be better for cancer.

[Jackie07]

Cell Cycle. 2011 Dec 15;10(24):4208-16. Epub 2011 Dec 15.
Energy transfer in "parasitic" cancer metabolism: mitochondria are the powerhouse and Achilles' heel of tumor cells.

Martinez-Outschoorn UE, Pestell RG, Howell A, Tykocinski ML, Nagajyothi F, Machado FS, Tanowitz HB, Sotgia F, Lisanti MP.
Source

The Jefferson Stem Cell Biology and Regenerative Medicine Center, Thomas Jefferson University, Philadelphia, PA, USA.

Abstract

It is now widely recognized that the tumor microenvironment promotes cancer cell growth and metastasis via changes in cytokine secretion and extracellular matrix remodeling. However, the role of tumor stromal cells in providing energy for epithelial cancer cell growth is a newly emerging paradigm. For example, we and others have recently proposed that tumor growth and metastasis is related to an energy imbalance. Host cells produce energy-rich nutrients via catabolism (through autophagy, mitophagy, and aerobic glycolysis), which are then transferred to cancer cells to fuel anabolic tumor growth. Stromal cell-derived L-lactate is taken up by cancer cells and is used for mitochondrial oxidative phosphorylation (OXPHOS) to produce ATP efficiently. However, "parasitic" energy transfer may be a more generalized mechanism in cancer biology than previously appreciated. Two recent papers in Science and Nature Medicine now show that lipolysis in host tissues also fuels tumor growth. These studies demonstrate that free fatty acids produced by host cell lipolysis are re-used via beta-oxidation (beta-OX) in cancer cell mitochondria. Thus, stromal catabolites (such as lactate, ketones, glutamine and free fatty acids) promote tumor growth by acting as high-energy onco-metabolites. As such, host catabolism, via autophagy, mitophagy and lipolysis, may explain the pathogenesis of cancer-associated cachexia and provides exciting new druggable targets for novel therapeutic interventions. Taken together, these findings also suggest that tumor cells promote their own growth and survival by behaving as a "parasitic organism." Hence, we propose the term "Parasitic Cancer Metabolism" to describe this type of metabolic coupling in tumors. Targeting tumor cell mitochondria (OXPHOS and beta-OX) would effectively uncouple tumor cells from their hosts, leading to their acute starvation. In this context, we discuss new evidence that high-energy onco-metabolites (produced by the stroma) can confer drug resistance. Importantly, this metabolic chemo-resistance is reversed by blocking OXPHOS in cancer cell mitochondria with drugs like Metformin, a mitochondrial "poison." In summary, parasitic cancer metabolism is achieved architecturally by dividing tumor tissue into at least two well-defined opposing "metabolic compartments:" catabolic and anabolic.

[lkc Gumby]

After following the research for a few years . I decided to go on it. Diarrhea can be a side effect, but I found, taking it gradually negated this totally for me. I am up to 1,000 mg per day with no problems.