I have a patient who was dx originally in 2012 with stage 3 ovarian cancer. She had complete debulking except for a 1.5 cm tumor implant on the diaphragm and under went 6 cycles of IV chemotherapy resulting in complete remission until October of 2014. At that time the PET showed a possible small tumor implant on the right kidney. Subsequent laparoscopy showed only suspicious washings and she had 6 cycles of IP and IV chemo finishing in 5/15.
In Feb 2018 her PET and CT scans showed retroperitoneal pelvic lymph node recurrence (5 on left, and 3 on the right) and a 2.5 cm liver implant. She was asymptomatic and this was done because of rising CA 125. While she was getting a second opinion for treatment she started herself on a very low carb diet, and I started her on metformin because of she does have prediabetes after reading the positive retrospective studies. The dose was gradually increased to 1500 mg daily.
The lesion on her liver shrunk by 50% by the end of March, and on her last PET scan done 6/15, has disappeared. only 1/5 lymph nodes remain in the left pelvis and the 2 of the 3 lymph nodes on the right side have remained unchanged, with one getting larger. Her CA 125 has decreased by 50% from it's highest level (in March) as of last week.
She would like to continue this treatment. Does anyone have any experience with using metformin for ovarian cancer? She has been measuring her serum ketones but since losing weight finds that she rarely exceeds 0.4. (Weight 118/ height 5'4"). I am suspicious that this is because she does not have that much fat left and apparently metformin decreases free fatty acids. I am also inclined to think the metformin is the key reason for the improvement rather than being in low ketosis.
Any suggestions or thoughts would be appreciated.
well dear its under trials , many trials have proved anticancer role of metformin. you may check literature as well.Ii am sharing one study with you, hope it will answer your its of 2016.
Regards!
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4734273/
7. Antitumor effect of metformin in ovarian cancer
The potential pharmacological effects of metformin in ovarian cancer are of interest. Obesity potentially contributes to the onset of ovarian cancer, and may additionally be stimulated by androgens, as in PCOS (36,39). Hyperandrogenism is caused by hyperinsulinemia, inhibition of IGF binding protein 1 (IGFBP1) and increased IGF-1 activity (39). Based on the risk reduction for ovarian cancer exhibited by oral contraceptives with anti-androgen activity (53) and the effects of metformin on PCOS, obesity and other tumors, we hypothesize that metformin may demonstrate efficacy for the treatment of ovarian cancer. Metformin inhibits tumor growth and induces apoptosis in ovarian cancer cells in vitro, as reported by Gotlieb et al (54), who identified that metformin inhibited cell growth in OVCAR-3 and OVCAR-4 cells in a dose-dependent manner, and administration of metformin in combination with cisplatin enhanced this pharmacological effect. These effects were induced by decreased phosphorylation of p70 S6 kinase (p70S6K) and S6K via AMPK phosphorylation (54).
A number of epidemiological studies have investigated the effects of metformin in ovarian cancer. In a case-control study of 1,611 diabetic patients, Bodmer et al (55) identified that the carcinogenic risk in the metformin-treated group was significantly lower (OR, 0.61; 95% CI, 0.30–1.25) than in the sulfonylurea-treated (OR, 1.26; 95% CI, 0.65–2.44) and insulin-treated groups (OR, 2.29; 95% CI, 1.13–4.65). In a study including 1,454 diabetic patients treated with metformin and 2,897 diabetic patients who were not administered metformin for a median duration of 4.0 years, Home et al (56) observed that none of the patients in the metformin group developed ovarian cancer, whereas 3 patients in the non-metformin group did. In an analysis with a median duration of 5.5 years, 6/3,344 patients treated with metformin and 3/1,103 patients who were not treated with metformin developed ovarian cancer (56).
In a systematic review of 28 studies, Zhang and Li (57) identified that metformin decreased mortality associated with ovarian cancer (relative risk (RR), 0.44; 95% CI, 0.30–0.64; P
Thank you for the response. I had already reviewed this article. I was hoping someone had experience outside of the in going trials regarding dosage.
Best Regards. MEM
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