Backgrounds: Metformin, a drug widely used in the treatment of type 2 diabetes mellitus, has been shown to reduce the risk of cancer. Here we examined if concomitant use of metformin enhances progestin therapy for fertility-sparing treatment in young women with endometrial cancer.
Patients and methods: We conducted a prospective observational study of women aged <40 years undergoing progestin therapy to preserve fertility. From January 2008 to December 2010, a total of 20 patients (14 endometrial cancer, 6 atypical endometrial hyperplasia) were treated with medroxyprogesterone acetate (MPA, 400 mg/day) and metformin (2250 mg/day) for 24 weeks. The treatment was continued for another 12 weeks when histological regression was partial but showed remarkable hormonal effects (partial response, PR). Even after MPA was stopped, metformin administration continued until conception.
Results:
Most patients were obese and insulin resistant; mean BMI was ≥25 in 18 patients (mean, 31.9 kg/m2; range, 22–50). HOMA-R was ≥2.5 in 17 patients (mean, 5.7; range, 1.6–20.7). At 24 weeks, 16 patients achieved complete response (CR) and the remaining 4 achieved PR. Of the 4 patients, 3 successfully achieved CR at 36 weeks and 1 eventually continued to show PR at 36 weeks; MPA is still being continued. Recurrence has been confirmed in 1 of 19 CR patients (5%) within the follow-up period (median, 24 months; range, 11–36) after treatment.
Conclusion: The recurrence rate in our study was lower than that observed in the previous study (22–100%). Metformin use inhibits recurrence of endometrial cancer after progestin therapy is discontinued.
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