A randomized controlled trial of metformin in women with components of metabolic syndrome: intervention feasibility and effects on adiposity and breast density.

Edgar Tapia, Diana Evelyn Villa-Guillen, Pavani Chalasani, Sara Centuori, Denise J Roe, Jose Guillen-Rodriguez, Chuan Huang, Jean-Phillippe Galons, Cynthia A Thomson, Maria Altbach, Jesse Trujillo, Liane Pinto, Jessica A Martinez, Amit M Algotar, H-H Sherry Chow

Journal: Breast cancer research and treatment 2021;190(1):69-78

PMID: 34383179

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Abstract

PURPOSE

Obesity is a known risk factor for post-menopausal breast cancer and may increase risk for triple negative breast cancer in premenopausal women. Intervention strategies are clearly needed to reduce obesity-associated breast cancer risk.

METHODS

We conducted a Phase II double-blind, randomized, placebo-controlled trial of metformin in overweight/obese premenopausal women with components of metabolic syndrome to assess the potential of metformin for primary breast cancer prevention. Eligible participants were randomized to receive metformin (850 mg BID, n = 76) or placebo (n = 75) for 12 months. Outcomes included breast density, assessed by fat/water MRI with change in percent breast density as the primary endpoint, anthropometric measures, and intervention feasibility.

RESULTS

Seventy-six percent in the metformin arm and 83% in the placebo arm (p = 0.182) completed the 12-month intervention. Adherence to study agent was high with more than 80% of participants taking ≥ 80% assigned pills. The most common adverse events reported in the metformin arm were gastrointestinal in nature and subsided over time. Compared to placebo, metformin intervention led to a significant reduction in waist circumference (p < 0.001) and waist-to-hip ratio (p = 0.019). Compared to placebo, metformin did not change percent breast density and dense breast volume but led to a numerical but not significant decrease in non-dense breast volume (p = 0.070).

CONCLUSION

We conclude that metformin intervention resulted in favorable changes in anthropometric measures of adiposity and a borderline decrease in non-dense breast volume in women with metabolic dysregulation. More research is needed to understand the impact of metformin on breast cancer risk reduction.

TRIAL REGISTRATION

ClinicalTrials.gov NCT02028221. Registered January 7, 2014, https://clinicaltrials.gov/ct2/show/NCT02028221.

Address: University of Arizona Cancer Center, University of Arizona, 1515 N Campbell Ave, Tucson, AZ, 85724, USA.; Department of Biological-Chemistry Sciences, University of Sonora, Hermosillo, Sonora, Mexico.; Department of Medicine, University of Arizona, Tucson, AZ, USA.; Department of Epidemiology and Biostatistics, University of Arizona, Tucson, AZ, USA.; Department of Radiology, Stony Brook University, Stony Brook, NY, USA.; Department of Medical Imaging, University of Arizona, Tucson, AZ, USA.; Department of Health Promotion Sciences, University of Arizona, Tucson, AZ, USA.; Department of Nutritional Sciences, University of Arizona, Tucson, AZ, USA.; Department of Family and Community Medicine, University of Arizona, Tucson, AZ, USA.; University of Arizona Cancer Center, University of Arizona, 1515 N Campbell Ave, Tucson, AZ, 85724, USA. [email protected].; Department of Medicine, University of Arizona, Tucson, AZ, USA. [email protected].

DOI: 10.1007/s10549-021-06355-9

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MeSH Terms: Adiposity, Breast Density, Breast Neoplasms, Feasibility Studies, Female, Humans, Mammography, Metabolic Syndrome, Metformin, Obesity