{
  "abstract": "Objective\n\nThe primary objective is to assess metformin's impact on progression free survival (PFS), overall survival (OS), and overall response rates (ORR). Secondary objectives included chemotherapy-related toxicity, glucose metabolism, and quality of life.Methods\n\nA systematic review and meta-analysis were conducted following PRISMA guidelines and registered prospectively in PROSPERO. A comprehensive literature search was performed in November 2024 across PubMed, Google Scholar, Ovid MEDLINE, and ClinicalTrials.gov. Randomized controlled trials evaluating metformin as an adjunct to chemotherapy were included. The primary outcomes assessed were PFS, OS, and ORR; secondary outcomes included chemotherapy-related side effects, glucose metabolism, and quality of life. Data extraction and quality assessment were performed using standardized tools, and statistical analyses were conducted using RevMan 5.4 Heterogeneity was assessed using the I² statistic, and a random-effects model was applied when necessary.Results\n\nNineteen RCTs involving 3,502 participants were included. Subgroup analyses demonstrated a significant OS benefit when metformin (1500 mg/day) was combined with platinum-based chemotherapy (HR = 0.61, 95% CI 0.46-0.81; p = 0.0006). Metformin also significantly improved ORR in patients with breast cancer (OR = 1.86, 95% CI 1.19-2.92; p = 0.007) and in studies using a 500 mg/day dose (OR = 3.39, 95% CI 1.37-8.39; p = 0.008). Overall, metformin significantly improved ORR (OR = 1.59, 95% CI 1.02-2.46; p = 0.04). However, no significant improvements were observed in overall PFS (HR = 1.08, 95% CI 0.96-1.22; p = 0.19) or OS (HR = 1.08, 95% CI 0.90-1.30; p = 0.41). Grade ≥3 adverse events were comparable between groups (OR = 1.10, 95% CI 0.66-1.84; p = 0.72).Conclusion\n\nAdjunctive metformin did not improve overall or PFS but was associated with a higher ORR, driven by increased complete responses, without increasing high-grade toxicity. A survival benefit was observed in exploratory subgroup analyses at a 1500 mg/day dose in platinum-based chemotherapy, warranting prospective trials to clarify these findings.",
  "abstract_shown": true,
  "affiliations": [
    "Faculty of Medicine and Surgery, Batterjee Medical College, Jeddah, Saudi Arabia.",
    "College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.",
    "College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.",
    "King Abdullah International Medical Research Center, Jeddah, Saudi Arabia.",
    "Department of Internal Medicine, Division of Endocrinology, Ministry of the National Guard-Health Affairs, Jeddah, Saudi Arabia.",
    "Department of Clinical Pharmacology and Toxicology, College of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia."
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 11,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Bushra Wadi Bin Saddiq"
    },
    {
      "affs": [
        0
      ],
      "name": "Ahmed Salah Morad"
    },
    {
      "affs": [
        0
      ],
      "name": "Tanveer Nidal Khan"
    },
    {
      "affs": [
        0
      ],
      "name": "Joud Jamal Alshowaikhat"
    },
    {
      "affs": [
        0
      ],
      "name": "Jorie Nasser Alsharari"
    },
    {
      "affs": [
        0
      ],
      "name": "Renad Omar Bajri"
    },
    {
      "affs": [
        1
      ],
      "name": "Meral Jehad AlZayer"
    },
    {
      "affs": [
        0
      ],
      "name": "Saaid Mounzer Mouazen",
      "orcid": "0009-0001-1013-9343"
    },
    {
      "affs": [
        0
      ],
      "name": "Mohammed Abdulhameed Abutaleb"
    },
    {
      "affs": [
        2,
        3,
        4
      ],
      "name": "Suhaib Radi"
    },
    {
      "affs": [
        5
      ],
      "name": "Hassan Alwafi"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/491fgf378vwjq.bib",
  "cited_by": 0,
  "doi": "10.3389/fonc.2026.1888506",
  "fulltext_url": "https://europepmc.org/articles/PMC13639577",
  "id": "491fgf378vwjq",
  "issns": [
    "2234-943X"
  ],
  "landing_url": "https://europepmc.org/article/MED/42840671",
  "language": "eng",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "1312|Metabolism, Diabetes, and Cancer"
    ]
  ],
  "openalex": "W7212010350",
  "pdf_url": "https://europepmc.org/articles/PMC13639577?pdf=render",
  "pmcid": "PMC13639577",
  "pmid": "42840671",
  "published": "2026-09-09",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/491fgf378vwjq.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:18:10Z",
      "native_id": "MED:42840671",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42840671"
    }
  ],
  "subjects": [
    {
      "field": "biochemistry",
      "origin": "openalex:1312|Metabolism, Diabetes, and Cancer",
      "subfield": "molecular-biology"
    }
  ],
  "title": "Revisiting metformin as a chemotherapy adjuvant: a systematic review and meta-analysis based on recent randomized-controlled trials.",
  "title_text": "Revisiting metformin as a chemotherapy adjuvant: a systematic review and meta-analysis based on recent randomized-controlled trials.",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:18:10Z",
  "url": "https://research.draconitic.com/paper/491fgf378vwjq",
  "venue": "Frontiers in oncology",
  "versions": []
}