Fighting Cancer With a Diabetes Drug

SGLT2 inhibitors have emerged as a gold standard medication for treating patients with heart failure (HF), regardless of the patient’s ejection fraction. These medications have consistently demonstrated the ability to reduce the risk of hospitalization and extend survival in patients with symptomatic HF.

Cardiotoxicity is a devastating complication of many common chemotherapy medications. Imagine the plight of a patient who successfully fights off a life-threatening malignancy, only to then go on to develop another life-threatening condition (eg, HF). Several common HF medications have shown potential in preventing chemotherapy-related cardiotoxicity, but their effects have been modest.

In this installment of Talking Therapeutics, we explore a first-of-its-kind trial evaluating the potential of SGLT2 inhibitors to prevent chemotherapy-related cardiotoxicity.

Talking Point: Strong Signal for Benefit

Study authors conducted a retrospective analysis of 95 203 patients from a large database, of whom 9402 were on an SGLT2 inhibitor and 85 800 patients were not on an SGLT2 inhibitor at baseline. After propensity score matching, there were 8675 patients in each cohort for this analysis, all of whom had diabetes and cancer and had been exposed potentially cardiotoxic chemotherapeutic agents.

Results showed that the primary outcome of developing chemotherapy-related cardiotoxicity at 12 months was lower in the SGLT2 inhibitor group: 646 patients (7.45%) vs 948 patients (10.9%) in the no SGLT2 inhibitor cohort (hazard ratio, [HR], 0.76: 95% CI, 0.69-0.84). There was also a lower risk with SGLT2 inhibitors for new-onset atrial fibrillation/flutter, new-onset metastatic cancer and systemic antineoplastic therapy. Subgroup analyses also demonstrated reduced risk of cardiotoxic effects across various classes of cancer therapies.

Talking Point: More Data Is Needed

While these findings are laudable and certainly cause for celebration in the cancer community, prospective data in patients who don’t have a current indication for SGLT2 inhibitor therapy (ie, diabetes) are needed before these agents can be recommended up front for prevention of chemotherapy-related cardiotoxicity.

However, if these findings are confirmed, SGLT2 inhibitors would be a wonderful addition to the current preventative regimens for chemotherapy-related cardiotoxicity, given that they are available orally and have relatively few side effects.