Pancreatic carcinoma is a highly aggressive tumor that usually presents when it has already metastasized. Therapeutic options for cure remain scarce and rely on combination chemotherapy with limited sustainability. Diabetes is considered an important risk factor for the development of pancreatic cancer due to the production of proinflammatory cytokines, which result in increased cell proliferation. More than half of patients diagnosed with pancreatic cancer eventually develop diabetes due to the destruction of insulin-producing cells. The interlinkage of both diseases might identify a possible preventative strategy for reducing the incidence of pancreatic carcinoma. This study reviewed the recent literature on the association between pancreatic cancer risk and SGLT2 inhibitors, GLP-1 RA, DPP-4 inhibitors, and biguanides. There are mixed data regarding the relationship between GLP-1 RA and DPP-4 inhibitors and pancreatic cancer, with some trials suggesting that they might increase the risk. In contrast, studies have mostly revealed that SGLT2 inhibitors have an antiproliferative effect on various tumors, such as liver, pancreatic, prostate, bowel, lung, and breast carcinoma, which might be due to their mechanism of blockage of reabsorption of glucose by cells, lowering the amount of available glucose for the growth of tumor cells. Metformin, the first-line agent for diabetes, has also been shown to be associated with decreasing pancreatic cancer risk and improving prognosis in those who already have the disease. Dedicated trials are needed to further delineate the association of antidiabetic drugs with the risk of pancreatic cancer in the general population, as previous studies have mostly focused on diabetic patients.
胰腺癌是一种高度侵袭性肿瘤，通常在发生转移后才被发现。目前治愈性治疗方案仍然稀缺，主要依赖可持续性有限的联合化疗。糖尿病被认为是胰腺癌发生的重要危险因素，其机制与促炎细胞因子的产生导致细胞增殖加速有关。超过半数的胰腺癌患者在确诊后最终会因胰岛素生成细胞受损而发展为糖尿病。这两种疾病之间的关联可能为降低胰腺癌发病率提供预防策略。本研究综述了近期关于胰腺癌风险与SGLT2抑制剂、GLP-1受体激动剂、DPP-4抑制剂及双胍类药物相关性的文献。关于GLP-1受体激动剂和DPP-4抑制剂与胰腺癌的关系存在不一致数据，部分试验提示可能增加风险。相比之下，研究多显示SGLT2抑制剂对肝癌、胰腺癌、前列腺癌、肠癌、肺癌及乳腺癌等多种肿瘤具有抗增殖作用，这可能源于其阻断细胞葡萄糖重吸收的机制，从而降低肿瘤细胞生长所需的葡萄糖供应。作为糖尿病一线药物的二甲双胍也被证实与降低胰腺癌风险相关，并能改善已患病者的预后。由于既往研究主要聚焦于糖尿病患者群体，未来需要专门试验进一步阐明降糖药物与普通人群胰腺癌风险的关联。
Role of SGLT2 Inhibitors, DPP-4 Inhibitors, and Metformin in Pancreatic Cancer Prevention
肿瘤(癌症)患者之家