Metformin
Comments
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So, ladies who want metformin...ask your PCP to test your fasting blood sugar. If it comes back over 100, (s)he is totally justified in prescribing metformin as a "pre-diabetes" drug, not an "off-label" use at all.
If you have any signs of polycystic ovaries, that's another perfectly acceptable use.
If you are overweight or have any other indications of metabolic syndrome (high blood pressure, high cholesterol, etc) that is another acceptable use.
There's more than one way for your doctor to justify a metformin prescription.
I don't know about getting it online - it's probably way more than the $4 a month you'll pay at WalMart.
However you get it, be sure to have your doctor order it first in 500 mg tablets so you can build up your dose gradually. That's the best way to avoid or minimize the GI distress. And it costs the same regardless of the strength of the pills. I am now taking 2 - 1000 mg tabs and it's still $4 or $10 for 3 months (180 tabs). When I was getting 360 tabs for 3 months, it was $10.
Good luck!
Michelle
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My oncologist called me - she said that she was very uncomfortable with metformin - felt the side effects were too scary (though that is not what I have heard) and that it could cause other problems including (acidosis?) and weight gain.
She knows that I don't come to her with every little thing I hear and knows that I research myself before I even go to her and also knows that I do some integrative stuff (she originally referred me to a complementary intergrative doc) so she said she looked over the studies that I sent her and yes, finds it interesting and that she feels there is a corrolation between sugar and cancer but that it isnt that simple (which we know- nothing with cancer is simple.)She is the one who got me Zometa early - 3 years ago and has no problem with thinking outside the box but that this makes her uncomfortable.
She said that she would be talking to her contact at Sloan and see what they say (because they are studying it there as well) and would keep her eye on it. I dont go back to her until October and she said by then maybe she would have more information for me.
I said, I should probably just do a better job of avoiding sweets, huh and she said - probably.
She was asking how many people I knew whose docs were prescribing it and where they were located (canada vs. us vs. europe).
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Quick question, just checked in after a few weeks of not being on. Does Metformin help those with neg or positive bc or has it shown to help women with bc in general?
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I just watched Dr. Oz and a study showed that taking a tbs(?) of vinegar before meals lowered blood sugar by 30%. I only caught it out of the corner of my eye so I am unclear of the exact amt to be taken. Check out the Dr Oz website and see what they say about vinegar...a more natural way to reduce blood sugars.
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Hi Mary - I was not able to get my oncologist to perscribe it after repeated attempts. Just not comfortable perscribing it for off label use. So, I ended up buying it from a drug company in England which I could dig up for you. I think it cost about $60 per month. I went to see my GP and had a discussion about it. He was aware of the bc benefits and very comfortable with the drug. I ended up leaving there with free samples and a perscription. After so much resistance from my oncologist, felt like I had won the lottery. I do have a good long term relationship with my GP. He feels very confident that it won't do me any harm and there is ongoing increasing evidence that it will be of great benefit. I think the difference may be the family physicians perscribe metformin all the time and oncologists do not.
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Here is some information about the phase III trial. I'm sorry it is spaced out like this. I don't know how to correct that. G.
METFORMIN
Name of the Trial
Phase III Trial of Metformin versus Placebo in Early-Stage Breast Cancer (CAN-NCIC-MA.32). See the protocol summary.“We think metformin may act against breast cancer through insulin-mediated or insulin-independent mechanisms of action, or both,” said Dr. Goodwin. “First, it may lower insulin levels, thereby reducing signaling through the PI3K [signaling] pathway, which is a growth/proliferation pathway in breast cancer cells. Secondly, independent of insulin, metformin alters metabolism in the mitochondria and turns on the [enzyme] AMP kinase, which then inhibits mTOR, a protein that helps regulate cell division and survival,” she explained.
“So, metformin is biologically a very interesting drug, and because it’s been used so widely, its side effects are well known,” Dr. Goodwin added. “In general, it’s a very safe and well-tolerated drug if you avoid its use in patients older than 80 and those with abnormal liver, kidney, or cardiac functions. The most common side effects are mild bloating and diarrhea that usually go away on their own after a few months, but we are starting off at half the dose of metformin for the first 4 weeks to help participants adjust.”
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Does anyone know what percentage it suppose to reduce reoccurence by? Bev I would love the website where you WERE going to order it from.
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Hi All,
MO just called and was suprised that there are 12 clinicial trials going on at this time on Metformin. I did not know there were that many.
MO said that there are not any in the USA with locations on the east coast.
I will need to check this out- anyone know anything different since I am east coast.
thanks
Chocolate
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ilovechocolate - Dana Farber in Boston is doing the Metformin trial:
http://www.dana-farber.org/Research/Clinical-Trials/Clinical-Trial.aspx?tid=2323
Would that be possible for you?
In regards to doctors not willing to try it, I agree with Beverly that PCPs are more acquainted with the possible side effects, and are perhaps more willing to give it a shot. The only concern my MO has is what effect low blood sugar can have on me, as my BS is in the normal range. But she is fairly satisfied that it is safe. She also knows that with my specific diagnosis, I don't have much to lose unfortunately. -
Just got back from an appt with onc. and I asked about metformin. She was not on board and didn't really have much to say about it, it seemed like she was unaware of any bc connection. I couldn't make sense of what she said other than there are several drugs being tested. I am going to ask my PCM next, I agree a GP prescripts it more and is probably more up on things. My other onc kept prescripting PPI's for my GERD which didn't even exist, after one trip to my PCM I was tested for h. pylori and now that's gone.
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Metformin has a reputation for helping people lose weight, not gain weight. And yes, it can cause lactic acidosis, but it's very, very rare and usually happens to people who drink too much.
Twelve clinical trials is pretty significant. My first MO poo-poo'd the idea, the second one told me I was on the right drug. It depends on whether or not your MO is current on the latest clinical trials and findings. And I agree that your PCP is more likely to uderstand Metformin. It has a reputation as one of the oldest, cheapest, safest diabetes drugs in existence. I really don't understand any MO saying it's risky.
Michelle
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Hello,
Just got back from seeing my MO and she brought up the subject and asked if I wanted to participate in the Phase III Trial for Metformin. She gave me all the paperwork and told me to do my own research and come back with questions if I am interested. She thinks it will be only be positive for me to participate (although it is a double blind study, so don't know if I will actually be taking it or not). The cancer center I go to is looking at enrolling ~3600 patients.
If anyone knows of any additional information about this trial, please post the links. Thank you.
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Proud Mom-
i am curious- if you can find it in your paperwork... if you don't get the drug do you get a sugar pill or something more helpful?
Luvring
Yeah- 12 trials really struck me as - wow- it really is tempting to order on line. I am holding on to my appointment with the holistic dr (do) in 3 weeks.
Chocolate
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There is more good info re Metformin in the thread titled "Metformin; Is Anyone On This Trial?" on the Clinical Trial, Research... forum. There is discussion about studies, docs' reactions, ordering online and includes a link to a British Co. online source. Not sure if it is the same company referenced by Bev. The thread was active back in February if you want to pull it up.
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Ilovechocolate - Love your name.
If I join the trial I will receive either Metformin or Placebo, neither my MO or I will be told. Although, I have read that if you start the trial and have GI issues at the beginning, odds are you are taking the Metformin. But if you do not have GI issues, you might be taking Metformin also, just not having any SEs.
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one more question- if you start the trial would if show in your blood work - like reduced insulin?
this is not my area of expertise. Also, do trial participants who don't get the real thing- get some benefit?
thanks
I really need some chcolate
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ProudMom, Please keep us posted about your decision to join the trial and I hope you get the Metformin if you do. Best of luck!
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Ilovechocolate - Hmmm interesting question about the blood work. If I get the placebo, the benefit is that I am being monitored for years (in addition to regular checkups), even after the trial ends.
Octobergrace - Thank you.
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ProudMom
I do wish you the best- let us know
I will let you know as well!
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Ladies....can someone explain the benefit of taking Metformin? I haven't heard much of this drug. I am just finishing the trial study of Zometa and I am wondering if I should be pushing for this drug now.
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VR- where are you when we need you? VR is great at explanations. My understanding is to basic-kills cancer cells. PLease correct me if I am incorrect.
I don't qualify for Dana Farber study because of my dx- officially stage 1 a and study requires 1c or greater.
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Metformin Is an AMP Kinase-Dependent Growth Inhibitor for Breast Cancer CellsMahvash Zakikhani1, Ryan Dowling2, I. George Fantus3, Nahum Sonenberg2, and Michael Pollak1+ Author AffiliationsDepartments of 1Oncology and 2Biochemistry, McGill University, Montreal, Quebec, Canada and 3Department of Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada Requests for reprints:
Michael Pollak, Cancer Prevention Center, Jewish General Hospital, E-763, 3755 Cote Ste. Catherine Montreal, Quebec, Canada H3T 1E2. Phone: 514-340-8222, ext. 4139; Fax: 514-340-8600; E-mail: Michael.pollak@mcgill.ca. AbstractRecent population studies provide clues that the use of metformin may be associated with reduced incidence and improved prognosis of certain cancers. This drug is widely used in the treatment of type 2 diabetes, where it is often referred to as an "insulin sensitizer" because it not only lowers blood glucose but also reduces the hyperinsulinemia associated with insulin resistance. As insulin and insulin-like growth factors stimulate proliferation of many normal and transformed cell types, agents that facilitate signaling through these receptors would be expected to enhance proliferation. We show here that metformin acts as a growth inhibitor rather than an insulin sensitizer for epithelial cells. Breast cancer cells can be protected against metformin-induced growth inhibition by small interfering RNA against AMP kinase. This shows that AMP kinase pathway activation by metformin, recently shown to be necessary for metformin inhibition of gluconeogenesis in hepatocytes, is also involved in metformin-induced growth inhibition of epithelial cells. The growth inhibition was associated with decreased mammalian target of rapamycin and S6 kinase activation and a general decrease in mRNA translation. These results provide evidence for a mechanism that may contribute to the antineoplastic effects of metformin suggested by recent population studies and justify further work to explore potential roles for activators of AMP kinase in cancer prevention and treatment. (Cancer Res 2006; 66(21): 10269-73 -
On the cell level...metaformin basically interfers with the production of producing carbohydrate energy that leads to the proliferation of cancer cells...I think.
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Energy Balance, Host-Related Factors, and Cancer ProgressionStephen D. Hursting and Nathan A. Berger+ Author AffiliationsFrom The University of Texas, Austin; University of Texas M. D. Anderson Cancer Center, Smithville, TX; and Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH. Corresponding author: Stephen D. Hursting, PhD, The University of Texas, 1 University Station A2700, Painter Hall, Room 5.32, Austin, TX 78712; e-mail: shursting@austin.utexas.edu. AbstractObesity is associated with an increased risk and worsened prognosis for many types of cancer, but the mechanisms underlying the obesity-cancer progression link are poorly understood. Several energy balance-related host factors are known to influence tumor progression and/or treatment responsiveness after cancer develops, and these have been implicated as key contributors to the complex effects of obesity on cancer outcome. These host factors include leptin, adiponectin, steroid hormones, reactive oxygen species associated with inflammation, insulin, insulin-like growth factor-1, and sirtuins. Each of these host factors is considered in this article in the context of energy balance and cancer progression. In addition, future research directions in this field are discussed, including the importance of study designs addressing energy balance across the life course, the development and application of highly relevant animal models, potential roles of cancer stem cells in the response to energy balance modulation, and emerging pharmacologic approaches that target energy balance-related pathways.
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What the above article means is that on a cellular level...how energy is created (in the mitochondria) is paramount.
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VR,
thank you for providing this information and explanation!!
Chocolate
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For the ladies on the trial...not having side effects does not mean you are on the placebo. I have been taking metformin for awhile...I have had absolutely no gi issues, and my blood sugar always was and remains within the normal range...so I don't think blood tests will be indicative.
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I talked to a nurse today who is in charge of a diabetic clinic and she said that we shouldn't be taking Metformin unless we are in the three or four studies that are ongoing presently. Her concern was that in some cases kidneys and livers can be damaged - especially because many of us have been on chemo - people in the studies are having their blood monitored closely and someone is checking things like creatinine levels - she also said that it is "foolish" to be ordering any drug online that doesn't have a prescription - I agree with her.
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Okay, so I went to DH''s appointment today for his minor issue and briefly mentioned my situation. The dr. stated that his wife was dx with bc last year so he was really up on it. Mentioned Metformin and he said it was safe (max dose 2000 he said- ), been around for 30 years and he would have no trouble writing for it. I said I wanted to make sure I was folllowed. .Appointment next week. Ofcourse, he also endorsed ovary removal. I will let you know.
Chocolate
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I'm on zometa, so still getting liver and kidney functon tested every 6 months. I don't think there has been much change with either, but even if there was, we wouldn't know if it was from the zometa or the metformin or combo of both. I agree that if you were to order this online without a prescription, you would probably want to get these levels checked periodically. My guess is that you could ask your pcp to test these--use the excuse that you just want to make sure chemo hasn't given you liver and kidney problems! I think the tests are pretty routine and inexpensive, so I don't think you would be told no.
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