Metformin and Breast Cancer

Sherryc:  My onc wasn't impressed, in fact, he blew off my questions as though they were stupid.  I just think they have their minds made up about what meds to give, based on guidelines for "standard of care" and they don't want to deviate from that.

My naturopath said that he wasn't a fan because it was a "manufactured drug" but that if I had mets or a more aggressive stage of bc he would consider prescribing it.

You could get a second opinion.  I have an app't with another MO in March and I will ask her what her thoughts are about this drug. 

fredntan:  I didn't even mention that I was taking Naltroxen to my MO.  After his reaction to Metformin, I can only imagine what he would have said about Naltroxen...probably that it's only used in drug and alcohol abuse, which it is, but in larger doses.  They even use it for babies in very small doses when the mother has had too many sedatives during labor.  It helps revive them, so how dangerous can it be if they use it on newborns.  So far, I've had absolutely no SE's.

The oncologists don't generally seem to be on board with Metformin yet...would suggest you discuss it with your GP instead (they prescribe it quite commonly and seem to have a good comfort level with it---that's how many of us have been successful in getting the prescription)

good luck!

Wish I could find an MO that thinks outside the box!  I'm starting on taxoxifen which I'm not happy about, but that is all he would prescribe...that or an Al.  I was worried about the SE's from Al's.

Metformin is also on the $4/$10 list at Target, and some pharmacies associated with grocery stores have programs that provide diabetes medication (which Metformin is) for free.

One caution is that if you are scheduled for some tests, like bone scans, CAT scans, or MRI's using contrast, you should stop the Metformin for a day before the test, and not start again until the injected dye is cleared from your system.

Taking the Metformin with food can help minimize those GI effects.

Kaara, ask for an HbA1c test the next time you have blood work done.  If you are anywhere near the cutoff for being pre-diabetic, the Tamoxifen may push your numbers close enough to the edge to justify the Metformin.  Your best bet for a prescription is probably your primary care doc since they prescribe Metformin all the time, while MO's don't.

LuvRVing:  LOL...my boyfriend and I had a good laugh after we visited my MO and asked about Metformin and he immediately brought up the black box label and went over all the SE's.  Of course, when he discussed tamox and Al's it was all rosy.  He said "Metformin is for people who have diabetes and are overweight and you aren't"...end of story!  I'll be getting another opinion.

Interesting article on Metformin.

 http://www.diabetesselfmanagement.com/blog/david-spero/metformin-wonder-drug/print/

Circles - there is not another drug that works the same as metformin, but it's generic and there could be one out there with different "fillers" which may be what's causing the rash, assuming it isn't something else. 

My only suggestion would be to try getting it from a different manufacturer and see if that makes a difference.  As far as I know, there is no drug with similar action.  Maybe getting the original branded "Glucophage" or "Fortamet" might make a difference.  Also, there is the regular version and the extended release version.  Depending on which one you have, you might try the alternative version. 

http://www.drugs.com/metformin.html

ladies, I found this discussion and I need to weigh in here and tell you a story about Metformin and it's effect on breast cancer-at least one type.

My wife, as of Christmas of 2011, was given 'a few months' to live. She was first diagnosed in 2008, no chemo worked but radiation shrunk the IBC affected area enough for surgery. In 2009 it came back. Over the next two years, nothing worked and we are on our 3rd oncologist, who told us a few days after Christmas that we were looking at a 'few months maybe' and that there wasn't anything left to try.

I put her on Metformin myself (I was desperate) and a few days later convinced her oncologist to prescribe it after handing him about 100 pages of all the preclinical studies that you can all find with a google search.

They now call her 'The Miracle' at the cancer center. Her Inflammatory Breast Cancer was very advanced skin mets, had crossed over her chest, begun to crawl up her throat and into the soft tissue in her throat and was literally choking her. A month later, it is in retreat.

 She is her2+, and her oncologist believes that this may be important, he's organizing a trial (it's a university hospital, that's how we ended up here.) and has a handful of women on it already, although they aren't presenting much in the way of skin mets, so they have to wait for scans to see if it's working for them as well as for my wife.

 You have to understand, she's had every chemo there is-and got next to no response from any of them, other than her spread has been slow, so I supposed given that she's got IBC that means they were working to some extent, but not well enough. Last year, Christmas '10 her first oncologist told her to 'accept reality' and that there was nothing more to do for her. I found a TDM-1 trial that would accept her (a miracle given how heavily pre-treated she'd been) but it didn't work. Then they sent us to our current oncologist, and she was on RAD 001 for awhile, and it seemed to work a bit for awhile and then stopped.

All hope was lost just six weeks ago. It's been a miracle. What was nasty, dark purple and swollen hard skin is now pink, healing, and soft skin. She's had an open wound for over a year (thanks to post Avastin flareup) that is now visibly shrinking, scabbing around the edges.

She IS on carboplatin and gemzar as well, but her doctor thinks (and I think too, as none of the other nasty chemos did anything positive for her-and she literally had every single thing that was FDA approved) that the metformin is the key.

It may not work for everyone, it may have something to do with the her2 status, but it is absolutely worth a chance if you can.

For what it's worth, she's had very little side effects other than she does tend to 'crash' a bit about 30-45 minutes after eating a meal. We both think, actually, that she's kind of always been that way but it's a little more noticeable now. A little fruit juice or an apple or something and she's fine. She is not diabetic although we both believe that something was up with her blood sugar before given the fact that the metformin is working so well and the 'crashes'. She is in the normal range and they are monitoring her very closely.

I just wanted you to know. I am telling everyone I can. This drug hasn't been pushed because there's no money in it but it just may be the answer for you! I know it was for us. I'm not exaggerating, a noted her2 specialist had given up and sent us home with a bag of morphine for Christmas. Now he's calling her 'the miracle'.

Please look into it.

Chris

Chris, I have copied your story and posted it on facebook. 

Chris:  That is a wonderful testimony!  We need to hear things like this.  My MO wouldn't even discuss Metformin when I brought it up...said it was for overweight diabetics of which I was not, and that I would need to discuss this with my PCP as he wasn't going to prescribe it!  Very frustrating.

Prayers that your wife continues to improve! 

Chris,

Thanks for your interesting posts, and tell your wife I'm so happy for you both. I wondered what her age range might be when reading what you had to say.

From what I have read the trials for the use of it for breast cancer got rolling in 2009, I think in Canada first...

At that time I was at wits end with the dilemma as a stage 1 t1c who had done chemotherapy and a bit of tamoxifen in order to reduce my risk of recurrence, only to find that medical providers were pretty much oblivious to the increased risk for recurrence that happens due to chemopause and weight gain. I have no other chronic diseases than bc. I spent over a year seeing the cancer center dietitian and then convinced my NP to refer me to an endocrinologist. Sadly, his take on it was "get a tummy tuck if you want, your tests indicate your diet is extremely proper, maintain daily exercise". I knew by then about the metformin trials and got an Rx from him for it even though he was not aware of any of the trials using it for cancer. I still exercise an hour every day and stick to a very healthy diet, but It has been a godsend in helping to keep from gaining more weight so that my risk for recurrence does not continue to increase.

I am especially fascinated by Dr. Lisanti's work with it and explanations for how it works to cause apoptosis of cancer cells.

My older sister had IDC 12 years ago and only did 2 weeks of tamoxifen for it and it never recurred, but she was dx'd with IBC 2 years ago (not HER2 positive). She is not diabetic but is quite overweight, like many other IBC patients.

I saw my PCP and provided him with a copy of the online news about the December 1st article in Cell Cycle about Dr. Lisanti, and he added it to my medical records to substantiate why I am taking the drug, as a breast cancer patient. I take a very low dose, only 250 mg per meal but it still has made a difference for me when nothing else I did was helping.

See my history below.

AlaskaAngel

Kaara,

Your laymans explanation of the sugar mech is right on. Simple and logical. I've been a diabetic for 20 years and been on metformin for 10. However, my diet consisted of lots of sugar and I didn't always take the metformin.

I totally believe that the sugar induced the BC. I had the lump in my breast for 35 years and it was destined to become cancer but the severity of it came from the SUGAR.IMO. 

Before chemo is rx'ed, dole out the metformin!!!

I had been on Atkins diet for the last 8 years--all sugar free.  My 25 year old lump turned into cancer somehow and was huge.  It looked like a visible lemon.  It is my belief that it grew slowly and didn't spread because I simply didn't eat sugar or starchy veggies.  I like the idea of Metformin.