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Drug Repurposing — SCE Medical Oncology MCQ

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ModerateImmunotherapy & Targeted TherapyDrug RepurposingSCE Medical Oncology

A 68-year-old man with metastatic melanoma is being treated with pembrolizumab. He also takes metformin and lisinopril for type 2 diabetes and hypertension. His oncologist notes that some studies suggest metformin may enhance immunotherapy efficacy. Should his metformin be continued?

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Correct answer: E — Continue metformin — it is safe with ICI and retrospective data suggest potential immune-potentiating effects, though no prospective RCT evidence exists to recommend adding it

Retrospective and preclinical data suggest metformin may enhance anti-tumour immunity through AMPK-mediated effects on T-cell function and tumour metabolism. Several retrospective analyses show improved ICI outcomes in metformin users. However, no prospective randomised trial has confirmed this. Metformin is safe to continue with ICI and there is no reason to discontinue it. Prospective trials (e.g. NCT03311308) are evaluating metformin + ICI combinations. This is an example of drug repurposing in oncology.

Reference: ESMO 2024 Translational Research perspective; Afzal et al JNCI 2019