Skip to main content

Advertisement

Log in

Type II Diabetes, Metformin Use, and Colorectal Neoplasia: Mechanisms of Action and Implications for Future Research

  • Molecular Epidemiology (L Jiao and CR Daniel-MacDougall, Section Editors)
  • Published:
Current Colorectal Cancer Reports

Abstract

Type 2 diabetes mellitus has been associated with increased colorectal cancer incidence and mortality. Recently, metformin, a drug used widely for treatment of type 2 diabetes mellitus, has gained much attention because of its anticancer effect. Several observational and preclinical studies reported that metformin was associated with decreased risk of colorectal cancer and improved colorectal cancer survival. Although the exact mechanisms underlying the anticancer effect of metformin are not known, several mechanisms have been proposed, including AMP-activated protein kinase mediated inhibition of mammalian target of the rapamycin, decreasing insulin-like growth factor 1 levels, anti-inflammatory activity, cell cycle arrest, and cancer stem cell inhibition. In addition, in patients with colorectal cancer, metformin may have potential as a chemopreventive agent and adjuvant drug. Large-scale, well-designed, long-term, and randomized controlled trials are needed to confirm the potential benefit of metformin for both the diabetic population and the nondiabetic population.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Deng L, Gui Z, Zhao L, Wang J, Shen L. Diabetes mellitus and the incidence of colorectal cancer: an updated systematic review and meta-analysis. Dig Dis Sci. 2012;57(6):1576–85.

    Article  CAS  PubMed  Google Scholar 

  2. Calle EE, Rodriguez C, Walker-Thurmond K, Thun MJ. Overweight, obesity, and mortality from cancer in a prospectively studied cohort of U.S. adults. N Engl J Med. 2003;348(17):1625–38.

    Article  PubMed  Google Scholar 

  3. Lee IM. Physical activity and cancer prevention—data from epidemiologic studies. Med Sci Sports Exerc. 2003;35(11):1823–7.

    Article  PubMed  Google Scholar 

  4. Secretan B, Straif K, Baan R, Grosse Y, El Ghissassi F, Bouvard V, et al. A review of human carcinogens—part E: tobacco, areca nut, alcohol, coal smoke, and salted fish. Lancet Oncol. 2009;10(11):1033–4.

    Article  PubMed  Google Scholar 

  5. Pollak M. Insulin and insulin-like growth factor signalling in neoplasia. Nat Rev Cancer. 2008;8(12):915–28.

    Article  CAS  PubMed  Google Scholar 

  6. Yu H, Pardoll D, Jove R. STATs in cancer inflammation and immunity: a leading role for STAT3. Nat Rev Cancer. 2009;9(11):798–809.

    Article  CAS  PubMed  Google Scholar 

  7. Stein KB, Snyder CF, Barone BB, Yeh HC, Peairs KS, Derr RL, et al. Colorectal cancer outcomes, recurrence, and complications in persons with and without diabetes mellitus: a systematic review and meta-analysis. Dig Dis Sci. 2010;55(7):1839–51.

    Article  PubMed Central  PubMed  Google Scholar 

  8. Bowker SL, Majumdar SR, Veugelers P, Johnson JA. Increased cancer-related mortality for patients with type 2 diabetes who use sulfonylureas or insulin. Diabetes Care. 2006;29(2):254–8.

    Article  PubMed  Google Scholar 

  9. Landman GW, Kleefstra N, van Hateren KJ, Groenier KH, Gans RO, Bilo HJ. Metformin associated with lower cancer mortality in type 2 diabetes: ZODIAC-16. Diabetes Care. 2010;33(2):322–6.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  10. Noto H, Goto A, Tsujimoto T, Noda M. Cancer risk in diabetic patients treated with metformin: a systematic review and meta-analysis. PLoS One. 2012;7(3):e33411.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  11. Lee JH, Kim TI, Jeon SM, Hong SP, Cheon JH, Kim WH. The effects of metformin on the survival of colorectal cancer patients with diabetes mellitus. Int J Cancer. 2012;131(3):752–9. The authors showed that metformin use in CRC patients with diabetes is associated with lower risk of CRC-specific and overall mortality.

    Article  CAS  PubMed  Google Scholar 

  12. Garrett CR, Hassabo HM, Bhadkamkar NA, Wen S, Baladandayuthapani V, Kee BK, et al. Survival advantage observed with the use of metformin in patients with type II diabetes and colorectal cancer. Br J Cancer. 2012;106(8):1374–8. The authors showed that CRC patients with DM treated with metformin appeared to have superior survival.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  13. Zhang ZJ, Zheng ZJ, Kan H, Song Y, Cui W, Zhao G, et al. Reduced risk of colorectal cancer with metformin therapy in patients with type 2 diabetes: a meta-analysis. Diabetes Care. 2011;34(10):2323–8. This meta-analysis showed metformin use appears to be associated with a significantly lower risk of CRC in patients with type 2 DM.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  14. American Diabetes Association. Standards of medical care in diabetes--2013. Diabetes Care. 2013;36(Suppl 1):S11-66.

    Google Scholar 

  15. Sarbassov DD, Ali SM, Sabatini DM. Growing roles for the mTOR pathway. Curr Opin Cell Biol. 2005;17(6):596–603.

    Article  CAS  PubMed  Google Scholar 

  16. Godsland IF. Insulin resistance and hyperinsulinaemia in the development and progression of cancer. Clin Sci (Lond). 2010;118(5):315–32.

    Article  CAS  Google Scholar 

  17. Lai GY, Park Y, Hartge P, Hollenbeck AR, Freedman ND. The association between self-reported diabetes and cancer incidence in the NIH-AARP Diet and Health Study. J Clin Endocrinol Metab. 2013;98(3):E497–502. This large prospective cohort study showed that diabetes was positively associated with the total incidence of cancer, including CRC.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  18. Larsson SC, Orsini N, Wolk A. Diabetes mellitus and risk of colorectal cancer: a meta-analysis. J Natl Cancer Inst. 2005;97(22):1679–87.

    Article  PubMed  Google Scholar 

  19. Yuhara H, Steinmaus C, Cohen SE, Corley DA, Tei Y, Buffler PA. Is diabetes mellitus an independent risk factor for colon cancer and rectal cancer? Am J Gastroenterol. 2011;106(11):1911–21. quiz 22.

    Article  PubMed Central  PubMed  Google Scholar 

  20. Bella F, Minicozzi P, Giacomin A, Crocetti E, Federico M, Ponz de Leon M, et al. Impact of diabetes on overall and cancer-specific mortality in colorectal cancer patients. J Cancer Res Clin Oncol. 2013. doi:10.1007/s00432-013-1439-8.

    Google Scholar 

  21. Jiang Y, Ben Q, Shen H, Lu W, Zhang Y, Zhu J. Diabetes mellitus and incidence and mortality of colorectal cancer: a systematic review and meta-analysis of cohort studies. Eur J Epidemiol. 2011;26(11):863–76.

    Article  PubMed  Google Scholar 

  22. Currie CJ, Poole CD, Gale EA. The influence of glucose-lowering therapies on cancer risk in type 2 diabetes. Diabetologia. 2009;52(9):1766–77.

    Article  CAS  PubMed  Google Scholar 

  23. Yang YX, Hennessy S, Lewis JD. Insulin therapy and colorectal cancer risk among type 2 diabetes mellitus patients. Gastroenterology. 2004;127(4):1044–50.

    Article  CAS  PubMed  Google Scholar 

  24. Bowker SL, Yasui Y, Veugelers P, Johnson JA. Glucose-lowering agents and cancer mortality rates in type 2 diabetes: assessing effects of time-varying exposure. Diabetologia. 2010;53(8):1631–7.

    Article  CAS  PubMed  Google Scholar 

  25. Krentz AJ, Bailey CJ. Oral antidiabetic agents: current role in type 2 diabetes mellitus. Drugs. 2005;65(3):385–411.

    Article  CAS  PubMed  Google Scholar 

  26. Hsieh MC, Lee TC, Cheng SM, Tu ST, Yen MH, Tseng CH. The influence of type 2 diabetes and glucose-lowering therapies on cancer risk in the Taiwanese. Exp Diabetes Res. 2012;2012:413782.

    Article  PubMed Central  PubMed  Google Scholar 

  27. Derosa G, Maffioli P. α-Glucosidase inhibitors and their use in clinical practice. Arch Med Sci. 2012;8(5):899–906.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  28. Weaver GA, Tangel CT, Krause JA, Parfitt MM, Jenkins PL, Rader JM, et al. Acarbose enhances human colonic butyrate production. J Nutr. 1997;127(5):717–23.

    CAS  PubMed  Google Scholar 

  29. Weaver GA, Tangel CT, Krause JA, Parfitt MM, Stragand JJ, Jenkins PL, et al. Biomarkers of human colonic cell growth are influenced differently by a history of colonic neoplasia and the consumption of acarbose. J Nutr. 2000;130(11):2718–25.

    CAS  PubMed  Google Scholar 

  30. Hamer HM, Jonkers D, Venema K, Vanhoutvin S, Troost FJ, Brummer RJ. Review article: the role of butyrate on colonic function. Aliment Pharmacol Ther. 2008;27(2):104–19.

    Article  CAS  PubMed  Google Scholar 

  31. Quesada CF, Kimata H, Mori M, Nishimura M, Tsuneyoshi T, Baba S. Piroxicam and acarbose as chemopreventive agents for spontaneous intestinal adenomas in APC gene 1309 knockout mice. Jpn J Cancer Res. 1998;89(4):392–6.

    Article  CAS  PubMed  Google Scholar 

  32. Yoshizumi T, Ohta T, Ninomiya I, Terada I, Fushida S, Fujimura T, et al. Thiazolidinedione, a peroxisome proliferator-activated receptor-gamma ligand, inhibits growth and metastasis of HT-29 human colon cancer cells through differentiation-promoting effects. Int J Oncol. 2004;25(3):631–9.

    CAS  PubMed  Google Scholar 

  33. Colmers IN, Bowker SL, Johnson JA. Thiazolidinedione use and cancer incidence in type 2 diabetes: a systematic review and meta-analysis. Diabetes Metab. 2012;38(6):475–84.

    Article  CAS  PubMed  Google Scholar 

  34. Chen SW, Tsan YT, Chen JD, Hsieh HI, Lee CH, Lin HH, et al. Use of thiazolidinediones and the risk of colorectal cancer in patients with diabetes: a nationwide, population-based, case-control study. Diabetes Care. 2013;36(2):369–75.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  35. Ueno T, Teraoka N, Takasu S, Nakano K, Takahashi M, Yamamoto M, et al. Suppressive effect of pioglitazone, a PPAR gamma ligand, on azoxymethane-induced colon aberrant crypt foci in KK-Ay mice. Asian Pac J Cancer Prev. 2012;13(8):4067–73.

    Article  PubMed  Google Scholar 

  36. Cerbone A, Toaldo C, Minelli R, Ciamporcero E, Pizzimenti S, Pettazzoni P, et al. Rosiglitazone and AS601245 decrease cell adhesion and migration through modulation of specific gene expression in human colon cancer cells. PLoS One. 2012;7(6):e40149.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  37. Jabbour S. Primary care physicians and insulin initiation: multiple barriers, lack of knowledge or both? Int J Clin Pract. 2008;62(6):845–7.

    Article  CAS  PubMed  Google Scholar 

  38. Campbell PT, Deka A, Jacobs EJ, Newton CC, Hildebrand JS, McCullough ML, et al. Prospective study reveals associations between colorectal cancer and type 2 diabetes mellitus or insulin use in men. Gastroenterology. 2010;139(4):1138–46.

    Article  PubMed  Google Scholar 

  39. Schoen RE, Tangen CM, Kuller LH, Burke GL, Cushman M, Tracy RP, et al. Increased blood glucose and insulin, body size, and incident colorectal cancer. J Natl Cancer Inst. 1999;91(13):1147–54.

    Article  CAS  PubMed  Google Scholar 

  40. Tran TT, Medline A, Bruce WR. Insulin promotion of colon tumors in rats. Cancer Epidemiol Biomarkers Prev. 1996;5(12):1013–5.

    CAS  PubMed  Google Scholar 

  41. Corpet DE, Jacquinet C, Peiffer G, Tache S. Insulin injections promote the growth of aberrant crypt foci in the colon of rats. Nutr Cancer. 1997;27(3):316–20.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  42. Wong P, Weiner MG, Hwang WT, Yang YX. Insulin therapy and colorectal adenomas in patients with diabetes mellitus. Cancer Epidemiol Biomarkers Prev. 2012;21(10):1833–40.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  43. Chung YW, Han DS, Park KH, Eun CS, Yoo KS, Park CK. Insulin therapy and colorectal adenoma risk among patients with type 2 diabetes mellitus: a case-control study in Korea. Dis Colon Rectum. 2008;51(5):593–7.

    Article  PubMed  Google Scholar 

  44. Desilets AR, Dhakal-Karki S, Dunican KC. Role of metformin for weight management in patients without type 2 diabetes. Ann Pharmacother. 2008;42(6):817–26.

    Article  CAS  PubMed  Google Scholar 

  45. Katsiki N, Hatzitolios AI. Insulin-sensitizing agents in the treatment of polycystic ovary syndrome: an update. Curr Opin Obstet Gynecol. 2010;22(6):466–76.

    Article  PubMed  Google Scholar 

  46. Kooy A, de Jager J, Lehert P, Bets D, Wulffele MG, Donker AJ, et al. Long-term effects of metformin on metabolism and microvascular and macrovascular disease in patients with type 2 diabetes mellitus. Arch Intern Med. 2009;169(6):616–25.

    Article  CAS  PubMed  Google Scholar 

  47. Cappelli C, Rotondi M, Pirola I, Agosti B, Gandossi E, Valentini U, et al. TSH-lowering effect of metformin in type 2 diabetic patients: differences between euthyroid, untreated hypothyroid, and euthyroid on L-T4 therapy patients. Diabetes Care. 2009;32(9):1589–90.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  48. Evans JM, Donnelly LA, Emslie-Smith AM, Alessi DR, Morris AD. Metformin and reduced risk of cancer in diabetic patients. BMJ. 2005;330(7503):1304–5.

    Article  PubMed Central  PubMed  Google Scholar 

  49. Libby G, Donnelly LA, Donnan PT, Alessi DR, Morris AD, Evans JM. New users of metformin are at low risk of incident cancer: a cohort study among people with type 2 diabetes. Diabetes Care. 2009;32(9):1620–5.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  50. Baur DM, Klotsche J, Hamnvik OP, Sievers C, Pieper L, Wittchen HU, et al. Type 2 diabetes mellitus and medications for type 2 diabetes mellitus are associated with risk for and mortality from cancer in a German primary care cohort. Metabolism. 2011;60(10):1363–71.

    Article  CAS  PubMed  Google Scholar 

  51. Ruiter R, Visser LE, van Herk-Sukel MP, Coebergh JW, Haak HR, Geelhoed-Duijvestijn PH, et al. Lower risk of cancer in patients on metformin in comparison with those on sulfonylurea derivatives: results from a large population-based follow-up study. Diabetes Care. 2012;35(1):119–24.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  52. Thakkar B, Aronis KN, Vamvini MT, Shields K, Mantzoros CS. Metformin and sulfonylureas in relation to cancer risk in type II diabetes patients: a meta-analysis using primary data of published studies. Metabolism. 2013. doi:10.1016/j.metabol.2013.01.014. This meta-analysis demonstrated that metformin use reduces cancer risk in subjects with type 2 DM, but sulfonylurea use may be associated with an increased cancer risk.

    PubMed  Google Scholar 

  53. Lee MS, Hsu CC, Wahlqvist ML, Tsai HN, Chang YH, Huang YC. Type 2 diabetes increases and metformin reduces total, colorectal, liver and pancreatic cancer incidences in Taiwanese: a representative population prospective cohort study of 800,000 individuals. BMC Cancer. 2011;11:20.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  54. Bodmer M, Becker C, Meier C, Jick SS, Meier CR. Use of metformin is not associated with a decreased risk of colorectal cancer: a case-control analysis. Cancer Epidemiol Biomarkers Prev. 2012;21(2):280–6.

    Article  CAS  PubMed  Google Scholar 

  55. Smiechowski B, Azoulay L, Yin H, Pollak MN, Suissa S. The use of metformin and colorectal cancer incidence in patients with type 2 diabetes mellitus. Cancer Epidemiol Biomarkers Prev. 2013. doi:10.1158/1055-9965.epi-13-0196.

    PubMed  Google Scholar 

  56. Zhang P, Li H, Tan X, Chen L, Wang S. Association of metformin use with cancer incidence and mortality: a meta-analysis. Cancer Epidemiol. 2013;37(3):207–18.

    Article  PubMed  Google Scholar 

  57. Hosono K, Endo H, Takahashi H, Sugiyama M, Uchiyama T, Suzuki K, et al. Metformin suppresses azoxymethane-induced colorectal aberrant crypt foci by activating AMP-activated protein kinase. Mol Carcinog. 2010;49(7):662–71.

    Article  CAS  PubMed  Google Scholar 

  58. Tomimoto A, Endo H, Sugiyama M, Fujisawa T, Hosono K, Takahashi H, et al. Metformin suppresses intestinal polyp growth in ApcMin/+ mice. Cancer Sci. 2008;99(11):2136–41.

    Article  CAS  PubMed  Google Scholar 

  59. Algire C, Amrein L, Zakikhani M, Panasci L, Pollak M. Metformin blocks the stimulative effect of a high-energy diet on colon carcinoma growth in vivo and is associated with reduced expression of fatty acid synthase. Endocr Relat Cancer. 2010;17(2):351–60.

    Article  CAS  PubMed  Google Scholar 

  60. Lee JH, Jeon SM, Hong SP, Cheon JH, Kim TI, Kim WH. Metformin use is associated with a decreased incidence of colorectal adenomas in diabetic patients with previous colorectal cancer. Dig Liver Dis. 2012;44(12):1042–7. This study showed that metformin use in diabetic patients with previous CRC is associated with a lower risk of recurrence of colorectal adenoma.

    Article  CAS  PubMed  Google Scholar 

  61. Kanadiya MK, Gohel TD, Sanaka MR, Thota PN, Shubrook Jr JH. Relationship between type-2 diabetes and use of metformin with risk of colorectal adenoma in an American population receiving colonoscopy. J Diabetes Complicat. 2013;27(5):463–6.

    Article  PubMed  Google Scholar 

  62. Higurashi T, Takahashi H, Endo H, Hosono K, Yamada E, Ohkubo H, et al. Metformin efficacy and safety for colorectal polyps: a double-blind randomized controlled trial. BMC Cancer. 2012;12(1):118. This is the first reported double-blind randomized controlled trial to show the effect of metformin on colorectal polyp formation.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  63. Spillane S, Bennett K, Sharp L, Barron TI. A cohort study of metformin exposure and survival in patients with stage I-III colorectal cancer. Cancer Epidemiol Biomarkers Prev. 2013;22(8):1364–73.

    Article  CAS  PubMed  Google Scholar 

  64. Cossor FI, Adams-Campbell LL, Chlebowski RT, Gunter MJ, Johnson K, Martell RE, et al. Diabetes, metformin use, and colorectal cancer survival in postmenopausal women. Cancer Epidemiol. 2013;37(5):742–9.

    Article  CAS  PubMed  Google Scholar 

  65. Goodwin PJ, Pritchard KI, Ennis M, Clemons M, Graham M, Fantus IG. Insulin-lowering effects of metformin in women with early breast cancer. Clin Breast Cancer. 2008;8(6):501–5.

    Article  CAS  PubMed  Google Scholar 

  66. Huang X, Wullschleger S, Shpiro N, McGuire VA, Sakamoto K, Woods YL, et al. Important role of the LKB1-AMPK pathway in suppressing tumorigenesis in PTEN-deficient mice. Biochem J. 2008;412(2):211–21.

    Article  CAS  PubMed  Google Scholar 

  67. Shaw RJ, Lamia KA, Vasquez D, Koo SH, Bardeesy N, Depinho RA, et al. The kinase LKB1 mediates glucose homeostasis in liver and therapeutic effects ofmetformin. Science. 2005;310(5754):1642–6.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  68. Guertin DA, Sabatini DM. Defining the role of mTOR in cancer. Cancer Cell. 2007;12(1):9–22.

    Article  CAS  PubMed  Google Scholar 

  69. Zakikhani M, Dowling R, Fantus IG, Sonenberg N, Pollak M. Metformin is an AMP kinase-dependent growth inhibitor for breast cancer cells. Cancer Res. 2006;66(21):10269–73.

    Article  CAS  PubMed  Google Scholar 

  70. Gotlieb WH, Saumet J, Beauchamp MC, Gu J, Lau S, Pollak MN, et al. In vitro metformin anti-neoplastic activity in epithelial ovarian cancer. Gynecol Oncol. 2008;110(2):246–50.

    Article  CAS  PubMed  Google Scholar 

  71. Morgensztern D, McLeod HL. PI3K/Akt/mTOR pathway as a target for cancer therapy. Anticancer Drugs. 2005;16(8):797–803.

    Article  CAS  PubMed  Google Scholar 

  72. Ben Sahra I, Laurent K, Giuliano S, Larbret F, Ponzio G, Gounon P, et al. Targeting cancer cell metabolism: the combination of metformin and 2-deoxyglucose induces p53-dependent apoptosis in prostate cancer cells. Cancer Res. 2010;70(6):2465–75.

    Article  CAS  PubMed  Google Scholar 

  73. Ben Sahra I, Laurent K, Loubat A, Giorgetti-Peraldi S, Colosetti P, Auberger P, et al. The antidiabetic drug metformin exerts an antitumoral effect in vitro and in vivo through a decrease of cyclin D1 level. Oncogene. 2008;27(25):3576–86.

    Article  CAS  PubMed  Google Scholar 

  74. Buzzai M, Jones RG, Amaravadi RK, Lum JJ, DeBerardinis RJ, Zhao F, et al. Systemic treatment with the antidiabetic drug metformin selectively impairs p53-deficient tumor cell growth. Cancer Res. 2007;67(14):6745–52.

    Article  CAS  PubMed  Google Scholar 

  75. Zhuang Y, Miskimins WK. Cell cycle arrest in metformin treated breast cancer cells involves activation of AMPK, downregulation of cyclin D1, and requires p27Kip1 or p21Cip1. J Mol Signal. 2008;3:18.

    Article  PubMed Central  PubMed  Google Scholar 

  76. Gou S, Cui P, Li X, Shi P, Liu T, Wang C. Low concentrations of metformin selectively inhibit CD133+ cell proliferation in pancreatic cancer and have anticancer action. PLoS One. 2013;8(5):e63969. This study provided a basis for combination of metformin with current therapies to improve the prognosis of cancer.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  77. Hirsch HA, Iliopoulos D, Tsichlis PN, Struhl K. Metformin selectively targets cancer stem cells, and acts together with chemotherapy to block tumor growth and prolong remission. Cancer Res. 2009;69(19):7507–11.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  78. Hirsch HA, Iliopoulos D, Struhl K. Metformin inhibits the inflammatory response associated with cellular transformation and cancer stem cell growth. Proc Natl Acad Sci U S A. 2013;110(3):972–7. This study showed that metformin may block a metabolic stress response that stimulates the inflammatory pathway associated with a wide variety of cancers, and cancer stem cell growth.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  79. Berstein LM, Yue W, Wang JP, Santen RJ. Isolated and combined action of tamoxifen and metformin in wild-type, tamoxifen-resistant, and estrogen-deprived MCF-7 cells. Breast Cancer Res Treat. 2011;128(1):109–17.

    Article  CAS  PubMed  Google Scholar 

  80. Rattan R, Graham RP, Maguire JL, Giri S, Shridhar V. Metformin suppresses ovarian cancer growth and metastasis with enhancement of cisplatin cytotoxicity in vivo. Neoplasia. 2011;13(5):483–91.

    CAS  PubMed Central  PubMed  Google Scholar 

  81. Kalender A, Selvaraj A, Kim SY, Gulati P, Brule S, Viollet B, et al. Metformin, independent of AMPK, inhibits mTORC1 in a rag GTPase-dependent manner. Cell Metab. 2010;11(5):390–401.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  82. Ersoy C, Kiyici S, Budak F, Oral B, Guclu M, Duran C, et al. The effect of metformin treatment on VEGF and PAI-1 levels in obese type 2 diabetic patients. Diabetes Res Clin Pract. 2008;81(1):56–60.

    Article  CAS  PubMed  Google Scholar 

  83. Xavier DO, Amaral LS, Gomes MA, Rocha MA, Campos PR, Cota BD, et al. Metformin inhibits inflammatory angiogenesis in a murine sponge model. Biomed Pharmacother. 2010;64(3):220–5.

    Article  CAS  PubMed  Google Scholar 

  84. Lund SS, Tarnow L, Stehouwer CD, Schalkwijk CG, Teerlink T, Gram J, et al. Impact of metformin versus repaglinide on non-glycaemic cardiovascular risk markers related to inflammation and endothelial dysfunction in non-obese patients with type 2 diabetes. Eur J Endocrinol. 2008;158(5):631–41.

    Article  CAS  PubMed  Google Scholar 

  85. Arai M, Uchiba M, Komura H, Mizuochi Y, Harada N, Okajima K. Metformin, an antidiabetic agent, suppresses the production of tumor necrosis factor and tissue factor by inhibiting early growth response factor-1 expression in human monocytes in vitro. J Pharmacol Exp Ther. 2010;334(1):206–13.

    Article  CAS  PubMed  Google Scholar 

  86. Salminen A, Hyttinen JM, Kaarniranta K. AMP-activated protein kinase inhibits NF-kappaB signaling and inflammation: impact on healthspan and lifespan. J Mol Med (Berl). 2011;89(7):667–76.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  87. Hwang YP, Jeong HG. Metformin blocks migration and invasion of tumour cells by inhibition of matrix metalloproteinase-9 activation through a calcium and protein kinase Cα-dependent pathway: phorbol-12-myristate-13-acetate-induced/extracellular signal-regulated kinase/activator protein-1. Br J Pharmacol. 2010;160(5):1195–211.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  88. Tan BK, Adya R, Chen J, Lehnert H, Sant Cassia LJ, Randeva HS. Metformin treatment exerts antiinvasive and antimetastatic effects in human endometrial carcinoma cells. J Clin Endocrinol Metab. 2011;96(3):808–16.

    Article  CAS  PubMed  Google Scholar 

  89. Graham GG, Punt J, Arora M, Day RO, Doogue MP, Duong JK, et al. Clinical pharmacokinetics of metformin. Clin Pharmacokinet. 2011;50(2):81–98.

    Article  CAS  PubMed  Google Scholar 

  90. Shu Y, Brown C, Castro RA, Shi RJ, Lin ET, Owen RP, et al. Effect of genetic variation in the organic cation transporter 1, OCT1, on metformin pharmacokinetics. Clin Pharmacol Ther. 2008;83(2):273–80.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  91. Masuda S, Terada T, Yonezawa A, Tanihara Y, Kishimoto K, Katsura T, et al. Identification and functional characterization of a new human kidney-specific H+/organic cation antiporter, kidney-specific multidrug and toxin extrusion 2. J Am Soc Nephrol. 2006;17(8):2127–35.

    Article  CAS  PubMed  Google Scholar 

  92. Emami Riedmaier A, Fisel P, Nies AT, Schaeffeler E, Schwab M. Metformin and cancer: from the old medicine cabinet to pharmacological pitfalls and prospects. Trends Pharmacol Sci. 2013;34(2):126–35.

    Article  PubMed  Google Scholar 

  93. Guppy A, Jamal-Hanjani M, Pickering L. Anticancer effects of metformin and its potential use as a therapeutic agent for breast cancer. Future Oncol. 2011;7(6):727–36.

    Article  CAS  PubMed  Google Scholar 

  94. Tseng CH. Diabetes, metformin use, and colon cancer: a population-based cohort study in Taiwan. Eur J Endocrinol. 2012;167(3):409–16.

    Article  CAS  PubMed  Google Scholar 

  95. Hosono K, Endo H, Takahashi H, Sugiyama M, Sakai E, Uchiyama T, et al. Metformin suppresses colorectal aberrant crypt foci in a short-term clinical trial. Cancer Prev Res (Phila). 2010;3(9):1077–83.

    Article  CAS  PubMed  Google Scholar 

  96. Manzano A, Perez-Segura P. Colorectal cancer chemoprevention: is this the future of colorectal cancer prevention? Sci World J. 2012;2012:327341.

    Article  CAS  Google Scholar 

  97. Iliopoulos D, Hirsch HA, Struhl K. Metformin decreases the dose of chemotherapy for prolonging tumor remission in mouse xenografts involving multiple cancer cell types. Cancer Res. 2011;71(9):3196–201.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  98. Jiralerspong S, Palla SL, Giordano SH, Meric-Bernstam F, Liedtke C, Barnett CM, et al. Metformin and pathologic complete responses to neoadjuvant chemotherapy in diabetic patients with breast cancer. J Clin Oncol. 2009;27(20):3297–302.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  99. Lee DJ, Kim B, Lee JH, Park SJ, Hong SP, Cheon JH, et al. The effect of metformin on responses to chemotherapy and survival in stage IV colorectal cancer with diabetes. Korean J Gastroenterol. 2012;60(6):355–61.

    Article  PubMed  Google Scholar 

Download references

Compliance with Ethics Guidelines

Conflict of Interest

Jin Ha Lee and Tae Il Kim declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Tae Il Kim.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lee, J.H., Kim, T.I. Type II Diabetes, Metformin Use, and Colorectal Neoplasia: Mechanisms of Action and Implications for Future Research. Curr Colorectal Cancer Rep 10, 105–113 (2014). https://doi.org/10.1007/s11888-013-0198-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11888-013-0198-x

Keywords

Navigation