Among patients with diffuse large B-cell lymphoma (DLBCL), adding metformin to standard chemotherapy regimens appears to improve efficacy without increasing toxicity rates, according to research presented at the SOHO 2023 Annual Meeting. The authors noted, however, that subgroup analysis is necessary for determining which patients are likely to benefit from this therapeutic strategy.

For this study, researchers evaluated the safety and efficacy of adding metformin to combination rituximab, doxorubicin, cyclophosphamide, vincristine, and prednisolone (R-CHOP) among patients with DLBCL. The study’s primary endpoints were toxicity and response rate; the secondary endpoints were disease-free survival and overall survival.

The study included 2 arms, a trial arm (50 patients) and a control arm (50 patients). Patients in the trial arm received standard R-CHOP plus metformin 1000 mg twice daily in 3-week cycles; patients in the control arm received standard R-CHOP only.

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Analysis showed that patients in the trial arm had higher rate of complete remission at first restaging (56% vs 32% in the control arm; P =.016), as well as higher rates of complete remission at treatment completion (94% vs 66%, respectively; P =.001). Furthermore, rates of relapse or progression were significantly lower in the metformin group (6% vs 54% with R-CHOP only; P <.001), as was the risk of mortality (4% vs 24%, respectively; P =.004).

Patients who received metformin had a higher risk of nausea (32% vs 14% with R-CHOP only; P =.032), neutropenia, anemia, thrombocytopenia, diarrhea, mucositis, hypoglycemia, vomiting, and metallic taste rates were all similar between the 2 groups.

There was also evidence that DLBCL pathology may affect the likelihood of complete remission: patients with germinal center B-cell disease had a much higher likelihood of complete remission (79%) compared with those with activated B cell disease (21%; odds ratio, 4.786; P =.013).

“Further studies with large numbers and subgroup analysis for certain types of DLBCL are needed,” the authors noted in their poster.


Alagizy H, Mubarak N, Hegazy A, Sohaib A, Ali M. Metformin in combination with the standard therapy in patients with diffuse large B-cell lymphoma: a randomized phase II clinical trial. Presented at: the Eleventh Annual Meeting of the Society of Hematologic Oncology (SOHO); September 6-9, 2023. Abstract ABCL-039.