GLP-1 receptor agonists in the context of cancer: the road ahead

Abstract

A rapidly increasing proportion of the population in the United States is taking glucagon-like peptide-1 receptor agonists (GLP-1RAs) for type 2 diabetes or weight loss. Consequently, an increasing number of patients presenting with new cases of cancer also have a current prescription for GLP-1RAs. The impact of GLP-1RAs on metabolism is quite profound, and it is entirely reasonable to assume these agents are also very impactful on the metabolism of cancer cells, in addition to the general metabolism of the patient. Although these drugs are relatively recent on the market, the study of metabolism in cancer is a well-established field and we can make predictions about how GLP-1RAs will interface with cancer treatments. In fact, some evidence points to a possible neoadjuvant effect of these drugs for patients with cancer that would justify the initiation of GLP-1RAs to support therapy in a subset of patients. At the same time, there is a very present concern that drugs that induce weight loss may also precipitate the loss of muscle mass, cachexia, in patients. Here, we will provide an overview of the existing literature around diabetes and metabolism in the context of cancer and cachexia.

Keywords: GLP-1 receptor agonists; cachexia; cancer; type 2 diabetes.

Figure 1.

In patients with cancer, T2D promotes cancer progression (left) and increases susceptibility to muscle loss (right). GLP-1RAs (bottom) probably have an inhibitory effect on cancer progression, but their effect on muscle is unknown. Figure created with a licensed version of Biorender. com. GLP-1RAs, glucagon-like peptide-1 receptor agonists; T2D, type 2 diabetes.