1665P - Prognostic impact of diabetes and antidiabetic medication in pancreatic cancer patients

Background

Diabetes mellitus (DM) is associated with pancreatic cancer (PC) as insulin is produced in the pancreatic beta cells. Whereas large epidemiological studies are available investigating the risk and prevalence of DM patients developing PC, only little is known about the impact of DM on the outcome of PC patients.

Methods

PC patients treated at the Medical University of Vienna between 1997 and 2020 with available information about their diabetic status at initial diagnosis of PC were identified from the PC database of our institution. We investigated the association of DM, antidiabetic drugs as well as random blood glucose and HbA1c levels with overall survival (OS, interval from initial diagnosis to death or last date of contact) in the overall patient cohort and subgroups of early and metastatic PC patients.

Results

Among 667 patients included into this analysis, 221 (33.1%) presented with DM at PC diagnosis, 53 (8.0%) developed DM later during the course of disease and 393 (58.9%) never developed DM. Presence of DM at initial diagnosis was significantly associated with a shorter OS in the overall patient population (13 vs. 17 months, hazard ratio (HR): 1.23, 95% confidence interval (CI 9.3 - 12.8; 6.6 - 11.3), p=0.024) as well as in patients with resectable disease (20 vs. 29 months, HR: 1.44, CI (13.4 - 31.1; 22.2 - 35.1), p=0.034). but showed no association in metastatic patients (8 vs. 11 months, HR: 1.21, CI (6.6 - 11.3; 9.3 - 12.8), p=0.200). Median OS was comparable between DM PC patients receiving metformin, insulin or other antidiabetic drugs (13 vs 15 vs 8 months, p=0.221, log-rank test). A random blood glucose at diagnosis of >300mg/dl compared to <200mg/dl (HR 2.29, 95%CI 0.06-3.53; p=0.005) as well as an HbA1c of >8% compared to <6.5% (HR 1.88, 95%CI 1.03-3.44; p=0.040) was associated with a significantly shorter OS.

Conclusions

Within this large cohort of PC patients, one third presented with DM at initial diagnosis. We observed a negative prognostic impact of DM especially in the subgroup of early PC patients. Different antidiabetic drugs thereby did not influence prognosis substantially. Only highly elevated levels of blood glucose and HbA1c seem to impact prognosis, whereas moderately elevated levels did not.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

G. Prager: Financial Interests, Personal, Advisory Board: Merck, Amgen, Servier, Bayer, Pierre Fabre, CECOG, Daiichi Sankyo Austria, AstraZeneca; Financial Interests, Personal, Invited Speaker: Roche, Sanofi, Lilly, BMS, MSD; Financial Interests, Institutional, Local PI: Incyte, Servier, BMS, Novartis. M. Preusser: Financial Interests, Personal, Advisory Board: Bayer, Bristol Myers Squibb, Novartis, Gerson Lehrman, CMC Contrast, GSK, Mundipharma, Roche, BMJ Journals, MedMedia, AstraZeneca, AbbVie, Lilly, Medahead, Daiichi Sankyo, Sanofi, Merck Sharp & Dohme, Tocagen, Adastra, Gan & Lee Pharmaceuticals; Financial Interests, Institutional, Research Grant, Clinical Trials and research: Boehringer Ingelheim, Bristol Myers Squibb, Roche, Daiichi Sankyo, Merck Sharp & Dohme, Novocure, GSK, AbbVie; Financial Interests, Institutional, Coordinating PI: PharmaMar; Non-Financial Interests, Leadership Role, Brain Tumor Group Chair (current): EORTC; Non-Financial Interests, Leadership Role, EANO Past-President (current): EANO; Non-Financial Interests, Other, Member Multi-Site Guideline Advisory Group: ASCO. A.S. Berghoff: Financial Interests, Personal, Invited Speaker: Roche, Bristol Myers Squibb, Merck, AstraZeneca; Financial Interests, Personal, Advisory Board: Daiichi Sankyo; Financial Interests, Institutional, Research Grant: Daiichi Sankyo, Roche. E.S. Bergen: Non-Financial Interests, Institutional, Advisory Board: Servier. All other authors have declared no conflicts of interest.