The study explored the survival outcomes associated with GLP-1RA use in comparison to other glucose-lowering medications—namely DPP4is and sodium-glucose cotransporter-2 inhibitors (SGLT2is)—among Medicare beneficiaries aged 66 and older who had been diagnosed with T2D and one of nine common cancers. These included thyroid, pancreatic, bladder, colorectal, lung, kidney, breast, endometrial, and prostate cancers. Only those who had survived at least a year post-cancer diagnosis and initiated treatment with one of the study drugs were included.
Using a retrospective cohort design and Medicare data from 2013 to 2020, the researchers matched patients 1:1 by propensity scores to minimize confounding factors. The analysis involved over 2,500 matched pairs in each comparison group. Patients were followed from the time they started the medication until death or the end of 2020.
Key findings were as follows:
- There was no significant difference in all-cause mortality between GLP-1RA and SGLT2i users (HR: 1.03).
- GLP-1RA use was linked to a significantly lower risk of all-cause mortality compared to DPP4i use (HR: 0.60).
- The survival benefit of GLP-1RAs over DPP4is was consistent across different age groups, sexes, and obesity statuses.
- The reduced mortality risk associated with GLP-1RA use also held true in patients with colorectal, lung, and breast cancers.
While the exact mechanisms behind this survival benefit are still under investigation, GLP-1RAs are known to provide more substantial reductions in blood sugar levels and body weight compared to DPP4is. Additionally, they may offer cardiovascular benefits and reduce systemic inflammation, factors that could potentially slow cancer progression and contribute to overall survival.
Despite the encouraging findings, the authors cautioned that causality cannot be confirmed due to the study's observational nature. Furthermore, some subgroup analyses were underpowered, and the possibility of residual confounding remains. Nevertheless, the study provides valuable real-world evidence supporting the potential role of GLP-1RAs in cancer survivorship.
The researchers concluded that GLP-1RAs could be a preferred therapeutic option for older adults with cancer and T2D, particularly when considering their broader metabolic and systemic benefits. They emphasized the need for future randomized clinical trials to validate these observations and determine whether GLP-1RAs can play a more defined role in improving cancer-related outcomes.
Reference:
Radwan RM, Lu Y, Dai H, et al. GLP-1 RA Use and Survival Among Older Adults With Cancer and Type 2 Diabetes. JAMA Netw Open. 2025;8(7):e2521887. doi:10.1001/jamanetworkopen.2025.21887
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