The impact of SGLT2i on the outcome of advanced lung cancer in patients with diabetes.

[OBJECTIVE] Sodium-glucose cotransporter-2 inhibitors (SGLT2i), a novel pharmacological agent for diabetes and heart failure, may influence oncologic outcomes. Their role in advanced lung cancer patients with diabetes is unclear. Our study aims to evaluate SGLT2i's effects in this population.

[METHODS] We performed a retrospective analysis of advanced lung cancer patients diagnosed with diabetes at our center between July 2020 and July 2024. The case cohort include patients who received SGLT2i, while the control cohort did not. The primary endpoint was overall mortality, and the secondary endpoint was a composite of cardiac events.

[RESULTS] The cohort included 188 patients, with 94 cases and 94 controls. Over a median follow-up of 16 months, the use of SGLT2i was significantly associated with improved survival for advanced lung cancer with diabetes. (hazard ratio, (HR) 0.56; 95% CI 0.35-0.87, P = 0.009). The survival rate was lower in major adverse cardiovascular events (MACE) group than non-MACE group, however the differences were not statistically significant (HR 1.69; 95% CI 0.96- 2.97, P = 0.067). During follow-up, the incidence of MACE (24 cases in total, with new-onset atrial fibrillation/flutter being the most common) did not differ significantly between SGLT2i and control groups (11.7% vs. 13.8%; P = 0.662).

[CONCLUSIONS] In advanced lung cancer patients with diabetes, SGLT2i was associated with a lower all-cause mortality rate. Yet SGLT2i had insignificant impact on the incidence of MACE and the post-MACE survival.