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Dr. Bukavina on GLP1R agonists and genitourinary cancers

Opinion
Video

"Our first question is, in patients who were on the GLP1R agonists for a prolonged period of time, were those patients at increased or decreased risk of developing the most common GU malignancies?" says Laura Bukavina, MD, MPH.

In this video, Laura Bukavina, MD, MPH, describes the background and notable findings from the European Urology Oncology paper, “Association Between GLP1R Agonists and Prostate, Kidney, and Bladder Cancers.” Bukavina is an assistant professor urologic oncology at the Cleveland Clinic Glickman Urological & Kidney Institute in Cleveland, Ohio.

Transcription:

Please describe the background for this study.

There's been a lot of talk about the GLP1R agonists, which many people probably know as Ozempic, currently in literature, but also out in the news. And the reason is that a lot of these GLP1 agonists have been shown to be associated with either an increased risk of cancer; for example, thyroid cancer in the original studies, or there's been some retrospective data showing that there's actually decreased risk of cancer in colorectal literature, as well as potentially some of the pancreatic literature. It's very early on in our understanding of how these work, and now there are data showing that there's potentially an association with Alzheimer's, and we're really trying to get the grasp of how these agonists, which are meant to be treating patients with diabetes, really have an effect on cancer overall? Can we use these agonists to help us in treatment of our cancer patients? Or are these detrimental? We wanted to look at this, and the first start is always looking at the available data before you start doing any kind of animal experiments. This was a research article that was published in European Urology Oncology. We used the format called the TriNetX database, which is a very large, de-identified database of multiple institutions within the United States and some overseas, where you're able to get really high, granular data from patients. So you're able to get their medications, you're really able to follow how long they've been on these medications, and then you're able to follow their diagnosis as they go along. It's a retrospective database, which is a limitation. But our first question is, in patients who were on the GLP1R agonists for a prolonged period of time, were those patients at increased or decreased risk of developing the most common GU malignancies? We looked at prostate, kidney, and bladder. And the reason why we looked at those 3 is because we know we have the number of patients that we need to make any decent conclusions about the association.

What were some of the notable findings? Were any of them surprising to you and your coauthors?

We went in thinking that it's probably not going to be much of a difference. We know from previous studies that there's some evidence potentially of metformin and insulin having increased or decreased risk of prostate cancer from what we know. But we really didn't expect the findings that we did. For example, in kidney cancer, when you compare GLP1 receptor agonists to metformin, people who are on those medications and not on metformin had an increased risk of kidney cancer. However, if you look at some of the other medications, like SGLT2 medication that sometimes patients with heart disease are put on with concomitant diabetes, people who are on GLP1 agonists have an increased risk of bladder cancer. It's important to understand that we didn't just compare this as like a presence or absence of being on GLP1. We wanted to make sure we divided based on different types of diabetic medications that patients could be on because some of those diabetic medications could also affect your risk of getting cancer down the line. What we found is that if they are on a GLP1 agonist, compared to SGLT2, or compared to metformin, they do have a higher risk of bladder or kidney cancer. Now for prostate, really, the only thing we saw is that patients who are on insulin vs GLP1, the patients who are on a GLP1 also had a higher risk of prostate cancer compared to the patients who were on insulin. Those patients had a decreased risk of prostate cancer.

This transcription was edited for clarity.

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