Sodium-glucose cotransporter 2 (SGLT2) inhibitors, a class of FDA-approved antidiabetic medications, may slow the growth of early-stage lung cancer and help patients with in situ pulmonary adenocarcinoma avoid surgery, including biopsies and resections.
In situ and early-stage cancers are a rapidly growing group of lung cancers, often detected incidentally on computed tomography scans as ground-glass opacities or small lung nodules, and patients with these lesions often have surgery.
Emerging evidence suggests that SGLT2 is involved in the development of early adenocarcinoma. The researchers investigated whether administering an SGLT2 inhibitor would slow the growth of nodules and decrease the need for surgery for early-stage pulmonary malignancies.
In a retrospective analysis, the researchers identified adult diabetic patients with a lung nodule confirmed on two or more serial CT scans between 2014 and 2024. They compared patients who were prescribed an SGLT2 inhibitor to similar patients who received a different class of antidiabetic medication.
They used multivariable adjusted Cox regression models and the log-rank test to investigate the incidence of lung nodule growth (defined as an increase of >2mm in size or the growth or development of a solid component suggesting invasive disease) and the time to intervention, including biopsy, resection, empiric radiotherapy, or chemotherapy.
Significant Reduction in Nodule Growth and Surgical Interventions
Of the 218 patients diagnosed with a lung nodule whose records were analyzed, 109 were prescribed an SGLT2 inhibitor, and 109 were prescribed an alternative diabetic medication. Demographic variables in both groups were similar, although mean HbA1c was slightly higher in patients who were prescribed an SGLT2 inhibitor than those who received an alternative diabetic medication (7.7 vs 7.1, respectively; P<0.01). Investigators followed both groups for similar lengths of time.
Patients who took an SGLT2 inhibitor were significantly less likely to have lung nodule growth than were those who were on alternative diabetic medications (13.8% vs 25.7%; P=0.04).
Patients who were prescribed an SGLT2 inhibitor had a cumulative surgical intervention incidence of 5.5% vs 11.9% among patients taking alternative diabetic medications (HR 0.15; 95% CI, 0.02-0.77; P=0.048). The number of patients needed to treat with an SGLT2 inhibitor to prevent one additional surgical intervention over 10 years was 15.6.
Reference
Welch K, McGovern, K, Chen L, et al. Sodium-Glucose Cotransporter 2 Inhibitors Attenuate Growth and Decrease Surgical Interventions on In-Situ Pulmonary Adenocarcinoma. Presented at: CHEST 2025, October 19-22, 2025; Chicago.
