The clinical potentials of combining paclitaxel-based chemotherapy regimen with metformin in cancer treatment: A systematic review and Meta-analysis

Behnam Omidi Sarajar; Nima Rastegar-Pouyani; Azadeh Rasouli; Fateme Nikbakht; Mahdieh Nezami Majd; Mohammad H Ghahremani; Seyed Nasser Ostad; Emad Jafarzadeh; Mohsen Dehghani

doi:10.1016/j.tranon.2025.102438

The clinical potentials of combining paclitaxel-based chemotherapy regimen with metformin in cancer treatment: A systematic review and Meta-analysis

Transl Oncol. 2025 Jun 11:59:102438. doi: 10.1016/j.tranon.2025.102438. Online ahead of print.

Authors

Behnam Omidi Sarajar¹, Nima Rastegar-Pouyani¹, Azadeh Rasouli¹, Fateme Nikbakht², Mahdieh Nezami Majd³, Mohammad H Ghahremani¹, Seyed Nasser Ostad¹, Emad Jafarzadeh⁴, Mohsen Dehghani⁵

Affiliations

¹ Department of Toxicology and Pharmacology, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.
² Department of Epidemiology, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran.
³ Department of Comparative biosciences (CBS), School of Veterinary Medicine, University of Tehran, Tehran, Iran.
⁴ Department of Toxicology and Pharmacology, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran. Electronic address: jafarzadeh-e@razi.tums.ac.ir.
⁵ Department of Epidemiology, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran. Electronic address: Dehghanimhs@mums.ac.ir.

Abstract

Background: Several clinical trials have shown that combining metformin with paclitaxel-based chemotherapy has a promising effect on various tumors but with inconsistent findings. We conducted a systematic review and meta-analysis to compare the effects of paclitaxel plus metformin versus paclitaxel-based chemotherapy alone in different organ neoplasms.

Methods: A comprehensive literature search was performed in Scopus, PubMed, Web of Sciences, Embase and also Google scholar until December 2023 using MeSH keywords and all similar terms limited to randomized controlled trials (RCTs). The retrieved studies were assessed for methodological quality. Pooled standardize mean difference (SMD), odds ratio (OR) and 95 % confidence intervals (CI) of clinical outcomes were calculated using random-effects meta-analysis.

Results: Of 921 records, ultimately, 14 RCTs met the criteria for inclusion in the meta-analysis. Based on a meta-analysis findings, combination therapy of a paclitaxel-based regimen with metformin was found to be significantly associated with improved overall survival (OS) compared to the paclitaxel alone in various types of cancers (pooled SMD: 1.27; 95 % CI: 0.10, 2.43). Moreover, the metformin plus paclitaxel showed a borderline significant improvement in the pathological complete response (pCR) rate compared to the paclitaxel alone (Pooled OR: 1.74; 95 % CI: 0.96, 3.15). However, there was no significant improvement in the metformin plus paclitaxel group compared to the paclitaxel group for progression-free survival (PFS) and disease-free survival (DFS).

Conclusion: The findings indicate that a combination of paclitaxel-based chemotherapy with metformin enhances OS and pCR in cancer patients. This combination therapy has the potential to improve treatment effectiveness and safety.

Keywords: Cancer; Chemotherapy; Combination therapy; Meta-analysis; Metformin; Paclitaxel.

Publication types

Review