Anticancer and anti-metastatic effects of metformin in cervical cancer: A narrative review
DOI:
https://doi.org/10.59692/jogeca.v33i5.467Keywords:
anticancer, anti-metastatic, cervical cancer, diabetes, nanoparticulate, metforminAbstract
Background: Cervical cancer is a significant cause of maternal morbidity and mortality despite concerted efforts towards its prevention. The high disease burden is attributed to the high prevalence of HIV, high treatment costs, and inaccessibility to treatment, particularly in developing countries. Multiple interventions, including metformin therapy, have been proposed for cervical cancer management. Metformin is a standard antidiabetic drug. In vitro studies have demonstrated mechanisms through which it can disrupt cervical cancer pathogenesis.
Objective: To review the literature on metformin’s anticancer and anti-metastatic effects in cervical cancer.
Methods: Literature searches were performed in the Google Scholar, PubMed, and ScienceDirect databases using keywords 'metformin', 'cervical cancer', and 'direct drug delivery’.
Results: Forty-four studies were included in this review. Metformin acts directly or indirectly on the molecular pathways involved in cervical cancer pathogenesis. Direct inhibition targets protein synthesis and angiogenesis, whereas indirect effects occur through increased insulin levels and the resultant decrease in glucose levels leading to glucose deprivation in cancer cells. The anti-metastatic effects of metformin are dose-dependent; therefore, high concentrations are required to achieve maximum effect. Direct drug delivery of metformin to tumor cells is viable to increase the bioavailability and minimize the systemic effects of metformin.
Conclusion: Metformin is affordable and readily available, with the potential to manage cervical cancer. High doses are needed to achieve anti-metastatic effects. Direct delivery of metformin may mitigate the adverse effects of the required high doses.
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