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Diabetes Treatment and Management / Advanced Breast Cancer Therapies · Journal article
The Oncologist · August 8, 2026
Encouraging direction, but not yet definitive.
This retrospective cohort study of 1,146 patients with metastatic solid tumors reports that concurrent use of SGLT2 inhibitors with immune checkpoint inhibitors was associated with improved median overall survival (27.4 vs. 17.4 months, HR 0.68, p=0.001) compared to ICI alone, with benefit most evident when SGLT2i was initiated at or before ICI start. However, the observational design, acknowledged immortal time bias, and lack of randomization limit causal inference; the result is suggestive but requires prospective validation.
Retrospective, multi-center, propensity-matched cohort analysis. Patients with a diagnosis of T2DM and/or congestive heart failure and advanced solid tumor malignancy treated with ICIs, identified from the Epic Cosmos database.. Intervention: SGLT2 inhibitors (three drugs analyzed) concurrent with immune checkpoint inhibitors (eleven ICIs analyzed), with at least one overlapping cycle.. Compared with: Immune checkpoint inhibitors alone, without SGLT2 inhibitor.. n = 1,146. Multi-center; specific institutions and countries not stated in abstract..
Median overall survival: SGLT2i+ICI 27.4 months vs. ICI alone 17.4 months (HR 0.68, p=0.001) Significant survival improvements in non-small cell lung cancer and renal cell carcinoma subgroups by histology Survival benefit persisted among patients prescribed SGLT2i at or prior to ICI initiation
Safety was not reported in the material analysed. Check the source before drawing any conclusion about harm.
The modest survival benefit observed is hypothesis-generating and warrants prospective investigation, but should not yet alter clinical practice without randomized confirmation. The attenuated benefit after accounting for immortal time bias and the observational nature of the data suggest caution in interpretation.
Retrospective propensity-matched cohort study showing modest survival improvement (HR 0.68) with SGLT2i+ICI versus ICI alone, but limited by observational design, immortal time bias concerns, and lack of mechanistic validation.
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The modest survival benefit observed is hypothesis-generating and warrants prospective investigation, but should not yet alter clinical practice without randomized confirmation. The attenuated benefit after accounting for immortal time bias and the observational nature of the data suggest caution in interpretation.
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Abstract Background Recently, sodium-glucose cotransporter-2 inhibitors (SGLT2i) have emerged as a treatment option for type 2 diabetes mellitus (T2DM) and have also shown promising anti-tumor activity in preclinical models. Limited clinical data exist regarding the use of SGLT2i in patients with metastatic solid tumor malignancies treated with immune checkpoint inhibitors (ICIs). Patients and Methods A retrospective, multi-center, matched cohort analysis of patients with a diagnosis of either T2DM and/or congestive heart failure and an advanced solid tumor malignancy treated with ICIs was performed using the Epic Cosmos database. Ten different solid tumor types, eleven ICIs, and three SGLT2i were analyzed. Patients in the exposure group also received an SGLT2i and had at least one overlapping cycle with ICI. Results Of the 1,146 patients included, 573 patients received SGLT2i+ICIs and 573 received ICIs alone. Compared to patients treated with ICIs, individuals who received SGLT2i+ICIs had improved median overall survival (mOS) (27.4 vs. 17.4 months, hazard ratio (HR) 0.68, log-rank test, p 0.001). When stratified by histology, significant improvements in mOS were seen for non-small cell lung cancer and renal cell carcinoma patients. Survival benefit was attenuated when accounting for immortal time bias in late initiators of SGLT2i, though persisted among patients prescribed SGLT2i at or prior to initiation of ICI. Patients in the exposure group experienced longer time on immunotherapy compared to the control group. Conclusion Patients prescribed SGLT2i at or prior to ICI initiation had a modest improvement in survival compared to patients treated with ICIs alone. SGLT2i may be a beneficial adjunctive therapy in patients treated with ICI, though further studies are needed.
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