Is GLP-1 (Glucagon-like peptide-1) contraindicated in patients with ER (Estrogen Receptor) and PR (Progesterone Receptor) positive breast cancer in remission?

From the Guidelines

GLP-1 receptor agonists are not contraindicated in patients with ER/PR positive breast cancer in remission. The provided evidence does not specifically address the use of GLP-1 in patients with ER/PR positive breast cancer in remission 1. However, based on the available information, there is no clear indication that GLP-1 receptor agonists would be harmful in this patient population. In fact, the focus of the provided study is on the treatment of HER2-positive breast cancer, which is a different subset of breast cancer than ER/PR positive disease.

When considering the use of GLP-1 receptor agonists in patients with a history of breast cancer, it is essential to weigh the potential benefits of these medications, such as improved glycemic control or weight loss, against any theoretical risks. Some preclinical research suggests that GLP-1 receptor agonists might have anti-tumor effects, although this area requires further investigation.

Key points to consider include:

• The lack of direct evidence linking GLP-1 receptor agonists to an increased risk of breast cancer recurrence 1.
• The importance of individualized risk assessment, taking into account the patient's complete medical history and specific cancer characteristics.
• The need for ongoing cancer screenings as recommended by oncology guidelines.
• The importance of prompt reporting of any concerning symptoms that may arise during GLP-1 therapy.

Given the current state of knowledge, the use of GLP-1 receptor agonists in patients with ER/PR positive breast cancer in remission appears to be safe, provided that patients are closely monitored and that the decision to use these medications is made in the context of a thorough discussion of the potential benefits and risks 1.

From the Research

GLP-1 and ER/PR Positive Breast Cancer

• The relationship between GLP-1 (Glucagon-like peptide-1) and ER (Estrogen Receptor) and PR (Progesterone Receptor) positive breast cancer in remission is complex and requires careful consideration of various studies.
• A study published in 2022 2 found that liraglutide, a GLP-1 receptor agonist, promoted breast cancer progression in triple-negative breast cancer cells and tissues through the NOX4/ROS/VEGF pathway.
• However, a systematic review and meta-analysis published in 2021 3 found that treatment with GLP-1 receptor agonists did not increase the risk of breast neoplasms.
• Another study published in 2021 4 found that GLP-1 receptor immunoreactivity was significantly higher in breast cancer patients with diabetes mellitus than without, and that GLP-1R status was correlated with biological features of breast cancer, especially in invasive breast cancer.

GLP-1 Receptor Agonists and Breast Cancer Risk

• The study published in 2021 3 suggested that GLP-1 receptor agonists do not increase the risk of breast cancer, but this finding may not be directly applicable to ER/PR positive breast cancer patients in remission.
• The study published in 2021 4 found that GLP-1R status was correlated with biological features of breast cancer, but did not specifically address the risk of breast cancer in ER/PR positive patients in remission.

Current Treatments for ER-Positive Breast Cancer

• The current treatments for ER-positive breast cancer include selective estrogen receptor modulators (SERMs), selective estrogen receptor downregulators/degraders (SERDs), and aromatase inhibitors (AIs) 5.
• The management of metastatic hormone receptor-positive breast cancer beyond CDK4/6 inhibitors is a rapidly evolving field, with several new agents being studied and potential for future regulatory approval 6.

Implications for GLP-1 Use in ER/PR Positive Breast Cancer

• The available evidence does not provide a clear answer to whether GLP-1 is contraindicated in patients with ER and PR positive breast cancer in remission.
• However, the studies suggest that GLP-1 receptor agonists may promote breast cancer progression in certain contexts, and that GLP-1R status is correlated with biological features of breast cancer 2, 4.
• Therefore, the use of GLP-1 receptor agonists in patients with ER/PR positive breast cancer in remission should be carefully considered and monitored, taking into account the individual patient's risk factors and medical history.