This is very interesting. However we must look at it in a nuanced way. Pioglitazone is definitely associated with greater rates of bladder cancer (cumulative dosage and time dependent), so it would be a big mistake to see pioglitazone as anti-cancer in general. That said, in limited circumstances, for PPAR-gamma mediated cancers like PC, it may have some use. Given the relative incidence of PC vs bladder cancer, this might be an interesting drug.
The anti-diabetic PPARγ agonist Pioglitazone inhibits cell proliferation and induces metabolic reprogramming in prostate cancer
“Our findings suggest that using metabolic drugs such as PPARγ agonists could improve PCa treatment outcomes by reducing tumor growth, reprogramming metabolic pathways, and promoting a more benign epithelial phenotype.”
Note, we are talking extant PC, which is distinct from primary prevention.
If I remember well that is the reason why it has be removed from the market in France and in a lot of EU countries.
Yes. That was the reason. There was some controversy about the exact risk numbers, but longer term use can elevate relative risk to 1.75 times. In absolute numbers over the span of years it may be a risk worth taking compared to benefits. That said, pioglitazone is definitely contraindicated in those who have previously had bladder cancer or strong risk factors for it. This is the next biggest risk after the risk of bone fractures. It’s a drug that needs careful consideration and close monitoring. That’s why I’m still researching it and not just jumping in. Preliminarily my plan is to try it at a low dose of 7.5mg/day later this year and evaluate it along the way for effectiveness vs A1c and fasting blood sugar.
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