2026 Proffered Presentations
S111: GLUCAGON-LIKE PEPTIDE-1 RECEPTOR AGONIST USE AND SURVIVAL OUTCOMES IN SKULL BASE AND HEAD AND NECK TUMORS
Emma J Anisman, BA; Abdulghafoor Alani, BS; Sohan Shah, BS; Preston Carey, BS; Sarah Harrington, BA; Benjamin F Bitner, MD; Elina Toskala; Marc Rosen, MD; Mindy Rabinowitz, MD; James Evans, MD; Gurston Nyquist, MD; Thomas Jefferson University
Introduction: GLP-1 agonists (GLP1a) have emerged as powerful treatment options for diabetes and obesity. GLP1a have been shown in in-vitro and translational studies to modulate tumor signaling in colon, thyroid, and prostate cancer. More recently, retrospective clinical studies have suggested that survival benefits may extend to tumors of the head and neck, including meningioma and thyroid carcinoma. So far, no large study has yet characterized the potential benefits of GLP1a on pituitary adenoma and many other head and neck cancers.
Objective: The primary outcome was to determine the effect of GLP1a on 5-year survival rate in pituitary adenoma and meningioma. Secondary outcomes included survival in craniopharyngioma, oral cavity carcinoma, and sinonasal carcinoma.
Methods: This retrospective cohort study was conducted using the TriNetX database, which includes global electronic health record data for over one hundred million patients. Cohorts included adults with obesity, as defined by BMI > 30, who were on either GLP1a or received bariatric surgery and were subsequently diagnosed with pituitary adenoma, meningioma, craniopharyngioma, oral cavity carcinoma, or sinonasal carcinoma. Cohorts were propensity score matched for age, race, BMI, smoking, prior history of malignancy, family history of malignancy, hypertension, hyperlipidemia, and economic status. Kaplan-Meier survival curves and hazard ratios with 95% confidence intervals were calculated.
Results: Out of 4,084 patients who developed pituitary adenoma after treatment with either GLP1a or bariatric surgery, 5-year survival was improved in patients taking GLP1a (HR 0.586, 95% CI 0.4–0.859). Out of 3,358 patients who developed meningioma, survival was also improved with GLP1a (HR 0.56, 95% CI 0.426–0.737). Out of 836 who developed craniopharyngioma, there was no significant difference in survival between treatments (HR 0.598, 95% CI 0.34–1.05). Out of 4,432 patients who developed thyroid cancer (HR 0.688, 95% CI 0.496–0.954) and 530 patients who developed oral cavity carcinoma (HR 0.585, 95% CI 0.354–0.968), 5-year survival was improved. In sinonasal carcinoma, there were too few cases to detect any survival difference.
Conclusions: In this study of patients with obesity who developed head and neck pathologies, GLP1a use was associated with improved 5-year survival in a wide range of head and neck pathologies compared to those who received bariatric surgery. Hyperinsulinemia may drive cell proliferation and inhibit apoptosis, and may also enhance signaling through IGF-1, providing a potential mechanism behind GLP1a impact on neoplastic growth. Although the impact of GLP1a on tumor signaling at the cellular level has yet to be elucidated in many of these tumors, there appears to be an overall survival benefit in patients with slow-growing tumors of the skull base including meningioma and pituitary adenoma. For patients with more aggressive tumors such as sinonasal carcinoma, further investigation is required as the potential benefits and impact on tumor biology may be more limited. Whether observed benefits are the result of direct tumor-level mechanisms or occur secondary to overall metabolic improvements to improve global health requires further investigation.