GLP-1 Agonists Are Linked to Modest Decrease in Obesity-Related Cancers in Adults With Diabetes

GLP-1 Agonist Use and Cancer Risk

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The use of GLP-1 receptor agonists correlated with a slight decrease in the incidence of obesity-related cancers and was not associated with higher cancer rates compared with the use of DPP-4 inhibitors in patients with diabetes, according to findings from a study presented during a 2025 ASCO Annual Meeting press briefing.1

The study, which included more than 170,000 patients, showed a 7% decrease in obesity-related cancer among patients who used GLP-1 receptor agonists (HR, 0.93; 95% CI, 0.88-0.98; P = .005), who experienced 2501 events vs 2671 events in patients who used DPP-4 inhibitors. Among females, 1754 events were observed with GLP-1 agonist use vs 1898 events with DPP-4 inhibitor use (HR, 0.92; 95% CI, 0.86-0.98; P = .01). Among males, there were 747 events with GLP-1 agonist use and 773 events with DPP-4 inhibitor use (HR, 0.95; 95% CI, 0.86-1.05; P = .29).

There was also an 8% decrease in all-cause mortality with the use of GLP-1 agonists vs DPP-4 inhibitors, with 2783 and 2961 events in each respective group (HR, 0.92; 95% CI, 0.87-0.97; P = .001). Among females, there were 1219 events with GLP-1 agonist use and 1514 events with DPP-4 inhibitor use (HR, 0.80; 95% CI, 0.74-0.86; P < .001). Among males, the respective numbers of events were 1564 with GLP-1 agonist use and 1447 with DPP-4 inhibitor use (HR, 1.04; 95% CI, 0.96-1.11; P = .34).

Investigators assessed 14 types of cancer and found that the protective association between GLP-1 agonists and cancer incidence was driven by cancers of the colon (HR, 0.84; 95% CI, 0.72-0.98; P = .02) and the rectum (HR, 0.72; 95% CI, 0.56-0.93; P = .01). Of note, there was no evidence of adverse association between GLP-1 agonists and pancreatic cancer.

Medullary thyroid cancer could not specifically be assessed in this study due to the small sample size. Although this disease is included in the warning labels for multiple GLP-1–directed medications, there was a lack of association between GLP-1 agonist use and thyroid cancer as a whole in this assessment.

“Findings extend the value of GLP-1[–directed] medicines beyond blood sugar control, weight, heart, and kidney health to potential cancer prevention in adults who are high-risk,” Lucas A. Mavromatis, a research assistant in the Division of Precision Medicine in the Department of Medicine at NYU Grossman School of Medicine, said during the presentation. “The effect size is small, follow-up was short, and assessed medications are primarily weaker, ‘diabetes dose’ formulations; long-term studies are needed to confirm the durability of effect and safety.”

Data were collected between 2013 and 2023 from 43 health system networks and included data from electronic health records and insurance claims. Patients included in the analysis were adults with type 2 diabetes with a body mass index of 30 kg/m2 or more who initiated treatment with either a GLP-1 agonist or a DPP-4 inhibitor for the first time.

Comparison groups included 85,015 pairs, and each GLP-1 starter patient was paired with 1 DPP-4 starter of similar age, sex, race, weight, laboratory values, year of prescription, and medical history. This followed the target trial emulation framework.

Outcomes included the first diagnosis of any 14 obesity-related cancers or death from any cause. Follow-up was from the first prescription until cancer, death, or the last recorded visit, with an average coverage of 3.9 years.

The background for the study was the gap in knowledge of the long-term effect of GLP-1–directed medications on the risk of cancer.

“GLP-1 treatments remain a strong option for people with diabetes and obesity and may favorably affect cancer risk. Decisions should balance benefits, costs, and [adverse] effects in discussion with clinicians,” Mavromatis concluded.

Reference

1. Mavromatis LA, Surapaneni A, Mehta S, et al. Glucagon-like peptide-1 receptor agonists and incidence of obesity-related cancer in adults with diabetes: a target-trial emulation study. Presented at: 2025 ASCO Annual Meeting; May 30-June 3, 2025; Chicago, IL. Abstract 10507.