Advancing Education, Research, and Quality of Care for the Head and Neck oncology patient.
Introduction: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are widely used to manage type 2 diabetes and obesity due to their effectiveness in weight loss and glycemic control. However, their application in head and neck cancer (HNC) patients, a population often facing metabolic and nutritional challenges, is not well-studied. HNC patients commonly experience unintentional weight loss and metabolic issues, making GLP-1 RAs either beneficial or problematic. With limited and inconclusive evidence on incretin-based therapies in non-pancreatic cancers, this study aims to examine temporal trends in GLP-1 RA use in adult HNC patients, filling important knowledge gaps regarding their risks and benefits in this unique group.
Methods: The TriNetX Analytics Research Network was queried for adult patients diagnosed with head and cancer with a concurrent GLP-1 RA prescription since 2012. Incidence proportion and prevalence of GLP-1 RA use in adult head and neck cancer patients between January 1 2012- January 1 2024 was calculated. Demographic and comorbidity information was collected for this cohort.
Results: During the study period, 221,723 adult head and neck cancer patients were identified, of whom 4,338 (1.9%) had a prescription for GLP-1 RAs. Of this cohort, the mean age was 67 years old, 57.9% of patients were men, 72.4% were White individuals, 12.4% were Black or African American individuals, and 2.3% were Asian individuals. 3,675 patients (84.7%) had a concurrent diagnosis of diabetes, while 2,690 patients (62.0%) carried a diagnosis of overweight and obesity. 2,254 patients (51.9%) were diagnosed with both conditions, while 225 patients (7.0%) with GLP-1 RA use had neither diagnoses. 416 patients (9.6%) of patients had active tobacco use and 282 patients (6.5%) had alcohol-related disorders while using GLP-1 RAs. The overall incidence of new GLP-1 RA use increased each year, with a 16-fold increase in recorded prescriptions among adult head and neck cancer patients per year, from 53 to 826 between 2012 to 2024. Similarly, prevalence of GLP-1 RA use among patients increased each year, with an 18-fold increase in GLP-1 RA prescriptions from 175 in 2012 to 3,197 prescriptions by 2024.
Conclusions: GLP-1 RA use in adults with head and neck cancer has increased substantially over the last decade, aligning with their broader use in managing diabetes and obesity. Most patients prescribed GLP-1 RAs had coexisting diabetes and/or overweight and obesity, common metabolic concerns in cancer patients. Interestingly, a small subset without these diagnoses were also prescribed GLP-1 RAs, suggesting possible off-label use or emerging applications. Given this rising trend and the metabolic complexity in head and neck cancer patients, further research is essential to clarify the safety, efficacy, and long-term impact of GLP-1 RAs in this population, particularly regarding cancer outcomes and treatment tolerability. These findings emphasize the need to characterize metabolic therapies in head and neck cancer to enhance care and inform future guidelines.