Glucagon-like peptide-1 receptor agonist use and survival outcomes among cancer patients receiving immune checkpoint inhibitors: a meta-analysis of cohort studies

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have emerged as potential immunometabolic modulators beyond their established metabolic indications. However, their association with survival outcomes in patients receiving cancer immunotherapy has not been systematically evaluated. We conducted the first meta-analysis to assess the association between GLP-1 RA use and overall survival (OS) in patients with solid tumors receiving immune checkpoint inhibitor (ICI) therapy. PubMed and Embase were systematically searched from inception to July 2026 for cohort studies reporting hazard ratios (HRs) with 95% confidence intervals (CIs) for OS in patients receiving ICIs with or without GLP-1 RA exposure. Pooled HRs were calculated using random-effects models. Exploratory subgroup analyses were performed according to cancer type, and 95% prediction intervals (PIs) were calculated to assess between-study variability. Six retrospective cohort studies were included in the primary meta-analysis, with one study-level OS estimate contributed by each study and a combined reported sample size of 14,833 patients. GLP-1 RA use was associated with improved OS (pooled HR = 0.52, 95% CI: 0.43–0.64; 95% PI: 0.29–0.94), with substantial statistical heterogeneity ( I² = 92.1%). Exploratory cancer-specific analyses showed variation in the magnitude of associations across tumor types, including melanoma (HR = 0.35, 95% CI: 0.26–0.48), urological cancers (HR = 0.35, 95% CI: 0.29–0.43), breast cancer (HR = 0.42, 95% CI: 0.27–0.63), non-small cell lung cancer (HR = 0.58, 95% CI: 0.43–0.78), and digestive system cancers (HR = 0.60, 95% CI: 0.42–0.85). GLP-1 RA use is associated with improved OS among patients with solid tumors receiving ICI therapy. Although the magnitude of the association varied across cancer-specific subgroups, these findings are exploratory and should not be interpreted as evidence of differential effects by cancer type. Given the observational nature of the available evidence, substantial between-study heterogeneity, and potential residual and time-related confounding, these findings should be considered hypothesis-generating and warrant prospective validation.