Current Evidence and Practical Considerations for GLP-1 Receptor Agonists in Gynecologic Oncology

Background Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are now widely used for obesity and diabetes and are increasingly prescribed to patients with gynecologic cancer, yet guidance on their use across the cancer care continuum remains limited. This narrative review synthesizes current evidence on GLP-1RA use across three domains, cancer risk, perioperative management, and systemic anticancer therapy, and provides practical management algorithms. Methods A structured search of PubMed and Embase identified 1349 records. Following screening, 76 studies met eligibility criteria and were included in this narrative review. Results Evidence on cancer risk was context dependent rather than uniform across the drug class, with the strongest protective signals observed among obese, non-diabetic patients, particularly for endometrial cancer, where a target-trial emulation of 80,899 patients demonstrated a 58% lower incidence with GLP-1RA use (HR 0.42, 95% CI 0.28–0.63). For major gynecologic surgery, GLP-1RAs consistently increased residual gastric content but were not associated with increased pulmonary aspiration, supporting risk-stratified continuation, guided by clinical assessment and selective point-of-care gastric ultrasound. During chemotherapy, targeted therapy, and pelvic radiotherapy, current evidence does not support routine discontinuation. Instead, temporary interruption should be considered for patients with clinically significant gastrointestinal toxicity, dehydration, impaired oral intake, or nutritional compromise. Conclusion For patients already receiving GLP-1RAs, current evidence supports individualized decisions regarding continuation during gynecologic cancer care. This review provides a practical, gynecologic oncology-specific framework to support clinical decision-making across the perioperative period and during anticancer therapy. Prospective disease-specific studies are needed to determine whether metabolic optimization with GLP-1RAs can improve oncologic outcomes.