We had the pleasure of speaking with Dr. Eman A. Toraih, the corresponding author of the Editor’s Choice Article in Cancers (ISSN: 2072-6694). Dr. Toraih is a physician–scientist and biostatistician with dual faculty appointments at SUNY Upstate Medical University and Suez Canal University, Egypt. Below, she shares her insights into her academic journey, research focus, and the motivation behind this landmark study.

“Survival Benefits of GLP-1 Receptor Agonists in Patients with Neuroendocrine Neoplasms: A Large-Scale Propensity-Matched Cohort Study”
by Manal S. Fawzy, Awwad Alenezy, Jessan A. Jishu, Issa Khan, Ahmad Dessouky, Ahmed Abdelmaksoud, Kristen E. Limbach and Eman A. Toraih
Cancers 2025, 17(9), 1593; https://doi.org/10.3390/cancers17091593
Available online: https://www.mdpi.com/2072-6694/17/9/1593

The following is an interview with Dr. Eman A. Toraih:

1. Could you briefly introduce yourself and describe your main research focus?

I am a physician–scientist and biostatistician with dual faculty appointments at SUNY Upstate Medical University and Suez Canal University. My work focuses on real-world evidence generation, biomarker discovery, and the intersection of metabolic health and cancer outcomes. In recent years, I have concentrated on leveraging large federated clinical databases—particularly TriNetX—to address clinically relevant questions that randomized trials often cannot capture, including heterogeneous populations, long-term outcomes, and drug repurposing. My goal is to bridge population-level data with actionable insights for individual patient care.

2. What inspired you to pursue this particular area of cancer research?

Neuroendocrine neoplasms remain relatively understudied despite their rising incidence and limited therapeutic options, particularly in advanced disease. At the same time, GLP-1 receptor agonists were rapidly transforming metabolic medicine beyond glycemic control. The observation that GLP-1 receptors are expressed in certain neuroendocrine tumors—combined with emerging preclinical signals—highlighted a clear gap: no large-scale clinical study had evaluated outcomes in NEN patients receiving these agents. That intersection between metabolic therapeutics and oncology presented a question that was both scientifically compelling and clinically relevant.

3. Was there a personal or professional turning point in your research career?

Several moments shaped my career, but a defining turning point was gaining access to large, federated real-world databases. Early in my training, research was often limited by single-institution data, small sample sizes, and resource constraints—especially for rare diseases. Working with platforms like TriNetX, which aggregate de-identified data across multiple healthcare systems, fundamentally changed my perspective. It enabled the study of diverse patient populations at a scale that reflects real clinical practice rather than the narrow scope of traditional studies. This experience shifted my focus from what is feasible within one center to what is meaningful across populations, and it reinforced the value of carefully designed observational research in answering clinically relevant questions.

4. In your own words, what are the key findings or main messages of your Editor's Choice Article?

The central finding is that among adult patients with neuroendocrine neoplasms who also had diabetes or obesity, those who received GLP-1 receptor agonists after their NEN diagnosis experienced substantially better survival compared to matched patients who did not receive these agents. After 1:1 propensity score matching across 3,043 patients per cohort, all-cause mortality occurred in 11.7% of GLP-1Ra users versus 24.7% of non-users—a 44.3% relative reduction in mortality risk, with a hazard ratio of 0.56 (95% CI: 0.49–0.63).  This benefit was consistent across sex, age groups, tumor grade—whether well-differentiated neuroendocrine tumors or poorly differentiated neuroendocrine carcinomas—and across the three primary sites examined: gastrointestinal, pancreatic, and lung. Lung NENs showed the most pronounced benefit (HR = 0.42). Among individual agents, tirzepatide demonstrated the strongest survival association (HR = 0.16), followed by semaglutide (HR = 0.27) and dulaglutide (HR = 0.52), while liraglutide and exenatide did not reach statistical significance.  The key message is not that GLP-1Ra should immediately replace established NEN therapies, but that this drug class—which millions of patients already receive—may offer meaningful adjunctive oncologic benefits and warrants rigorous prospective evaluation.

5. What current developments in your area of expertise are most exciting to you?

Three developments are particularly compelling. First, the recognition that metabolic pathways are central—not peripheral—to cancer biology. Second, the emergence of dual and triple receptor agonists, such as tirzepatide, which introduce new mechanistic possibilities and may explain differential effects observed across agents. Third, the integration of artificial intelligence into clinical research workflows. When used appropriately, AI can accelerate hypothesis generation and pattern recognition in large-scale datasets without replacing rigorous statistical reasoning.

6. What were the biggest challenges you encountered during this study, and how did you overcome them?

The primary challenge was confounding. Patients receiving GLP-1RAs represent a selected population with differences in survival, access to care, and follow-up. We addressed this using comprehensive propensity score matching across demographics, comorbidities, procedures, and medications. However, we explicitly acknowledge that residual confounding and immortal time bias cannot be fully eliminated. A second limitation was data granularity. Key variables such as tumor stage and dosing were limited in TriNetX. These limitations informed both our interpretation and our call for prospective trials.

7. How do you see this research evolving or influencing future studies in the field?

This study should be viewed as hypothesis-generating. The next step is prospective randomized trials stratified by tumor type, grade, and specific GLP-1RA agent to establish causality. In parallel, translational studies examining GLP-1 receptor expression across tumor subtypes could help identify patients most likely to benefit. More broadly, this work contributes to a growing body of literature exploring the role of metabolic therapies in oncology and supports a move toward more integrated, cross-disciplinary approaches.

8. What advice would you give to early career researchers who aim to publish impactful work in oncology?

Start with a meaningful clinical question, not with a dataset. The strongest research is driven by genuine uncertainty. Develop a deep understanding of your methods, particularly when working with real-world data. Knowing when an approach is appropriate is as important as knowing how to apply it. Choose journals strategically based on audience, not just metrics. And write clearly, complex analyses lose value if they are not communicated effectively.

9. Why did you choose Cancers for this publication, and how was your experience with the journal?

Cancers was an appropriate platform given its broad, clinically engaged, and international readership. This is particularly important for neuroendocrine neoplasms, which span multiple subspecialties. The editorial and peer-review process was efficient and constructive. Reviewers engaged thoughtfully with methodological considerations, particularly around propensity matching and bias, which strengthened the final manuscript. The Editor’s Choice recognition is appreciated and helps extend the visibility of findings that may inform future clinical research.