Remote Cognitive Assessment and Wearable Device While Assessing the Impact of Metformin in Patients With History of Cranial Radiation Therapy

PRIMARY OBJECTIVE: I. Determine the feasibility of completing serial remote cognitive, activity/sleep, and self-report assessments in clinical trial participants who have previously received cranial radiation. SECONDARY OBJECTIVES: I. Assess the acceptance or satisfaction of patients with the remote monitoring in this trial and how these may differ between those who receive metformin versus (vs.) not. II. Evaluate compliance and feasibility in terms of the adherence to study drug in those randomized to receive metformin. III. Assess and compare neurocognitive function scores and the impact of receiving metformin + health promotion with wearable device vs. wearable device only. IV. Assess the safety and tolerability of metformin in patients who have previously received cranial radiation. EXPLORATORY OBJECTIVES: I. Investigate the relationship of metformin and other health outcomes such as activity and sleep data and how these compare to the results for patients who are randomized to the control group, who do not receive metformin. II. Explore potential differences in these compliance and satisfaction measures and how they may correspond to health disparities and social determinants of health. OUTLINE: Patients are randomized to 1 of 2 groups. GROUP A: Patients receive metformin orally (PO) twice day (BID) for 12 months. Treatment repeats every 28 days for up to 12 months in the absence of disease progression or unacceptable toxicity. Patients also wear a wearable device to monitor health and undergo neurocognitive test throughout the study. GROUP B: Patients receive standard of care (SOC) treatment for 12 months. Patients also wear a wearable device to monitor health and undergo neurocognitive test throughout the study. Upon completion of study treatment, patients are followed up at 30 days then every 3 months for up to 2 years.