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Malignant tumors are the leading causes of death from chronic non-communicable diseases and the most important factors influencing life expectancy in recent year, with poor treatment response and poor prognosis. Metformin, the preferred hypoglycemic drug for diabetes mellitus type 2, has been recognized by more and more peers for its anti-tumor effect. However, there is no independent clinical guideline, consensus and large prospective clinical trial at home and abroad. This expert guideline aimed to provide clinical practice reference for the application of metformin in anti-tumor treatment. This expert consensus recommends that metformin, used in combination for most malignancies with diabetes mellitus type 2, can assist in anti-tumor effect and enhance chemotherapeutic drug sensitivity, and reduce the morbidity and mortality of multiple malignancies. Metformin is not recommended or opposed for a small number of malignancies complicated with diabetes mellitus type 2, such as estrogen receptor (ER)-negative or triple-negative breast cancer. Metformin is not recommended for most malignant tumors without diabetes, such as lung cancer, colorectal cancer and prostate cancer. However, metformin can be used with informed consent in a very small number of malignancies without diabetes.