Proposed protective effect of ADT on COVID-19 risk questioned
medwireNews: Two independent studies by Italian and Finnish researchers have found no association between androgen deprivation therapy (ADT) and a reduced risk for COVID-19 in men with prostate cancer.
These results, reported as letters to the Annals of Oncology, are in contrast to those of an earlier study from the Veneto region in Italy that suggested a protective effect of ADT on SARS-CoV-2 infection risk.
The first of the current studies – led by Orazio Caffo, from Santa Chiara Hospital in Trento – included 1949 men with metastatic castration-sensitive or castration-resistant prostate cancer treated at one of 19 medical oncology centers in northern Italy. All men were receiving ADT, either alone or alongside a chemotherapeutic agent (docetaxel or cabazitaxel), an androgen-targeting agent (abiraterone or enzalutamide), or radium-223.
In all, 36 patients tested positive for SARS-CoV-2, giving an incidence rate of 1.8%, which the researchers note was higher than the rate of 0.07% observed in the Veneto study.
Nearly two-thirds (61.1%) of the patients with COVID-19 needed hospitalization, and at the time of analysis, 55.6% had recovered, 13.9% remained positive for the infection, and 30.6% had died.
Caffo and colleagues suggest that the difference between their findings and the Veneto results could be due to differences in the study populations. They note that their study included “a homogeneous population” of men with metastatic disease, while the Veneto study drew on a regional cancer registry and comprised men who may have received “ADT for metastatic disease or biochemical relapse in the absence of any clinically detectable signs of disease.”
The study authors conclude that “[t]hese findings do not apparently support the postulated protective effect of ADT, at least in patients with metastatic [prostate cancer].”
For the second study, Taneli Raivio (University of Helsinki) and team drew on registry data to identify 352 Finnish men with prostate cancer who underwent testing for SARS-CoV-2 between 7 March and 14 May, 2020.
Of these, 134 were considered to be receiving ADT – based on a history of orchiectomy or a prescription for a gonadotropin-releasing hormone analog or antagonist, and/or androgen-targeting agent (flutamide, bicalutamide, enzalutamide, or abiraterone) – whereas the remaining 218 either had no such treatment recorded or had stopped ADT prior to the SARS-CoV-2 test.
A total of 17 men had a confirmed diagnosis of COVID-19, giving an overall incidence of 4.8%. But there was no significant difference in the incidence between men who were receiving ADT and those who were not, at 4.5% and 5.0%, respectively.
Receipt of ADT was also not significantly associated with COVID-19 severity, with a comparable proportion of patients in each group needing intensive care or dying.
Raivio et al believe that methodologic differences may be the main factor underlying the contrasting results of their study and the Veneto one.
And they conclude: “[O]ur results do not support a role for ADT in the prevention of SARS-CoV-2 infection in men with prostate cancer via ADT-mediated decrease in the expression of TMPRSS2.
“These results do not encourage compassionate use of drugs that suppress pituitary gonadotropin secretion or inhibit androgen synthesis or androgen receptor in an attempt to decrease SARS-CoV-2 infection risk or to alleviate the course of COVID-19.”
medwireNews is an independent medical news service provided by Springer Healthcare. © 2020 Springer Healthcare part of the Springer Nature Group
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