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07-05-2020 | Prostate cancer | News

Link between ADT and reduced COVID-19 risk proposed

Author: Shreeya Nanda


medwireNews: An analysis of Italian patients suggests a potential protective role of androgen deprivation therapy (ADT) against SARS-CoV-2 infection.

The researchers explain that “[c]ell entry of SARS-CoV-2 depends on binding of the viral spike (S) proteins to ACE2 and on S protein priming by TMPRSS2,” which in turn is regulated by the androgen receptor (AR) protein.

They therefore hypothesized that ADT “may protect patients affected by prostate cancer from SARS-CoV-2 infections.”

And indeed, among the 42,434 men with prostate cancer in the Veneto region of Italy, SAR-CoV-2 infection occurred in just four of the 5273 men who received ADT versus 114 of the 37,161 men who did not receive ADT.

The estimated number of SARS-CoV-2 cases per 100,000 individuals was 76 in the ADT and 318 in the no ADT group, which translated into a significant 4.05-fold increased risk for SARS-CoV-2 in the no ADT group, report Andrea Alimonti (Università della Svizzera Italiana, Bellinzona, Switzerland) and colleagues in the Annals of Oncology.

When ADT-treated prostate cancer patients were compared with 79,661 patients with other tumors, the SARS-CoV-2 risk for the latter group was even greater, at a 5.17-fold increased risk, while the estimated total SARS-CoV-2 cases per 100,000 individuals were 76 and 392, respectively.

Alimonti et al emphasize that “these data need to be further validated in additional large cohorts of SARS-CoV-2 infected patients and corrected for multiple variables,” but they propose that ADT, via luteinizing hormone-releasing hormone agonists or antagonists or AR inhibitors, “may be considered to prevent SARS-CoV-2 infections or complications in high-risk male populations.”

The team continues: “Given that the effects of these compounds are reversible, they could be used transiently (e.g. one month) in patients affected by SARS-CoV-2, thereby reducing the risk of side effects due to a long-term administration.”

In a press release, the journal’s editor-in-chief Fabrice André (Institut Gustave Roussy, Villejuif, France) added a note of caution: “We decided to publish this study because it provides a rationale to evaluate the efficacy of ADT prospectively in patients infected with COVID-19.

“Nevertheless, the study does not provide a definitive conclusion about the role of ADT in patients infected with COVID-19, and this class of drugs should not be used for this purpose until prospective trials have confirmed its efficacy.”

The study also examined the SARS-CoV-2 risk among male cancer patients, using data from 4532 men who tested positive for SARS-CoV-2 in the Veneto region up to the data cutoff of 1 April 2020. The incidence of SARS-CoV-2-positivity was 0.3% for cancer patients versus 0.2% for men without cancer, which equated to a significant 1.79-fold higher risk for men with cancer.

Men tended to have worse COVID-19 outcomes than women, say Alimonti and colleagues with even poorer outcomes among men with cancer than those without. For instance, 67.2% of male cancer patients were hospitalized due to COVID-19 versus 47.0% of those without cancer, while the corresponding mortality rates were 17.4% and 6.9%.

“Our data are in line with recent reports from China that demonstrated […] similar trends in male patients and those with cancer,” write the researchers.

medwireNews is an independent medical news service provided by Springer Healthcare. © 2020 Springer Healthcare part of the Springer Nature Group

7 May 2020: The coronavirus pandemic is affecting all healthcare professionals across the globe. Medicine Matters’ focus, in this difficult time, is the dissemination of the latest data to support you in your research and clinical practice, based on the scientific literature. We will update the information we provide on the site, as the data are published. However, please refer to your own professional and governmental guidelines for the latest guidance in your own country.

Ann Oncol 2020; doi:10.1001/jamaoncol.2020.0465