Abstract

Androgen deprivation therapy (ADT) has been theorized to decrease the severity of SARS-CoV-2 infection in patients with prostate cancer owing to a potential decrease in the tissue-based expression of the SARS-CoV-2 coreceptor transmembrane protease, serine 2 (TMPRSS2). To examine whether ADT is associated with a decreased rate of 30-day mortality from SARS-CoV-2 infection among patients with prostate cancer. This cohort study analyzed patient data recorded in the COVID-19 and Cancer Consortium registry between March 17, 2020, and February 11, 2021. The consortium maintains a centralized multi-institution registry of patients with a current or past diagnosis of cancer who developed COVID-19. Data were collected and managed using REDCap software hosted at Vanderbilt University Medical Center in Nashville, Tennessee. Initially, 1228 patients aged 18 years or older with prostate cancer listed as their primary malignant neoplasm were included; 122 patients with a second malignant neoplasm, insufficient follow-up, or low-quality data were excluded. Propensity matching was performed using the nearest-neighbor method with a 1:3 ratio of treated units to control units, adjusted for age, body mass index, race and ethnicity, Eastern Cooperative Oncology Group performance status score, smoking status, comorbidities (cardiovascular, pulmonary, kidney disease, and diabetes), cancer status, baseline steroid use, COVID-19 treatment, and presence of metastatic disease. Androgen deprivation therapy use was defined as prior bilateral orchiectomy or pharmacologic ADT administered within the prior 3 months of presentation with COVID-19. The primary outcome was the rate of all-cause 30-day mortality after COVID-19 diagnosis for patients receiving ADT compared with patients not receiving ADT after propensity matching. After exclusions, 1106 patients with prostate cancer (before propensity score matching: median age, 73 years [IQR, 65-79 years]; 561 (51%) self-identified as non-Hispanic White) were included for analysis. Of these patients, 477 were included for propensity score matching (169 who received ADT and 308 who did not receive ADT). After propensity matching, there was no significant difference in the primary end point of the rate of all-cause 30-day mortality (OR, 0.77; 95% CI, 0.42-1.42). Findings from this cohort study suggest that ADT use was not associated with decreased mortality from SARS-CoV-2 infection. However, large ongoing clinical trials will provide further evidence on the role of ADT or other androgen-targeted therapies in reducing COVID-19 infection severity.

Highlights

  • Since the recognition of SARS-CoV-2 in December 2019 in Wuhan, China, COVID-19 has rapidly spread worldwide, causing widespread disease and mortality.[1]

  • Androgen Deprivation Therapy and Mortality Among Patients With Prostate Cancer and COVID-19. Findings from this cohort study suggest that androgen deprivation therapy (ADT) use was not associated with decreased mortality from SARS-CoV-2 infection

  • We focused on the cohort receiving ADT and compared the rates of 30-day mortality for patients receiving additional prostate cancer therapies, grouped by androgen receptor–targeted agent, abiraterone in combination with prednisone, and chemotherapy, compared with ADT alone

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Summary

Introduction

Since the recognition of SARS-CoV-2 in December 2019 in Wuhan, China, COVID-19 has rapidly spread worldwide, causing widespread disease and mortality.[1]. Of substantial therapeutic interest is the potential for androgen deprivation therapy (ADT) to downregulate TMPRSS2 transcription in pulmonary tissue and, in turn, reduce host susceptibility to or severity of SARS-CoV-2 infection.[4,8] Other types of therapy, such as the use of androgen receptor inhibitors (ARIs), may exert an effect through mechanisms associated with the androgen axis or pathway.[9]

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