Research Refutes ADT Protective Effect Against SARS-CoV-2 Infection

Author: By Lynda Williams, Senior medwireNews Reporter

medwireNews: Findings from two population studies have found no evidence to suggest that use of androgen deprivation therapy (ADT) for prostate cancer may reduce the risk of SARS-CoV-2 infection. 

Both sets of research, published as letters to the Annals of Oncology, contradict an earlier report from the Veneto region in Italy which indicated that ADT users were less likely to test positive for the virus, and more likely to have a positive outcome from COVID-19, than other prostate cancer patients. 

Orazio Caffo, from the University of Torino in Italy, and co-authors collated information for 1949 metastatic castration-resistant or castration-sensitive prostate cancer patients treated at one of 19 high-volume oncology departments in Northern Italy up to 6 May 2020. 

The patients were undergoing treatment with ADT alone or in combination with docetaxel or cabazitaxel chemotherapy, abiraterone or enzalutamide therapy, or radium-223. 

Of the 36 (1.8%) patients who tested positive for SARS-CoV-2 infection, 61.1% were admitted to hospital, 55.6% recovered and five patients had ongoing infection at time of analysis. Overall, 30.6% of patients died, including 25.0% of the 12 patients aged less than 70 years and 33.3% of the 24 patients aged 70 years or older, similar to the greater than 30.3% rate previously found among the Italian men in this age group. 

“Clearly, all of our patients had advanced disease and this may explain the different incidence of SARS-CoV-2 infection” from the earlier report, Orazio Caffo et al suggest. 

However, Taneli Raivio, from the University of Helsinki in Finland, and co-authors also say they found no evidence to “support a role for ADT in the prevention of SARS-CoV-2 infection in men with prostate cancer”, as hypothesised to occur “via ADT-mediated decrease in the expression of TMPRSS2.”

The team collected data from 352 men from the Hospital District of Helsinki and Uusimaa who were tested for SARS-CoV-2 infection between 7 March and 14 May 2020, 134 of whom had undergone orchiectomy or were receiving pharmaceutical ADT.

Overall, 4.8% of patients tested positive for the virus, 35.0% of whom were using ADT. Analysis did not find a significant correlation between ADT use and the likelihood of SARS-CoV-2 infection, or the severity of COVID-19 in terms of mortality or requirement for intensive care. Nor was an association detected between ADT use and the presence of comorbidity among infected patients.

The investigators suggest that the up to fourfold difference in the infection rate between the Helsinki and Veneto regions may “represent a potential confounding factor”, but even after adjusting for this, the researchers did not show a significant link between ADT use and infection.

“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”, Taneli Raivio and colleagues conclude. 

References  

Caffo O, Zagonel V, Baldessari C, et al. On the relationship between androgen-deprivation therapy for prostate cancer and risk of infection by SARS-CoV-2. Ann Oncol; Advance online publication 17 June 2020. https://doi.org/10.1016/j.annonc.2020.06.005

Koskinen M, Carpen O, Honkanen V, et al. Androgen deprivation and SARS-CoV-2 in men with prostate cancer. Ann Oncol; Advance online publication 29 June 2020. https://doi.org/10.1016/j.annonc.2020.06.015