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Does Androgen Deprivation Therapy Reduce Severity of COVID-19 in Prostate Cancer Patients?
Early in the pandemic, a variety of reports suggested that androgen deprivation therapy (ADT), a widely used treatment for men with advanced prostate cancer, might decrease the severity of COVID-19 in prostate cancer patients infected with SARS-CoV-2. That hypothesis was based on the fact that the TMPRSS2:ERG gene fusion — which leads to an androgen-regulated fusion oncogene — is the most frequent genomic alteration in prostate cancer, and the TMPRSS2 protein is known to play a major role in the pathogenicity of SARS-CoV-2.
To explore whether ADT can modulate outcomes of COVID-19, investigators performed an exploratory cohort analysis of 1106 prostate cancer patients with SARS-CoV-2 infection (median age, 73; 51% non-Hispanic white). The primary outcome was all-cause mortality within 30 days of COVID-19 diagnosis in patients receiving ADT compared with patients not receiving ADT. Additional subgroup analyses compared 30-day mortality among those treated with ADT alone versus those receiving additional prostate cancer therapies, including androgen receptor–targeted agents, abiraterone in combination with prednisone, and chemotherapy.
After propensity score matching (PSM) to balance covariate distributions among the ADT groups, 30-day mortality was similar for patients receiving ADT and those not receiving ADT (15% and 14%, respectively), indicating no impact of ADT on death rates. In addition, no differences were observed in any of the subgroups receiving additional prostate cancer therapy.
As noted by the authors, this study was limited by its retrospective nature and the lack of testosterone values in the study cohort. Prospective studies are underway to further explore whether ADT can modulate the severity of COVID-19.
Schmidt AL et al.
Title: Association between androgen deprivation therapy and mortality among patients with prostate cancer and COVID-19.
Source: JAMA Netw Open 2021 Nov 12; [e-pub]. (Abstract/FREE Full Text)