Does ADT help reduce mortality among patients with Prostate Cancer and COVID-19?
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).
In a new study conducted by Andrew L. Schmidt and team, it was found that the use of ADT was not associated with a statistically significant difference in the rates of 30-day mortality from any cause following COVID-19 infection among men receiving androgen deprivation therapy compared with those men who didn't receive that therapy.Large ongoing clinical trials, on the other hand, will provide more evidence on the role of ADT or other androgen-targeted therapies in reducing COVID-19 infection severity.
The findings of this study were published in the Journal of American medical Association on 12th November, 2021.
This cohort study looked at patient data from the COVID-19 and Cancer Consortium registries between March 17, 2020, and February 11, 2021. The consortium maintains a centralized multi-institution registry of COVID-19 patients with a current or previous cancer diagnosis. The data was collected and managed using the REDCap software, which was hosted at Vanderbilt University Medical Center in Nashville, Tennessee. Initially, 1228 patients aged 18 or older with prostate cancer listed as their primary malignant neoplasm were included; 122 patients with a second malignant neoplasm, insufficient follow-up, or poor data quality were excluded. 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 were all taken into account.
Following exclusions, 1106 patients with prostate cancer (median age, 73 years; 561 (51%) self-identified as non-Hispanic White) were included for analysis. 477 of these patients were chosen for propensity score matching (169 who received ADT and 308 who did not receive ADT). There was no significant difference in the primary end point of all-cause 30-day mortality after propensity matching.
In conclusion, following PSM, there was no significant difference in the all-cause 30-day mortality rate following COVID-19 infection or in COVID-19 severity associated with ADT use. These findings do not support the hypothesis that ADT could be beneficial in lowering the mortality or severity of SARS-CoV-2 infection.
Schmidt AL, Tucker MD, Bakouny Z, et al. Association Between Androgen Deprivation Therapy and Mortality Among Patients With Prostate Cancer and COVID-19. JAMA Netw Open. 2021;4(11):e2134330. doi:10.1001/jamanetworkopen.2021.34330.