A study of 4,532 men in the Veneto region of Italy has found that those who were being treated for prostate cancer with androgen-deprivation therapies (ADT) were less likely to develop COVID-19, and if they were infected, their disease tended to be less severe. This research was published by Montopoli et al as a prepress article in Annals of Oncology.
The researchers found that of 4,532 men infected with COVID-19, 9.5% (n = 430) had cancer and 2.6% (n = 118) had prostate cancer. Male patients with cancer had a 1.8-fold increased risk of COVID-19 infection among the whole male population and tended to develop more severe disease.
However, when the team looked at all patients with prostate cancer in the Veneto region, they found that only 4 out of 5,273 men on ADT developed COVID-19—and none of them died of the infection. This was compared to 37,161 men with prostate cancer who were not receiving ADT, of whom 114 developed COVID-19 and 18 of whom died. Among 79,661 patients with other types of cancer, 312 developed COVID-19 and 57 died.
Lead author Andrea Alimonti, MD, of the Università della Svizzera Italiana, said, “Patients with prostate cancer receiving androgen-deprivation therapies had a significant fourfold reduced risk of COVID-19 infections compared to patients who did not receive ADT. An even greater difference was found when we compared [patients with] prostate cancer receiving ADT to patients with any other type of cancer; there was a more than fivefold reduction in risk of infection among the prostate cancer patients on ADT.”
The researchers believe their findings suggest that even if men did not have prostate cancer, those who are at high risk of developing COVID-19 could possibly take ADT for a limited period of time to prevent infection, while those who become infected could take ADT to reduce the severity of the symptoms.
"There are several clinically approved therapies that decrease the levels of androgens and that can be administered to patients. For instance, luteinizing hormone–releasing hormone (LH-RH) antagonists can decrease the levels of testosterone in patients in 48 hours, and the effect of this therapy is transient. Once a patient stops taking the drug, his testosterone levels go back to the previous levels. These treatments to lower testosterone levels, if given for no more than a month, do not have major side effects," said Dr. Alimonti.
"I hope that our findings inspire other clinicians to carry out clinical trials using transient ADT in men infected with COVID-19, in addition to other experimental therapies. Although these data need to be further validated in additional large cohorts of patients with COVID-19, they provide an answer to the hypothesis that androgen levels can facilitate coronavirus infections and increase the severity of symptoms, as has been seen in male patients,” he added.
Dr. Alimonti and his colleagues started to investigate the effect of ADT on vulnerability to COVID-19 this year after recent research showed that a protein called TMPRSS2 helped COVID-19 to infect healthy human cells. TMPRSS2 is a member of a family of proteins called type II transmembrane serine proteases, which are involved in a number of processes in the body including cancer and viral infections. There are high levels of TMPRSS2 in patients with prostate cancer, and its action is regulated by the androgen receptor, at which therapies such as ADT are targeted. The androgen receptor also regulates TMPRSS2 levels in nonprostate tissues, including the lungs.
"This could explain why men infected by COVID-19 develop a more aggressive form of disease than women," said Dr. Alimonti. "It is known that ADT can decrease the levels of TMPRSS2 in [patients with] prostate cancer, and some experimental evidence demonstrates that this could happen not only in the prostate, but also in other tissues…. [We] wanted to see if ADT could decrease the risk of developing coronavirus infection in men with prostate cancer."
The researchers suggested that ADT could be combined with other drugs that stop viruses from multiplying and infecting human cells, or with drugs that interfere with the activity of TMPRSS2 in the body.
Study limitations include the fact that patients with cancer infected with COVID-19 may have been tested for the virus more than patients without cancer, since they are more often in the hospital.
Disclosure: For full disclosures of the study authors, visit annalsofoncology.org.The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.