Dr Tagawa Reviews the Role of ADT in COVID-19 in Prostate Cancer

Scott Tagawa, MD, MS FACP, Weill Cornell Medicine, New York-Presbyterian Hospital, discusses the impact of androgen deprivation therapy on the clinical course of COVID-19 in patients with prostate cancer. These data were presented by Dr Tagawa and co-investigators at the 2020 ASCO GU Cancers Symposium. 

Transcript

Hi, my name is Scott Tagawa. I am a medical oncologist at Weill Cornell Medicine, New York Presbyterian Hospital. At the 2021 Genitourinary Cancers Symposium, we presented a paper on the role of androgen deprivation therapy on the clinical course of COVID-19 infection in men with prostate cancer.

By way of background, there are conflicting data on the incidence and severity of COVID-19 in patients with cancer in general, as well as men with prostate cancer.

We also know that a gene called TMPRSS2 is required for entry of the SARS-CoV-2 virus into cells. TMPRSS2 is commonly fused with the ERG gene, called the TMPRSS2-ERG rearrangement. That is known to be regulated by androgens in prostate cancer.

Since the study was initiated, there are some lab studies that point away towards AR regulation of the TMPRSS2 gene in lung tissue. However, there are ongoing studies utilizing different forms of hormonal therapy against COVID-19. Therefore, it is plausible that hormonal therapy may have an impact on the severity of COVID-19 in men with prostate cancer.

A study that included data from seven centers, mostly in the New York area, took data from the March through May 2020 timeline and entered data into a central database. We collected specific, individualized data on demographics, comorbidities, status of prostate cancer as well as the treatment, and outcome from COVID-19. These were put together and then analyzed.

Overall, the primary endpoint of the study was to look at outcome of COVID-19 with relationship to the use of hormonal therapy or ADT in men with prostate cancer. Overall, we saw no difference.

Because the data were collected in an individualized manner, we were able to correct for some comorbidities, cancer status, including factors such as Gleason score, as well as stage.

Unlike some other large databases, we were able to collect that information, but there was no difference in the overall outcomes of documented COVID-19 infection on hospitalization, oxygen utilization, or a requirement for mechanical ventilation with or without andro deprivation therapy.

Andro deprivation therapy was associated with more severe prostate cancer, as expected. Again, as we controlled for that on outcomes of men with documented COVID-19, there was no overall difference.

I would not say that this study definitively is in favor or refutes the possibility of ADT or hormonal therapy affecting the incidence of COVID-19 or the severity but does point away from an effect on the severity as we were able to control for severity of the cancer.

One of the strengths of the study is, because it was a prospective collection at seven different centers, we were able to include individual groups and individual patient data. It was a reasonably large data set in a short period of time, over 400 patients.

Weaknesses are...It was only 400+ patients over a relatively short period of time. The follow-up period was also relatively short, so a three-month accrual period, about a six-month outcome period, although we know that, unfortunately, during that period of time, at the peak of the pandemic particularly in the Northeast, some of those acute outcomes required less follow-up.

We did include only those that were PCR-positive. This was not able to really address the potential protective effect of ADT on the incidence of COVID-19. We also know of some imperfections with data around diagnosis. For instance, some that were symptomatic but not tested and then later "confirmed" to have COVID-19 infection by an antibody test were not included in this particular database.

That being said, I think that is one of the nice things, was that this database was created, can continue to grow, and we will have longer follow-up to address some of those additional questions.