Association Between Androgen Deprivation Therapy and Mortality Among Patients With Prostate Cancer and COVID-19

• Type of Material: Article
• Authors: Andrew L Schmidt, Dana-Farber Cancer Institute; Matthew D Tucker, Vanderbilt University; Ziad Bakouny, Dana-Farber Cancer Institute; Chris Labaki, Dana-Farber Cancer Institute; Chih-Yuan Hsu, Vanderbilt University; Yu Shyr, Vanderbilt University; Andrew J Armstrong, Duke University; Tomasz M Beer, Oregon Health and Science University Knight Cancer Institute; Ragneel R Bijjula, UPMC Western Maryland; Mehmet Bilen, Emory University; Cindy F Connell, Penn State Cancer Institute; Scott Jospeh Dawsey, Cleveland Clinic; Bryan Faller, Missouri Baptist Medical Center; Xin Gao, Massachusetts General Hospital; Benjamin A Gartrell, Montefiore Einstein College of Medicine; David Gill, Intermt Healthcare; Shuchi Gulati, University of Cincinnati; Susan Halabi, Duke University; Clara Hwang, Henry Ford Hospital; Monika Joshi, Cleveland Clinic; Ali Raza Khaki, University of Washington; Harry Menon, Cleveland Clinic; Michael J Morris, Memorial Sloan Kettering Cancer Center; Matthew Puc, Virtua Health Network; Karen B Russell, Tallahassee Memorial Healthcare; Neil J Shah, Memorial Sloan Kettering Cancer Center; Nima Sharifi, Cleveland Clinic Taussig Cancer Institute; Justin Shaya, University of California San Diego; Michael T Schweizer, University of Washington; John Steinharter, Dana Farber Cancer Institute; Elizabeth M Wulff-Burchfield, University of Kansas; Wenxin Xu, Dana Farber Cancer Institute; Jay Zhu, Penn State Cancer Institute; Sanjay Mishra, Vanderbilt University; Petros Grivas, University of Washington; Brian I Rini, Vanderbilt University; Jeremy L Warner, Vanderbilt University; Tian Zhang, Duke University; Toni K Choueiri, Dana Farber Cancer Institute; Shilpa Gupta, Cleveland Clinic Taussig Cancer Institute; Rana R McKay, University of California San Diego
• Language: English
• Date: 2021-11-12
• Publisher: AMER MEDICAL ASSOC
• Publication Version: Final Published Version
• Copyright Statement: 2021 Schmidt AL et al. JAMA Network Open.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1001/jamanetworkopen.2021.34330
• Title of Journal or Parent Work: JAMA NETWORK OPEN
• Volume: 4
• Issue: 11
• Start Page: e2134330
• End Page: e2134330
• Grant/Funding Information: The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.; Vanderbilt Institute for Clinical and Translational Research developed and supports REDCap through grant UL1 TR000445 from the National Center for Advancing Translational Sciences.
• Keywords: Life Sciences & Biomedicine; Science & Technology; General & Internal Medicine; EXPRESSION; SARS-COV-2; TMPRSS2; CCC19; OUTCOMES; Medicine, General & Internal
• Research Categories: Health Sciences, Oncology; Health Sciences, Medicine and Surgery

Abstract

Importance: 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). Objective: To examine whether ADT is associated with a decreased rate of 30-day mortality from SARS-CoV-2 infection among patients with prostate cancer. Design, Setting, and Participants: This cohort study analyzed patient data recorded in the COVID-19 and Cancer Consortium registry between March 17, 2020, and February 11, 2021. The consortium maintains a centralized multi-institution registry of patients with a current or past diagnosis of cancer who developed COVID-19. Data were collected and managed using REDCap software hosted at Vanderbilt University Medical Center in Nashville, Tennessee. Initially, 1228 patients aged 18 years or older with prostate cancer listed as their primary malignant neoplasm were included; 122 patients with a second malignant neoplasm, insufficient follow-up, or low-quality data were excluded. Propensity matching was performed using the nearest-neighbor method with a 1:3 ratio of treated units to control units, adjusted for 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. Exposures: Androgen deprivation therapy use was defined as prior bilateral orchiectomy or pharmacologic ADT administered within the prior 3 months of presentation with COVID-19. Main Outcomes and Measures: The primary outcome was the rate of all-cause 30-day mortality after COVID-19 diagnosis for patients receiving ADT compared with patients not receiving ADT after propensity matching. Results: After exclusions, 1106 patients with prostate cancer (before propensity score matching: median age, 73 years [IQR, 65-79 years]; 561 (51%) self-identified as non-Hispanic White) were included for analysis. Of these patients, 477 were included for propensity score matching (169 who received ADT and 308 who did not receive ADT). After propensity matching, there was no significant difference in the primary end point of the rate of all-cause 30-day mortality (OR, 0.77; 95% CI, 0.42-1.42). Conclusions and Relevance: Findings from this cohort study suggest that ADT use was not associated with decreased mortality from SARS-CoV-2 infection. However, large ongoing clinical trials will provide further evidence on the role of ADT or other androgen-targeted therapies in reducing COVID-19 infection severity.