key: cord-354458-o2kcd085
authors: Caffo, Orazio; Zagonel, Vittorina; Baldessari, Cinzia; Berruti, Alfredo; Bortolus, Roberto; Buti, Sebastiano; Ceresoli, Giovanni Luca; Donini, Maddalena; Ermacora, Paola; Fornarini, Giuseppe; Fratino, Lucia; Masini, Cristina; Massari, Francesco; Mosca, Alessandra; Mucciarini, Claudia; Procopio, Giuseppe; Tucci, Marcello; Verri, Elena; Zucali, Paolo; Buttigliero, Consuelo
title: On the relationship between androgen-deprivation therapy for prostate cancer and risk of infection by SARS-CoV-2
date: 2020-06-18
journal: Ann Oncol
DOI: 10.1016/j.annonc.2020.06.005
sha: 
doc_id: 354458
cord_uid: o2kcd085

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prostate cancer (PC) and risk of infection by SARSCoV-2 through a population-based study of patients with laboratory-confirmed SARS-CoV-2 infection from 68 hospitals in Veneto (1) . They found that only four out of 5,273 PC patients treated with ADT (0.07%) developed SARS-CoV-2 infection and such patients had a significantly lower risk of SARS-CoV-2 infection than the patients who did not receive ADT.

To further investigate this potential relationship, we identified all of the cases of COVID-19 that have occurred in metastatic castration-resistant PC (mCRPC) and metastatic castration-sensitive PC (mCSPC) patients treated in most of the high-volume referral medical oncology departments in northern Italy. Italy was the first country outside China to experience widespread SARS-CoV-2 infection and, as of 6 May 2020, the country with the fourth highest number of cases and deaths (2), with the regions of northern Italy accounting for 80.4% of the cases and 86.7% of the deaths (3).

The 19 high-volume medical oncology departments contributing to this study were treating a median of 80 metastatic PC patients each (range 48-230) for a total of 1,949. All of the patients were receiving ADT alone or in combination with one chemotherapeutic agent (docetaxel or cabazitaxel), one new-generation androgen-targeting agent (abiraterone or enzalutamide), or one radiopharmaceutical agent (radium 223).

Thirty-six of these patients had a confirmed diagnosis of SARS-CoV-2 infection (1.8%). Their median age was 74.5 years, and 66.7% were aged ≥70 years. Most of the infected patients (61.1%) were hospitalised; five are still infected, 20 (55.6%) have recovered, and 11 (30.6%) have died.

Our finding that the risk of developing a SARSCoV-2 infection among patients with metastatic PC is higher than that described by Montopoli et al. may be due to differences in selection of the population considered to be potentially exposed to the infection. They evaluated a cohort of patients identified by means of a regional cancer registry, who may receive ADT for metastatic disease or biochemical relapse in the absence of any clinically detectable signs of disease, but the authors did not indicate which disease stage the patients were in when they were administered ADT. On the contrary, we identified a homogenous population of consecutive mCSPC/mCRPC patients treated in most of the high-volume referral medical oncology departments in northern Italy. Clearly, all of our patients had advanced disease and this may explain the different incidence of SARSCoV-2 infection.

In terms of lethality of SARSCoV-2 infection, we observed three deaths among the 12 patients aged <70 years (25%), a lethality rate that is higher than that expected in infected Italian males aged <70 years as a whole (<13.0%). The eight deaths among the 24 patients aged ≥70 years (33.3%) lead to a lethality rate that is in line with that observed in Italian SARS-CoV-2 positive males aged ≥ 70 years as a whole (>30.3%) (3).

These findings do not apparently support the postulated protective effect of ADT, at least in patients with metastatic PC.

Androgen-deprivation therapies for prostate cancer and risk of infection by SARS-CoV-2: a population-based study (n=4532)

COVID-19) disease pandemic -Statistics & Facts

Disclosure OC received honoraria as speaker or advisor for Astra Zeneca, Astellas, Janssen, Pfizer VZ received honoraria as speaker or advisor for