Dr. Fizazi notes that the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus needs several proteins to bind to the body, including TMPRSS2, which is familiar to us in the role it plays in prostate cancer, specifically TMPRSS2 being regulated by the androgen receptor.
Whether androgen deprivation therapy (ADT) is protective of COVID-19 has been evaluated with a recent publication by Montopoli et al.1 In this study, data was assessed for 9,280 patients (4,532 males) with laboratory-confirmed SARS-CoV-2 infection from 68 hospitals in Veneto, one of the Italian regions that was most affected by the COVID-19 pandemic. Comparing the total number of SARS-CoV-2-positive cases, prostate cancer patients receiving ADT had a significantly lower risk of SARS-CoV-2 infection compared with patients who did not receive ADT (OR 4.05, 95% CI 1.55-10.59). Furthermore, a greater difference was found comparing prostate cancer patients receiving ADT with patients with any other type of cancer (OR 4.86, 95% CI 1.88-12.56).
Looking more generally at COVID-19 and GU cancers, Dr. Fizazi notes that his group at Gustave Roussy looked at determinants of outcomes of patients affected by COVID-19 (data in press). From March 14th –April 15th, 3,616 patients were hospitalized, of which 12% were COVID-19 positive. Among 140 patients with cancer and COVID-19, they found that chemotherapy within the last 3 months was a predictor of worsening clinical state (ICU admission).
Specific to M1 castration-sensitive prostate cancer (CSPC) cancer, there is debate as to whether hormonal therapies or docetaxel should be used. In Dr. Fizazi’s opinion, given the risks surrounding chemotherapy in the current pandemic, and the multiple phase 3 trials showing progression-free survival (PFS), quality of life (QoL), and survival benefit for next-generation AR targeting agents, we should be using these agents rather than docetaxel in the current landscape. Citing data in press from his institution, Dr. Fizazi also notes that worse performance status was also a predictor of overall survival among cancer patients with COVID-19 (HR 3.4, 95% CI 1.2-9.8).
Dr. Fizazi concluded with the following take-home messages from his presentation looking at the medical oncologist’s role during the COVID-19 pandemic:
- There is a higher risk of COVID-19 infection/severe infection in patients with recent chemotherapy, thus novel hormonal therapy should be used in M1 CSPC rather than docetaxel
- ADT may reduce the risk of COVID-19 infection secondary to the relationship with TMPRSS2
- We should consider limiting patients coming into the hospital during the pandemic
Written by: Zachary Klaassen, MD, MSc – Assistant Professor of Urology, Georgia Cancer Center, Augusta University/Medical College of Georgia Twitter: @zklaassen_md at the 12th European Multidisciplinary Congress on Urological Cancers (EMUC) (#EMUC20 ), November 13th - 14th, 2020
Presenter by: Karim Fizazi, MD, Ph.D. Professor of Medicine of Institut Gustave Roussy, (IGR) in Villejuif, France
1. Montopoli M, Zumerle S, Vettor R, et al. Androgen-deprivation therapies for prostate cancer and risk of infection by SARS-CoV-2: A population-based study (N = 4532). Ann Oncol 2020 Aug;31(8):1040-1045.
TMPRSS2 and COVID-19: Serendipity or Opportunity for Intervention? Lorelei Mucci & Philip Kantoff