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. 2021 Nov 1;4(11):e2134330.
doi: 10.1001/jamanetworkopen.2021.34330.

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

Andrew L Schmidt  1 , Matthew D Tucker  2 , Ziad Bakouny  1 , Chris Labaki  1 , Chih-Yuan Hsu  2 , Yu Shyr  2 , Andrew J Armstrong  3 , Tomasz M Beer  4 , Ragneel R Bijjula  5 , Mehmet A Bilen  6 , Cindy F Connell  7 , Scott Joseph Dawsey  8 , Bryan Faller  9 , Xin Gao  10 , Benjamin A Gartrell  11 , David Gill  12 , Shuchi Gulati  13 , Susan Halabi  3 , Clara Hwang  14 , Monika Joshi  8 , Ali Raza Khaki  15   16 , Harry Menon  8 , Michael J Morris  17 , Matthew Puc  18 , Karen B Russell  19 , Neil J Shah  17 , Nima Sharifi  8 , Justin Shaya  20 , Michael T Schweizer  15 , John Steinharter  1 , Elizabeth M Wulff-Burchfield  21 , Wenxin Xu  1 , Jay Zhu  7 , Sanjay Mishra  2 , Petros Grivas  15 , Brian I Rini  2 , Jeremy Lyle Warner  2 , Tian Zhang  3 , Toni K Choueiri  1 , Shilpa Gupta  8 , Rana R McKay  20
Affiliations

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

Andrew L Schmidt et al. JAMA Netw Open. .

Erratum in

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.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Bakouny reported grants from Genentech/imCORE; nonfinancial support from Bristol Myers Squibb; and personal fees from UpToDate outside the submitted work. Dr Shyr reported grants from the National Cancer Institute during the conduct of the study. Dr Armstrong reported grants from Bayer, Janssen, and Pfizer/Astellas; and personal fees from Bayer, Janssen, and Pfizer/Astellas outside the submitted work. Dr Beer reported grants paid to his institution from Alliance Foundation Trials, Astellas Pharma, Bayer, Boehringer Ingelheim, Corcept Therapeutics, Endocyte Inc, Freenome, Grail Inc, Harpoon Therapeutics, Janssen Research and Development, Medivation Inc, Sotio, Theraclone Sciences/OncoResponse, and Zenith Epigenetics; personal fees from Arvinas, Astellas Pharma, AstraZeneca, Bayer, Bristol Myers Squib, Clovis Oncology, Constellation, GlaxoSmithKline, Grail Inc, Janssen, Merck & Co, Myovant Sciences, Novartis, Pfizer, Sanofi, and Tolero; and stock ownership in Arvinas Inc and Salarius Pharmaceuticals outside the submitted work. Dr Bilen reported grants to his institution from AAA, AstraZeneca, Bayer, Bristol Myers Squibb, Genentech/Roche, Genome and Company, Incyte, Nektar, Peloton Therapeutics, Pfizer, SeaGen, Tricon Pharmaceuticals, and Xencor outside the submitted work; and personal fees from AstraZeneca, Bayer, Bristol Myers Squibb, Calithera Biosciences, Eisai, EMD Serono, Exelixis, Genomic Health, Janssen, Nektar, Pfizer, Sanofi, and SeaGen outside the submitted work. Dr Gill reported personal fees from Amgen and personal fees from Pfizer outside the submitted work. Dr Gulati reported grants to her institution from AstraZeneca outside the submitted work. Dr Hwang reported funding from the Henry Ford Cancer Institute; grants from AstraZeneca, Bayer, and Merck & Co; grants to her institution from AstraZeneca, Bausch, Bayer, Dendreon, Exelixis, Genentech, and Merck & Co; personal fees from Astellas, Bayer, Bristol Myers Squibb, Dendreon, EMD Sorono, Exelixis, Genentech, Janssen Scientific, Medivation, and Sanofi/Genzyme outside the submitted work; and stock ownership in Johnson and Johnson by an immediate family member. Dr Joshi reported grants from AstraZeneca and Pfizer; grants to his institution from Bayer, Endocyte, Corcept, Janssen, Progenics, and Roche/Genentech; personal fees from Bayer and Sanofi outside the submitted work; personal fees from Athenex, Curium, Exelexis, and ORIC; and being an uncompensated consultant for Advanced Accelerator Applications, Bayer, Endocyte, Janssen, Lantheus, Norvartis, and Progenics. Dr Khaki reported stock ownership in Merck & Co and Sanofi stock outside the submitted work. Dr Morris reported personal fees from AstraZeneca, Athenex, Curium, Exelixis, and Oric Pharmaceuticals outside the submitted work. Dr Shah reported grants from Aravive; and personal fees from Merck & Co outside the submitted work. Dr Schweizer reported funds to his institution from AstraZeneca, Bristol Myers Squibb, Elevate Bio, Hoffmann-La Roche, Immunomedics, Janssen, Madison Vaccines, Merck & Co, Pfizer, Tmunity, and Zenith Epigenetics; and personal fees from AstraZeneca, Janssen, PharmaIn, and Resverlogix outside the submitted work. Dr Wulff-Burchfield reported personal fees from Astellas, Bristol Myers Squibb; being on the advisory board for Exelixis; grants from Pfizer outside the submitted work; grants from Pfizer Global Medical; family members with stock ownership in Immunomedics and Nektar. Dr Xu reported grants from The ASCO Conquer Cancer Foundation outside the submitted work. Dr Mishra reported grants from National Cancer Institute during the conduct of the study; and personal fees from National Geographic outside the submitted work. Dr Grivas reported grants to his institution from Bavarian Nordic, Bristol Myers Squibb, Clovis Oncology, Debiopharm, GlaxoSmithKline, Immunomedics, Kure It Cancer Research, Merck & Co, Mirati Therapeutics, Pfizer, and QED Therapeutics; and personal fees from Astellas Pharma, AstraZeneca, Bayer, Bristol Myers Squibb, Clovis Oncology, Dyania Health, Driver, EMD Serono, Exelixis, Foundation Medicine, Genentech/Roche, Genzyme, GlaxoSmithKline, Guardant Health, Heron Therapeutics, Immunomedics/Gilead, Infinity Pharmaceuticals, Janssen, Merck & Co, Mirati Therapeutics, Pfizer, QED Therapeutics, Regeneron Pharmaceuticals, Seattle Genetics, and 4D Pharma PLC outside the submitted work. Dr Warner reported grants from the National Institute of Cancer during the conduct of the study; grants from AACR; personal fees from Roche and Westat; and ownership of HemOnc.org LLC outside the submitted work. Dr Zhang reported grants to his institution from AbbVie/Stemcentrx, Acerta, Astellas, Merck & Co, Janssen, Merrimack, Mirati Therapeutics, Novartis, OmniSeq, PGDx, Pfizer, and Regeneron outside the submitted work; having a spouse who is a stockholder/employee for Capio Biosciences and Archimmune Therapeutics and a stockholder/consultant for Nanorobotics; consulting/speaking with Genomic Health and Sanofi Aventis; consulting/advisory board with Amgen, AstraZeneca, Bayer, Bristol Myers Squibb, Calithera, Dendreon, Foundation Medicine, Janssen, MJH Associates, and Pfizer; and personal fees from Aptitude Health, Aravive, Bristol Myers Squibb, Dendreon, Eisai, Exelixis, Janssen, Merck & Co, MJH Associates, Pacific Genuity, Pfizer, QED Therapeutics, Sanofi-Aventis, and SeaGen outside the submitted work. Dr Choueiri reported nonfinancial support from COVID-19 and Cancer Consortium (CCC19) steering committee, and ESMO-CoCare steering committee during the conduct of the study; personal fees from Bristol Myers Squibb, Eli Lilly and Company, Exelixis, Merck & Co, Novartis, Pfizer, Roche/Genentech, and UptoDate; and participating in the European Society for Medical Oncology and the American Society of Clinical Oncology planning committees and the Genitourinary Steering Committee of the National Institute of Cancer. Dr Gupta reported grants to her institution from AstraZeneca and Isoray; and personal fees from AstraZeneca, Bristol-Myers Squibb, Exelixis, Janssen, Merck & Co, Pfizer, and Seattle Genetics outside the submitted work. Dr McKay reported research funding from Bayer, Pfizer, and Tempus; and personal fees from AstraZeneca, Bayer, Bristol Myers Squibb, Calithera, Caris, Dendreon, Exelixis, Janssen, Johnson and Johnson, Merck & Co, Myovant, Novartis, Pfizer, Sanofi, Sorrento Therapeutics, Tempus, and Vividion. No other disclosures were reported.

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