The so-called “androgen-deprivation” treatments used in prostate cancer therapy may have a protective effect against COVID-19. A study conducted by the Istitute of Oncology Research (IOR, affiliated to USI) based on health data obtained from the Veneto region in Italy has observed a lower risk of developing the coronavirus disease for men subject to this type of therapy. The study, performed in collaboration with the Institute for Research in Biomedicine (IRB, also affiliated to USI) and led by Andrea Alimonti, Professor at USI, ETH Zurich and the University of Padua, investigates a suggested link between the mechanisms of “aggression” of the coronavirus and those of male hormones. However, the suggestion is subject to further investigation with other data, research and clinical studies before any possible therapy can be outlined.
The study, in the leading cancer journal Annals of Oncology, included 5.273 patients with prostate cancer reveiving the androgenic deprivation therapy (ADT), which is based on treatments that target male hormones and their effects on tumor development. Of these 5.273 patients, only 4 contracted COVID-19 and none died. Of the 37.161 prostate cancer patients not treated with ADT, on the other hand, 114 contracted the new coronavirus infection and 18 died. Out of 79.661 patients with other cancers, 312 developed COVID, with 57 deaths.
According to Prof. Alimonti, “patients with prostate cancer receiving androgen-deprivation therapies had a significant four-fold reduced risk of COVID-19 infections compared to patients who did not receive ADT. An even greater difference was found when we compared prostate cancer patients receiving ADT to patients with any other type of cancer; there was a more than five-fold reduction in risk of infection among the prostate cancer patients on ADT”.
This is the first study to suggest a link between ADT and COVID-19. The researchers believe their findings suggest that even if men did not have prostate cancer, those who are at high risk of developing COVID-19 could take ADT for a limited period of time to prevent infection, while those who become infected could take ADT to reduce the severity of the symptoms. This is to have an extra ‘bonus’, combined with therapy, to improve the situation of some patients.
The research idea
The investigations on a possible protective effect of anti-androgenic treatments against COVID-19 started from an intuition reported a few weeks ago by Franco Cavalli, IOR President, in the Corriere del Ticino. Starting from the data on the disease and its increased aggressiveness in humans, the “suspcions” turned to a particular protein, called TMPRSS2; this protein is one of the mechanisms exploited by the novel coronavirus to infect the cells of the human body. Patients with prostate cancer have high levels of this protein, whose action is regulated by the androgen receptor targeted by therapies such as ADT.
After the first laboratory investigations, performed in collaboration with the group led by Dr. Andrea Cavalli at the IRB and the first cross-checks with data on Chinese patients, the study on data from Veneto allowed to further investigate the hypothesis.
“It is known that ADT can decrease the levels of TMPRSS2 in prostate cancer patients, and some experimental evidence demonstrates that this could happen not only in the prostate but also in other tissues”, observes Andrea Alimonti. “So I wanted to see if ADT could decrease the risk of developing coronavirus infection in men with prostate cancer”.
Preliminary clinical protocols, with required caution
“I hope our results will lead other researchers to conduct clinical trials using temporary ADT treatment in men infected with Sars-CoV-2, in addition to other experimental therapies. Although they need to be further validated on other large cohorts of patients, these data provide a response to the hypothesis that androgenic hormone levels may increase coronavirus infections and the severity of symptoms, as has been observed in male patients”, points out Alimonti, Professor at the USI Faculty of Biomedical Sciences, adding that at the Ente ospedaliero cantonale (EOC, the cantonal healthcare provider) a preliminary clinical testing protocol is being developed, thanks to Silke Gillessen Sommer, Medical and Scientific Director of the Oncological Institute of Italian Switzerland (IOSI) and also Professor at the USI Faculty of Biomedical Sciences.
Editor-in-chief of Annals of Oncology, Professor Fabrice André, Director of Research at the Institut Gustave Roussy, Villejuif, France, said: “We decided to publish this study because it provides a rationale to evaluate the efficacy of ADT prospectively in patients infected with COVID-19. Nevertheless, the study does not provide a definitive conclusion about the role of ADT in patients infected with COVID-19, and this class of drugs should not be used for this purpose until prospective trials have confirmed its efficacy”.