Cell entry of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) depends on binding of the viral spike (S) proteins to angiotensin-converting enzyme 2 and on S protein priming by TMPRSS2. Inhibition of TMPRSS2 may work to block or decrease the severity of SARS-CoV-2 infections. Intriguingly, TMPRSS2 is an androgen-regulated gene that is up-regulated in prostate cancer where it supports tumor progression and is involved in a frequent genetic translocation with the ERG gene. First- or second-generation androgen-deprivation therapies (ADTs) decrease the levels of TMPRSS2. Here we put forward the hypothesis that ADTs may protect patients affected by prostate cancer from SARS-CoV-2 infections.
We extracted data regarding 9280 patients (4532 males) with laboratory-confirmed SARS-CoV-2 infection from 68 hospitals in Veneto, one of the Italian regions that was most affected by the coronavirus disease 2019 (COVID-19) pandemic. The parameters used for each COVID-19-positive patient were sex, hospitalization, admission to intensive care unit, death, tumor diagnosis, prostate cancer diagnosis, and ADT.
There were evaluable 9280 SARS-CoV-2-positive patients in Veneto on 1 April 2020. Overall, males developed more severe complications, were more frequently hospitalized, and had a worse clinical outcome than females. Considering only the Veneto male population (2.4 million men), 0.2% and 0.3% of non-cancer and cancer patients, respectively, tested positive for SARS-CoV-2. 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). 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).
Our data suggest that cancer patients have an increased risk of SARS-CoV-2 infections compared with non-cancer patients. However, prostate cancer patients receiving ADT appear to be partially protected from SARS-CoV-2 infections.
Annals of oncology : official journal of the European Society for Medical Oncology. 2020 May 06 [Epub]
M Montopoli, S Zumerle, R Vettor, M Rugge, M Zorzi, C V Catapano, G M Carbone, A Cavalli, F Pagano, E Ragazzi, T Prayer-Galetti, A Alimonti
Department of Pharmaceutical and Pharmacological Sciences, Università degli Studi di Padova, Padova, Italy; VIMM - Veneto Institute of Molecular Medicine, Fondazione per la Ricerca Biomedica Avanzata, Padova, Italy., VIMM - Veneto Institute of Molecular Medicine, Fondazione per la Ricerca Biomedica Avanzata, Padova, Italy; Department of Medicine, Università degli Studi di Padova, Padova, Italy., Department of Medicine, Università degli Studi di Padova, Padova, Italy., Department of Medicine, Università degli Studi di Padova, Padova, Italy; Veneto Tumour Registry - Azienda Zero, Padova, Italy., Veneto Tumour Registry - Azienda Zero, Padova, Italy., Institute of Oncology Research, Oncology Institute of Southern Switzerland, Università della Svizzera Italiana, Bellinzona, Switzerland., Institute for Research in Biomedicine, Università della Svizzera Italiana, Bellinzona, Switzerland., VIMM - Veneto Institute of Molecular Medicine, Fondazione per la Ricerca Biomedica Avanzata, Padova, Italy., Department of Pharmaceutical and Pharmacological Sciences, Università degli Studi di Padova, Padova, Italy., Department of Oncological and Gastroenterological Sciences - Urology Unit, Azienda Ospedaliera di Padova, Padova, Italy., VIMM - Veneto Institute of Molecular Medicine, Fondazione per la Ricerca Biomedica Avanzata, Padova, Italy; Department of Medicine, Università degli Studi di Padova, Padova, Italy; Institute of Oncology Research, Oncology Institute of Southern Switzerland, Università della Svizzera Italiana, Bellinzona, Switzerland; Department of Health Sciences and Technology, ETH Zürich, Zurich, Switzerland. Electronic address: .