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Schmidt AL, Tucker MD, Bakouny Z, Labaki C, Hsu CY, Shyr Y, Armstrong AJ, Beer TM, Bijjula RR, Bilen MA, Connell CF, Dawsey SJ, Faller B, Gao X, Gartrell BA, Gill D, Gulati S, Halabi S, Hwang C, Joshi M, Khaki AR, Menon H, Morris MJ, Puc M, Russell KB, Shah NJ, Sharifi N, Shaya J, Schweizer MT, Steinharter J, Wulff-Burchfield EM, Xu W, Zhu J, Mishra S, Grivas P, Rini BI, Warner JL, Zhang T, Choueiri TK, Gupta S, McKay RR. Association Between Androgen Deprivation Therapy and Mortality Among Patients With Prostate Cancer and COVID-19. JAMA Netw Open 2021; 4:e2134330. [PMID: 34767021 PMCID: PMC8590166 DOI: 10.1001/jamanetworkopen.2021.34330] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
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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Affiliation(s)
- Andrew L. Schmidt
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | | | - Ziad Bakouny
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Chris Labaki
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Chih-Yuan Hsu
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Yu Shyr
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Andrew J. Armstrong
- Duke Cancer Institute Center for Prostate and Urologic Cancer, Duke University, Durham, North Carolina
| | - Tomasz M. Beer
- Oregon Health and Science University Knight Cancer Institute, Portland
| | | | - Mehmet A. Bilen
- Winship Cancer Institute of Emory University, Atlanta, Georgia
| | | | | | | | - Xin Gao
- Massachusetts General Hospital, Boston
| | | | - David Gill
- Intermountain Healthcare, Salt Lake City, Utah
| | - Shuchi Gulati
- University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Susan Halabi
- Duke Cancer Institute Center for Prostate and Urologic Cancer, Duke University, Durham, North Carolina
| | - Clara Hwang
- Henry Ford Cancer Institute, Henry Ford Hospital, Detroit, Michigan
| | - Monika Joshi
- Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio
| | - Ali Raza Khaki
- University of Washington, Seattle Cancer Care Alliance, Fred Hutchinson Cancer Research Center, Seattle
- Stanford University, Stanford, California
| | - Harry Menon
- Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio
| | | | | | | | - Neil J. Shah
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Nima Sharifi
- Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio
| | - Justin Shaya
- Moores Cancer Center, University of California, San Diego
| | - Michael T. Schweizer
- University of Washington, Seattle Cancer Care Alliance, Fred Hutchinson Cancer Research Center, Seattle
| | - John Steinharter
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | | | - Wenxin Xu
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Jay Zhu
- Penn State Cancer Institute, Hershey, Pennsylvania
| | - Sanjay Mishra
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Petros Grivas
- University of Washington, Seattle Cancer Care Alliance, Fred Hutchinson Cancer Research Center, Seattle
| | - Brian I. Rini
- Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Tian Zhang
- Duke Cancer Institute Center for Prostate and Urologic Cancer, Duke University, Durham, North Carolina
| | - Toni K. Choueiri
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Shilpa Gupta
- Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio
| | - Rana R. McKay
- Moores Cancer Center, University of California, San Diego
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Lewin JS, Nour SG, Connell CF, Sulman A, Duerk JL, Resnick MI, Haaga JR. Phase II clinical trial of interactive MR imaging-guided interstitial radiofrequency thermal ablation of primary kidney tumors: initial experience. Radiology 2004; 232:835-45. [PMID: 15333798 DOI: 10.1148/radiol.2323021351] [Citation(s) in RCA: 132] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE To perform a phase II clinical trial to evaluate efficacy and safety of interactive magnetic resonance (MR) imaging-guided radiofrequency (RF) interstitial thermal ablation (ITA) of primary renal tumors. MATERIALS AND METHODS Ten male patients (age range, 25-83 years) with peripheral renal cell carcinoma and contraindications to surgery were treated with percutaneous RF ITA entirely guided and monitored with a 0.2-T MR imaging unit. By using a 200-W RF ablation system and custom-fabricated MR imaging-compatible cool-tip electrodes, pulsed RF current was applied for single or multiple ablation cycle(s) of 12-15 minutes until the entire tumor was replaced by an enlarging zone of low signal intensity on T2-weighted and/or short inversion time inversion-recovery images acquired intermittently during the procedure. Kidney MR images were acquired before, immediately after, and 2 weeks after ablation and then every 3 months for 1 year and every 6 months thereafter. Intra- and postprocedural complications were assessed with clinical evaluation of patients for pain and hemodynamic instability and evaluation of MR images for evidence of hemorrhage or other unexpected findings. Follow-up images were assessed for delayed complications such as renal ischemia, infarct, urinoma, or tumor recurrence. RESULTS Treated tumors ranged between 0.63 and 16.90 mL in volume and 1.0 and 3.6 cm in maximum diameter. Successful RF electrode insertion and/or repositioning into the renal mass was achieved in all cases with direct MR "fluoroscopic" guidance. Thirty ablation cycles were conducted at 21 electrode positions in the 10 procedures, and complete ablation, as defined with MR imaging, was achieved in all cases by the end of the procedure. Apart from two small self-limited perirenal hematomas, no intra- or postprocedural complications were observed. No delayed complications or tumor recurrence occurred during a mean follow-up period of 25 months +/- 9.4 (standard deviation). CONCLUSION Although these results are preliminary, interactive MR imaging-guided RF ITA for treatment of primary renal tumors has a high success rate.
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Affiliation(s)
- Jonathan S Lewin
- Dept of Radiology, Case Western Reserve University, Cleveland, Ohio, USA.
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Pretlow TG, Schwartz S, Giaconia JM, Wright AL, Grimm HA, Edgehouse NL, Murphy JR, Markowitz SD, Jamison JM, Summers JL, Hamlin CR, MacLennan GT, Resnick MI, Pretlow TP, Connell CF. Prostate cancer and other xenografts from cells in peripheral blood of patients. Cancer Res 2000; 60:4033-6. [PMID: 10945604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Good models for the investigation of human prostate cancer are few. Cells from approximately 9.2-21 ml of peripheral blood from patients with metastatic prostate cancer or metastatic colon cancer were injected s.c. into nude mice. Prostate cancer from 2 of 11 patients and colon cancer from 1 of 3 patients were found to be growing as metastases in the lungs of the nude mice. To our knowledge, this is the first report of the formation of xenografts from carcinoma cells taken directly from the peripheral blood of patients. Expanding circulating cancer cells with this approach may have important translational applications including: (a) development of models of human cancers; and (b) sampling of cancers from specific patients for novel molecular and therapeutic approaches.
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Affiliation(s)
- T G Pretlow
- Department of Pathology, Case-Western Reserve University Medical Center, Cleveland, Ohio 44106, USA
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Lewin JS, Connell CF, Duerk JL, Chung YC, Clampitt ME, Spisak J, Gazelle GS, Haaga JR. Interactive MRI-guided radiofrequency interstitial thermal ablation of abdominal tumors: clinical trial for evaluation of safety and feasibility. J Magn Reson Imaging 1998; 8:40-7. [PMID: 9500259 DOI: 10.1002/jmri.1880080112] [Citation(s) in RCA: 193] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
This clinical trial was performed to evaluate the safety and feasibility of interactive MR-guided radiofrequency (RF) interstitial thermal ablation (ITA) performed entirely within the MR imager. RF-ITA was performed on 11 intra-abdominal metastatic tumors during 13 sessions. The RF electrode was placed under MR guidance on a .2-T system using rapid fast imaging with steady state precession (FISP) and true FISP images. A custom 17-gauge electrode was used and was modified in four sessions to allow circulation of iced saline for cooling during ablation. Tissue necrosis monitoring and electrode repositioning were based on rapid T2-weighted and short-inversion-time inversion recovery (STIR) sequences. Morbidity and toxicity were assessed by clinical and imaging criteria. The region of tissue destruction was visible in all 11 tumors treated, as confirmed on subsequent contrast-enhanced images. No significant morbidity was noted, and patient discomfort was minimal. In conclusion, interactive MR-guided RF-ITA is feasible on a clinical .2-T C-arm system with supplemental interventional accessories with only minor patient morbidity. The ability to completely ablate tumors with RF-ITA depends on tumor size and vascularity.
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Affiliation(s)
- J S Lewin
- Department of Radiology, University Hospitals of Cleveland and Case Western Reserve University, OH 44106, USA.
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Connell CF, Berger NA. Management of advanced squamous cell carcinoma of the penis. Urol Clin North Am 1994; 21:745-56. [PMID: 7974903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
In some parts of the world, SCC of the penis represents a significant health problem. Although in the early stages it can be cured by surgery, it is often advanced at the time of presentation and many patients refuse surgery. Once the lymph nodes are involved with tumor, the prognosis is poor, with a 5-year survival of 10% to 30%. Because of the high associated morbidity and mortality, effective means of treating this disorder must be developed. As shown by the studies outlined earlier in the article, SCC of the penis is responsive to many cytotoxic agents and is also a radiosensitive tumor. Some of the agents active in this disorder are outlined in Table 1. These agents include bleomycin, methotrexate, cisplatin, and 5-FU. Using the combined-modality approach with chemotherapy, radiation therapy, and surgery, many patients with advanced disease have achieved a clinical remission with long survivals. Further work with larger sample sizes and randomized comparisons between the available regimens need to be performed in order to determine the optimal therapy for this disease. In addition, studies with new agents and radiation and surgical techniques need to be performed so that we may continue to improve our rates of long-term remission from this disease.
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Affiliation(s)
- C F Connell
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio
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