# Long-Term Oncological Outcomes in Metastatic Prostate Cancer Patients Who Are Able to Maintain/Recover Ongoing Anticancer Therapy After SARS-CoV-2 Infection—Results of the MEET-URO 22 Study

## TL;DR

This study found that prostate cancer patients who recovered from COVID-19 and continued their treatment had survival rates similar to historical data, suggesting no major long-term impact on cancer outcomes.

## Contribution

The study provides new insights into the long-term oncological outcomes of prostate cancer patients who resumed treatment after SARS-CoV-2 infection.

## Key findings

- Hospitalization, infection duration, and type of anticancer agent influenced treatment resumption after SARS-CoV-2 infection.
- Survival outcomes in patients who resumed treatment were comparable to historical data from clinical trials.
- SARS-CoV-2 infection did not appear to significantly worsen long-term oncological outcomes in this selected patient group.

## Abstract

Although the relationship between androgen deprivation therapy for prostate cancer (PC) and the biological mechanisms of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection remains unequivocally unclear, exposure to the virus may influence PC evolution by altering the expression of a specific gene. This study aims to evaluate the long-term oncological outcomes of patients with metastatic PC who were undergoing medical therapy at the time of contracting SARS-CoV-2 and who resumed/continued medical treatment after recovery. Our study suggests that the post-infection evolution of anticancer treatments was influenced by hospitalization, infection duration, and the type of ongoing anticancer agent. Moreover, among patients who were able to resume treatment, the survival outcomes we observed were within the range reported in historical data from pivotal clinical trials, suggesting that SARS-CoV-2 infection may not have led to a significant deterioration in long-term oncology outcomes. Our results provide further data on the complex relationship between PC and SARS-CoV-2 infection.

Background: Although the relationship between androgen deprivation therapy (ADT) for prostate cancer (PC) and the biological mechanisms of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection remains unequivocally unclear, it is possible that exposure to the virus may influence PC evolution by altering TMPRSS2 expression. This study aims to evaluate the long-term oncological outcomes of patients with metastatic PC who were undergoing medical therapy at the time of contracting SARS-CoV-2 and who resumed/continued anticancer treatment after recovery. Methods: We retrospectively evaluated a consecutive series of 151 metastatic PC patients who developed SARS-CoV-2 infection while receiving one active systemic anticancer therapy (125 metastatic castration-resistant PC (mCRPC) patients and 26 metastatic hormone-sensitive PC (mHSPC) patients). We evaluated variables that influence the ability to maintain or resume the ongoing therapy. For the maintained/resumed therapies, we calculated the post-infection overall survival (piOS) and the overall survival (OS). Results: Of the patients, 12.6% died due to SARS-CoV-2 infection, 10.6% recovered from the infection but failed to maintain/resume the ongoing anticancer treatment, and the remaining 76.8% maintained/resumed the treatment after recovery. Hospitalization, duration of infection, and the type of ongoing anticancer agent influenced these treatment changes. In the cohort of mCRPC patients, the median piOS was 32 months, and the median OS was 67.8 months. The median piOS was not achieved in the cohort of mHSPC patients, while the median OS was 122 months. The outcomes of single anticancer agents were in line with those of pivotal trials. Conclusions: Although observed in a highly selected population of PC patients who survived SARS-CoV-2 infection and were able to resume/maintain anticancer therapy, the survival outcomes of this study appear to be in line with those reported in pivotal studies, and SARS-CoV-2 infection does not seem to have adversely affected long-term oncological outcomes.