It is debated which sequence of treatments to adopt after docetaxel. Our data do not support the superiority of any of the three new agents in third-line treatment, regardless of the previously administered new agent.
information for conducting a meta-analysis. Our statement 'no statistically significant associations were reported for prostate and pancreatic cancers', which refers to cancer risk, is supported by summary estimates provided in the text and in Figure 3 (RR per 1 score 0.99, 95% CI 0.97e1.02; I 2 ¼ 0%, P het 0.43; six studies and 0.86, 95% CI 0.62e1.18; I 2 ¼ 90%, P het <0.001; two studies, respectively). Apart from lacking a doseeresponse relationship, the results for pancreatic cancer were only reported in two studies and were highly heterogeneous. Unfortunately, a meta-analysis was not possible for mortality data, because not enough studies assessed the relationship between meeting the 2007 World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) recommendations and survival in patients with pancreatic or prostate cancer (Table 2B). As already stated in our discussion, upcoming studies using the recently updated WCRF/AICR score are warranted to draw firmer conclusions regarding mortality or cancer survival. 2 Concerning the comment regarding the use of relative risks (RRs), we used this term to uniformly refer to risk estimates [i.e. hazard ratio (HR), risk ratio, odds ratio (OR)] in tables and figures. In particular, all cohort studies provided results in HRs and only caseecontrol studies used ORs. Thus, a primary meta-analysis synthesizing findings within the same study design does not have an issue of combining different measures of association. In addition, results for HR and OR were pooled to produce a summary estimate in the meta-analysis. This was done under the assumption that when events are rare and absolute cancer risks are small, these measures will be approximately equal in the studies. 3 Finally, we assessed between-study heterogeneity and small-study effects using standard methods (Cochran's Q, I 2 , Egger's regression asymmetry test and funnel plot), and we appreciate the efforts of Jayaraj et al. 1 to complement our analysis with additional statistics that make our findings more transparent.
Background
Patients with cancer are at increased risk of complicated severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection, but it is still unclear if the risk of mortality is influenced by cancer type or ongoing anti-cancer treatments. An interesting debate concerning the potential relationship between androgen deprivation therapy (ADT) and SARS-CoV-2 infection has recently been opened in the case of prostate cancer (PC), and the aim of this multi-centre cohort study was to investigate the incidence and outcomes of SARS-CoV-2 infection in patients with metastatic castration-resistant prostrate cancer (mCRPC).
Patients and methods
We retrospectively reviewed the clinical records of patients with mCRPC who developed SARS-CoV-2 infection, and recorded their baseline clinical characteristics, their history of PC and SARS-CoV-2 infection, and their oncological status and treatment at the time of infection. The primary study end point was the death rate and the possible impact of the patients' PC-related history and treatments on mortality.
Results
Thirty-four of the 1433 patients with mCRPC attending the participating centres (2.3%) developed SARS-CoV-2 infection, 22 (64.7%) of whom were hospitalised. Most of the patients were symptomatic, the most frequent symptoms being fever (70.6%), dyspnoea (61.8%), cough (52.9%) and fatigue (38.2%). After a median follow-up of 21 days (interquartile range: 13–41), 13 patients had died (38.2%), 17 recovered (50.0%) and four (11.7%) were still infected. The number of treatments previously administered for mCRPC had a significant impact on mortality (p = 0.004).
Conclusions
Our findings contribute additional data to the current debate concerning the postulated protective role of ADT, which seems to be less in patients with metastatic PC.
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