Two Italian women researchers study breast cancer drugs against Covid-19

Once again, we are witnessing female success:

“Clinical outcome of SARS-CoV-2 infection in breast and ovarian cancer patients underwent anti-estrogenic therapy” is research of Monica Montopoli and Arianna Calcinotto, female researchers of the University of Padova). This research published in the journal “Annals of Oncology”. This analysis proves how SERM pharmacists (Selective Estrogen Receptor Modulators) would be effective in counteracting SARS-CoV-2 infection and subsequent virus development.

Several studies have reported a higher susceptibility of men to develop severe respiratory disease following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection when compared with women. To explore the implication of hormonal regulation in coronavirus disease-2019 (COVID-19) clinical outcomes, we assessed SARS-CoV-2 infections, hospital admissions, and deaths in women affected by hormone-driven cancers (HDCs) and treated with antiestrogen therapies (AETs).

Out of 51 060 women (median age: 56 years) tested for SARS-CoV-2 infection from 22 February 2020 to 01 April 2020, 2478 had a clinical history of malignancy (4.9%), including 926 breast and 60 ovarian cancers. Women affected by cancers (331/2478) had a significantly higher prevalence of infection versus non-cancer patients.

The study, carried out in close collaboration between VIMM-University of Padua, the Veneto Cancer Registry and the IOR in Bellinzona, examined a female population of 51,060 women tested for SARS-CoV-2 infection in the Veneto Region.

The study therefore suggests an off-target effect played by SERMs potentially involving an alteration in the fusion mechanism between the virus and the host cell, identifying a possible clinical use in the treatment of COVID-19 patients.

This finding, in line with the recent discovery developed by the public-private consortium Exscalate4CoV, funded by the European Commission under the Horizon 2020 call – which predicts efficacy of raloxifene as a potential drug against COVID-19 – will need to be further validated in a larger cohort of SARS-Cov-2 infected women and adjusted for multiple variables.

Cancer patients developed more severe conditions and required hospitalization in 49.5% of cases versus 26.5% of women without cancer. During the study follow-up, 19.3% of cancer patients versus 7.3% of non-cancer patients died.

Compared with women without cancer, patients affected by breast cancer had a higher risk of hospitalization and death. A total of 90.6% of SARS-CoV-2-positive cancer patients were affected by comorbidity as compared with 47.8% of non-cancer patients. Cardiovascular disease was the most frequent (39.9% of cancer patients and 28.4% of non-cancer patients) together with respiratory disease (33.2% and 19.1%, respectively).

Four hundred and eighty-three patients affected by HDCs were receiving AETs. The prevalence of comorbidity was even higher among women under AET (94.2%). Specifically, 198 patients were treated with selective estrogen receptor modulators, degraders, or down-regulators (SERMs), of which 16 were under ovarian function suppression therapy (OFST). Three hundred and thirty-four women were under aromatase inhibitors (AIs), of which 16 were also under OFST, and 48 women were under luteinizing hormone-releasing hormone agonists (LAs) (16 were also under OFST).

SARS-CoV-2 positivity was found in 14 women under SERM treatment (7.1%), 44 women under AI (13.2%), and 3 women under LA (6.3%). Hospitalization was required by 51.9% of women under AET, and 19.2% died.

No significant association with SARS-CoV-2 infection, hospitalization, or death emerged among all patients with HDCs receiving AET. However, SARS-CoV-2 infection was significantly lower in women aged ≥50 years. Considering separately the three categories of AETs, only patients under SERMs had a lower prevalence of SARS-CoV-2 as compared with patients not receiving any AETs. SARS-CoV-2 positivity was significantly higher in patients under AIs than in those under SERMs.

Altogether, our data indicate that female cancer patients have an increased risk of SARS-CoV infection and develop more severe forms of COVID-19, in line with recent findings.

Moreover, ablation of estrogens in these patients reduced the prevalence of COVID-19. Therefore, the use of SERMs in the treatment of COVID-19 patients may represent a possibility. These data need to be further validated in a larger cohort and corrected to multiple variables. Moreover, molecular studies are required to elucidate the molecular bases for the protective effect observed in women under SERM treatment.

The study was approved by the Bioethics Committee of the Veneto Region (protocol no. 245343/2020).

“The result we have obtained, Montopoli comments, although it requires a larger sample size and further molecular studies to shed light on the mechanism and protective effect observed in women treated with SERM, it identifies a new and possible way to prevent or mitigate the effects of the virus.