Man oh man, do I love lifestyle, supplement, or potential drug repurposing! It is a wonderful area of medicine that always needs more attention. The idea is simple, but getting the proof for it is not as simple. What you are looking for is a 2-for-1, or 3-for-1, or multiple benefits for one product, or even other uses for it. For example, exercise, diet, and other lifestyle changes we now know can offer the ultimate repurposing situation, because they increase the chances you can become healthier from head-to-toe! They not only fight or prevent one thing, but countless medical conditions and, of course, they are synergistic with many beneficial medications which, again is part of the reason I love repurposing so much!
Another example can be found in the recent data from the VITAL trial (mentioned in an earlier column this year) of vitamin D, which has been traditionally known for bone health, demonstrating a potential ability to reduce the risk of autoimmune disease! I did not see that one! Very nice! Look, I am a cheap person, and I am always looking to find multiple benefits from just one thing. For example, if I buy my dog some tasty and expensive dog food, then I am expecting him to be nicer to me and simultaneously follow any directions I give, such as “sit” or “stay” or “rollover” or “rollover in reverse now” or “jump up and down when Michigan scores a touchdown,” etc. Sorry, I digress.
Anyhow, think about baby aspirin and its ability to reduce the risk of another heart attack, but now it is also recommended for some women during pregnancy to reduce the risk of a serious problem called preeclampsia (if they are at high-risk). Now, in the prescription medication world you have metformin, the diabetes drug being tested currently along with conventional medicine for prostate cancer, and we should know the results of these larger studies soon. This latest example I did not see coming, but it is so darn fascinating I had to just comment on it! The headlines in the newspaper (sorry I meant to say “internet media sites”) demonstrated that the oral drug sabizabulin demonstrated a 55% reduction in the risk of early mortality in hospitalized patients with COVID-19 vs. placebo!1 Wow!
This was a phase 3 trial that found the result in an interim analysis, and it is one of the largest preliminary reductions in mortality for a medication in those hospitalized for COVID-19. Also, when the subgroups were analyzed, they all appeared to favor the drug over the placebo (regardless of age, sex, BMI, comorbidity, geographic location of study site, etc.). Wait a second! Sabizabulin?! Sounds like the name of a unique musical band or some trendy food product! I had never heard of it until I started writing this month’s column! Heck, if you just say “sabizabulin” 3 times fast, then it might twist your tongue a bit. However, what some people do not realize is that this is the exact same drug being used in a phase 3 clinical trial right now for some men with metastatic castrate resistant prostate cancer (mCRPC) who have also become resistant to at least one oral androgen receptor targeting agent (ARTA).2,3
I do not remember the last time a potential prostate drug had such a strong potential antiviral effect, especially during a pandemic. Sabizabulin is what is known as a “microtubule disruptor”, which is a fancy way to say it impacts cell cytoskeleton/structure/transport and could have, not only antiviral, but also anti-inflammatory effects, and it might also disrupt viral and cellular replication and proliferation. But it is also a serious medicine with pros and cons that needs more research. Still, it is theoretically possible that the same drug that could be approved for hospitalized COVID-19 patients in the future could also theoretically be approved for prostate cancer in a few years. Of course, it could also be a bust in either or both situations, but the story is just getting so darn fascinating and interesting that it is part of the reason I love what I do, and I love reporting on some of the more fascinating quiet, non-headline stories in prostate cancer, but you knew that! Now, I must go and see if my dog is finally willing to listen to me again. Where did I put those dog treats that cost more than the food I buy for myself?! Ugh!
- Barnette KG, et al. for the Phase 3 COVID-19 Investigators. New Engl J Med Evidence 2022; published July 6, 2022. https://doi.org/10.1056/EVIDoa2200145.
- Markowski MC, et al. Clin Cancer Res 2022; 28: 2789-2795.
- Dreicer R, et al. Phase 3 trial VERACITY clinical study… 2022 ASCO Genitourinary Cancers Symposium. J Clin Oncol Volume 40 Issue 6 (suppl). https://ascopubs.org/doi/abs/10.1200/JCO.2022.40.6_suppl.TPS217