VA scientists race to determine effectiveness of prostate cancer drug for COVID-19 patients

Dr. Matthew Rettig is one of the leading VA researchers on prostate cancer.

As chief of hematology and oncology at the VA Greater Los Angeles Health Care System, he has played a major role in some 50 clinical trials, with a focus on studying potential drugs for aggressive prostate cancer.

Until now, though, Rettig has never faced such urgency to generate evidence of how well a treatment works. He’s leading a clinical trial to investigate a prostate cancer drug as a potential treatment for male Veterans with COVID-19. In a double-blind randomized controlled study, he and his colleagues are comparing the drug degarelix (trade name Firmagon) to placebo for improving the clinical outcomes of nearly 200 Veterans who have been hospitalized with COVID-19.

Drug used to treat aggressive cases of prostate cancer

Degarelix is often used to treat cases of prostate cancer that metastasize. The male hormone testosterone can fuel the spread of prostate cancer. Degarelix rapidly but temporarily suppresses the body’s production of testosterone, which regulates the protein TMPRSS2. The virus that causes COVID-19, a respiratory disease, relies on TMPRSS2 to penetrate lung cells. By using degarelix, Rettig and his team believe they can reduce the production of TMPRSS2 in lung tissue and prevent the virus from entering lung cells.

“Anytime we’re doing a clinical trial for advanced prostate cancer, there’s not that much of a time pressure where we’re looking at days,” he says. “This is something where the pressure to deliver in a timely fashion is very high because of the lethality of this disease and the potential for it to expand, as well as the fact that we don’t have a really good viable therapy for sick patients with COVID-19.”

`Something that has global impact’

To Rettig, the trial could have implications far beyond VA.

“This is not about just helping people in VA,” he says. “This is something that has global impact because of the lack of treatment for COVID-19 and all of the fear and anxiety that accompanies this pandemic. So most importantly, I would like to be able to make an impact for the millions of people who are affected and are concerned about getting infected with this virus. So many people are dependent on something that may reduce the severity of COVID-19. This drug has great potential.”

Rettig designed the trial, known as HITCH, in just a few weeks. Patient enrollment began in mid-May. About two-thirds of the 200 participants are taking degeralix, with the rest assigned to placebo. He hopes to complete patient data analysis in no more than five months.

Testing taking place in cities that are COVID-19 hot spots

The Prostate Cancer Foundation (PCF) is not directly supporting the trial. But the VA medical centers that were chosen for the testing—West Los Angeles, Puget Sound in Washington State, and New York City (Manhattan and Brooklyn)—are in COVID-19 hot spots where there are VA-PCF Centers of Excellence. That means an infrastructure already exists with investigators, rooms, and equipment for research that normally focuses on prostate cancer but is now targeted at a COVID-19 treatment.

Trial coordinators  are also recruiting the VA hospitals in Chicago, Philadelphia, and the Bronx, N.Y.

“This is an amazing story of dedication and nimbleness in VA, which is jumping into the COVID-19 research fight during a time of national emergency, and it will be remembered as an act of patriotism for years to come,” says Dr. Jonathan Simons, president and CEO of the Prostate Cancer Foundation. “The clinical research nurses, data managers, pharmacists and everyone else on the VA-PCF teams are voluntarily `redeploying’ their expertise to COVID-19 TMPRSS2 anti-viral clinical trials, including the use of degarelix.”

The University of California at Los Angeles, where Rettig directs the prostate cancer program in the Institute of Urologic Oncology, is involved in the analysis of research specimens but not the clinical side of the VA trial.

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