# Use food effects to cut the dose and cost of oral drugs that absorb better with meals

Source: https://onco.cc/ideas/idea-tr1-food-effect-dose-reduction/  
OnCo record `idea-tr1-food-effect-dose-reduction` (Idea). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Some cancer pills are absorbed several times better with food, but the label says take them fasting at a high dose. Taking a quarter of the dose with breakfast can give the same drug levels at a quarter of the price.

## Summary

Randomised PK and non-inferiority trials of low-dose-with-food versus standard fasting dosing for oral agents with large positive food effects (abiraterone is the established example; others include several kinase inhibitors), followed by label changes and guideline adoption. Regulators accept PK-bridged non-inferiority; payers fund the trials because savings are immediate.

## Fields

- Kind: Idea
- Last checked: 2026-09-08
- Hypothesis: Low-dose-with-food regimens will show equivalent exposure and non-inferior efficacy for most agents with a fourfold or greater food effect, cutting drug cost by 50-75 percent.
- Rationale: Fasting dosing was chosen to reduce variability, not to maximise benefit; for drugs whose absorption is limited fasting, feeding is a cheap way to increase exposure, and the variability concern can be tested directly.
- Proposed test: Identify candidates from label PK data; run PK-bridged randomised non-inferiority trials for the two with the largest spend, with a pre-agreed pathway to label change.
- Maturity: early-clinical
- Actor: research

## Sources

- Bottleneck evidence (Wrong doses): FDA Oncology Center of Excellence, Project Optimus: https://www.fda.gov/about-fda/oncology-center-excellence/project-optimus

## Connected records

- cancers: [Prostate cancer](https://onco.cc/cancers/prostate/)
- technologies: [Androgen deprivation & AR pathway inhibitors](https://onco.cc/technologies/androgen-deprivation/), [Small-molecule kinase inhibitors](https://onco.cc/technologies/kinase-inhibitors/)
- bottlenecks: [Prices and value](https://onco.cc/bottlenecks/b-drug-pricing/), [Wrong doses](https://onco.cc/bottlenecks/b-dose-optimisation/)

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