Prescribe a quarter dose of abiraterone with breakfast
Taking 250 mg of abiraterone with a low-fat meal gives the same hormone suppression as the standard 1,000 mg on an empty stomach, so the same drug treats four times as many men for the price.
Overview
A randomised trial (Szmulewitz et al., JCO 2018) showed 250 mg abiraterone with a low-fat breakfast was non-inferior to 1,000 mg fasting on PSA response and testosterone suppression in metastatic castration-resistant prostate cancer, because food increases absorption several-fold. NCCN guidelines list the food-effect dose as an option. Adoption is patchy because the label still says fasting and because there is no commercial incentive to promote it. Generic abiraterone makes the absolute saving smaller in the US but large where the branded product is still used or where patients pay out of pocket.
- Wrong doses · Most drug doses were chosen as the highest a person can tolerate, which is often more than they need.
- Prices and value · New cancer drugs routinely cost over $150,000 a year, often for months of benefit. Systems cannot afford them and patients go bankrupt.
- Most of the world has almost no cancer care · Seven in ten cancer deaths happen in low- and middle-income countries, where radiotherapy, pathology, surgery and drugs are scarce.
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