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June 12, 2017

Can the 'food effect' lower cancer drug costs?

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    To combat rising drug prices, a group of doctors is testing the so-called "food effect" to see whether some commonly prescribed cancer drugs can be taken with food at lower doses—and an initial study has shown promising results, Laurie McGinley reports for the Washington Post's "To Your Health."

    6 ways your pharmacist can reduce costs and improve quality

    According to "To Your Health," because many oral cancer drugs were tested on patients who had been fasting, the drugs' directions now tell patients to fast before taking the medications. However, Mark Ratain, a pharmacologist who directs the University of Chicago's Center for Personalized Therapeutics, said that food can alter the absorption rate, or bioavailability, of some drugs. The group of doctors exploring this topic includes individuals from the University of Chicago, Memorial Sloan Kettering Cancer Center, and Fred Hutchinson Cancer Research Center. They recently created a not-for-profit called the Value in Cancer Care consortium to help organize their research.

    Early data show promise

    In a pilot study involving 72 prostate cancer patients, the doctors tested whether Zytiga, a drug commonly prescribed to treat advanced prostate cancer and taken without food, could be taken at a lower dose with a low-fat breakfast. The doctors found that 25 percent of the standard dose of Zytiga when consumed with the low-fat food was just as effective as the full dose taken without food.

    Russell Szmulewitz, an oncologist with the University of Chicago who presented the findings at a conference earlier this year, said reducing the dosage of a costly drug such as Zytiga—which fetches a $9,400 per month price tag—would lower costs for all patients. "It's inefficient, even wasteful, to take this medicine while fasting," Szmulewitz said.

    An additional benefit, according to "To Your Health," could be a reduction in side effects, as the doctors found patients who had eaten breakfast while taking the lower dose of Zytiga experienced fewer stomach issues.

    Researchers look ahead to new trials

    The group of doctors now is raising money to establish a network of medical centers to launch and run several new 300-person clinical trials to continue testing the theory. They also plan to explore whether some prescription drugs can be taken for a shorter time than typically prescribed, and whether lower cost non-cancer drugs ultimately could be substituted for costly cancer-drugs.

    "This is the most practical and realistic way we have available right now to reduce the cost of cancer therapy and to increase value," Allen Lichter, the former president of the American Society of Clinical Oncology and chair of the new consortium, said. "It doesn't require Congress to do anything or regulators to approve imports. It involves careful clinical study to show the oncology community some of these drugs can be used better. This is a win-win situation if we can show it works—fewer side effects and much better access for our patients."

    Disagreements with the idea

    But not everyone is convinced that altering doses is the right approach to reducing drug costs, "To Your Health" reports.

    Benjamin Davies, assistant professor of urology at the University of Pittsburgh School of Medicine, said that cancer drugs are certainly too costly, but cutting back on their dosage "seems like a backwards approach." He said, "We should address drug prices directly. To suggest that we can't regulate or legislate our way out of this problem is a wrong assumption"

    Janssen, the manufacturer of Zytiga, warned that the drug should be taken as described in the "prescribing information." The company also questioned the safety of the food effect, saying, "Use of food as a way to increase bioavailability in patients with cancer could present problems and risks" due to "the variation in the content and composition of meals" (McGinley, "To Your Health," Washington Post, 6/8).

    6 ways your pharmacist can reduce costs and improve quality

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