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Consuming low-fat diet with prostate cancer drug could cut costs by 75 per cent
The multi-site study with United States is part of Singapore’s larger efforts to address escalating costs of oncology drug treatment.

Prostate cancer patients taking Abiraterone Acetate, a standard drug for prostate cancer, with a low-fat meal instead of on an empty stomach, as prescribed, could decrease their daily dose, boost outcome and lowers cost for the patient.

This multi-site study is a collaboration between the National University Health System (NUHS) including National University Cancer Institute, Singapore (NCIS) and National University Hospital (NUH) with the University of Chicago, US National Cancer Institute, Emory University and the Illinois Cancer Care in Peoria, Illinois.

Abiraterone Acetate, approved for use in 2013 by the Health Sciences Authority of Singapore, is the standard medicine used to treat metastatic castration-resistant prostate cancer. When taken with food, prostate cancer patients could decrease their daily dose of Abiraterone Acetate, prevent digestive issues and cut costs by 75 per cent.

The amount of Abiraterone Acetate that gets absorbed and enters the blood stream can be multiplied four or five times if the drug is swallowed with a low-fat meal (7 per cent fat, about 300 calories). That can increase to 10 times with a high-fat meal (57 per cent fat, 825 calories).

The standard schedule requires patients to fast overnight, take four of the 250 mg pills first thing in the morning. Then, wait at least one more hour before eating breakfast.

Researchers observed that the standard therapy seemed wasteful and caused inconvenience to patients.

In 2012, they designed a clinical trial of taking this drug with and without breakfast. 72 patients with advanced prostate cancer were enrolled. Half of the patients were told to take the recommended dose (1000mg), every morning with water on an empty stomach. The other half were to take one-fourth of the standard dose (250mg) with a low-fat breakfast such as cereal with skim milk.

The results found that both groups kept the disease under control. Abiraterone Acetate’s ability to lower levels of prostate-specific antigen, a surrogate marker for prostate cancer, was slightly greater for patients in the low-dose with food group when measured at 12 weeks.

“A one-month supply of the recommended dose of Abiraterone Acetate costs about SGD4,000 to 5,000. That adds up to a little more than SGD60,000 each year. Many patients take the drug for two to three years”, said Dr Yong Wei Peng, Senior Consultant, Department of Haematology-Oncology, National University Cancer Institute, Singapore (NCIS).

The progression-free survival rate, for patients in both the low- and high-dose groups, is about 8.6 months. Despite the small size of the study, the authors of the study were confident that outcomes were positive for patients who took the lower drug dose with food and that was comparable to the group of patients who took the recommended standard drug dose on an empty stomach. It was also slightly more convenient and much less expensive for the patients who took the lower dose drug with food.

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