Health.com
March 28, 2018

WEDNESDAY, March 28, 2018 (HealthDay News) -- Here's one way to cut the cost of a $10,000-a-month prostate cancer drug: Take it with food, some researchers suggest.

Investigators said they found that taking Zytiga (abiraterone acetate) with a low-fat breakfast boosts its efficiency. That could make it more convenient and significantly cheaper, the new study suggested.

Zytiga is the standard medicine for prostate cancer that has spread and has progressed despite hormonal therapy. Patients are told to take four 250-milligram pills first thing in the morning, then wait an hour before eating breakfast.

But the small study found that taking one-fourth of the recommended dose with a low-fat breakfast -- for example, cereal with skim milk -- was just as effective. In addition, it enabled patients to cut drug costs by 75 percent.

"The patient gets a simplified schedule, slightly more control over his daily life, the convenience of eating whenever he chooses and the opportunity to share the cost-savings with his insurance company," said study lead author Dr. Russell Szmulewitz.

"Taking this medicine while fasting is wasteful," added Szmulewitz, a prostate cancer specialist at the University of Chicago.

A one-month supply of Zytiga costs $8,000 to $11,000 when bought wholesale, or just over $100,000 each year. Many patients take the drug for two to three years, the study authors noted.

Combining the lower dose -- a single 250-mg pill -- with food did not reduce the drug's effectiveness. Progression-free survival was identical for 34 patients who took the lower dose with food and 34 patients who took the recommended dose without food -- about 8.6 months, the findings showed.

Taking the lower dose with food reduced costs by as much as $300,000 per patient, the researchers said.

"Although it should be validated with a larger trial with more robust clinical endpoints, given the pharmacoeconomic implications, these data warrant consideration by prescribers, payers and patients," Szmulewitz said in a university news release.

The study was published March 28 in the Journal of Clinical Oncology.

Zytiga's per-patient cost of about $10,000 a month is a textbook example of what's called "financial toxicity," said study co-author Dr. Mark Ratain, director of the university's Center for Personalized Therapeutics.

This refers to the economic burden placed on patients by the high cost of care, Ratain explained.

"At least three-quarters of this expensive drug is wasted. It's excreted and flushed away," he added.

More information

The U.S. National Cancer Institute has more on prostate cancer treatment.

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