Advanced Prostate Cancer
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Abiraterone 500mg Daily

Hi guys,

Due to the high expense of Abiraterone we are looking at my Father taking 500mg a day with food instead of 1000mg a day fasted state, now he taken 1000mg a day for a loading dose for one month. My Fathers oncologist is happy with this as well.

I know the professor who invented Abiraterone stated that after a loaded dose of 1000mg a day for a a month you could even game 250mg a day with food.

Anybody got any experience with this ? And what kind of food did you take with it if so ? I know high fat is suggested.

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It infuriates me that anyone ever has to start a post with, "Due to the high expense of . . ."

I will avoid the politics of that on this forum and say that if the doctor is on board, give it a shot. Keep an eye on his PSA, scans and physical health.

My best to you.

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When Abiraterone/zytiga failed for me with full dose, MO suspected I was not absorbing and I took full dose with a high fat breakfast,inc high fat yogurt,eggs,,and got more time,liver numbers must be followed, mine were fine the whole time. I wonder if there is a test to measure serum abiraterone/zytiga in blood to know if he is getting the abiraterone, from the amount he will be doing?

Dan

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Hey Dan. Did it start to help again when taken with food ?

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Yes it did, and MY MO from Dana Farber said they had men getting another 8 months on zytiga with food after zytiga fasting stopped working. Important to follow liver and other markers when doing, and under supervision of Medical Oncologist.

Dan

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Dan,

I was lucky as you probably remember on Zytiga and Prednisone. Felt good ...Zytiga stopped working after 7 or 8 months. Oncol. said Provenge which I am finishing #3 this Friday. However, I get sick when I think of food. Dr. did not want me on Prednisone any more..I believe it helped my appetite. He prescribed as my wife, Shyrlene, wrote, Melinol. I stopped taking it....got me unbelievably exhausted. My granddaughter told me about candy Marijuana which shd. help me eat.

I did get from several of the fellows one or two other thgs. to help when no appetite.

Being you and so many others seem to know so much regarding our situation...what is your recommendation?

sidnw

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Sidn, I am wondering why you would have no appetite? I myself am on 5mg prednisone and have been for a long time. There is marinol, and there is also megace, According to PCRI megace has an isolated incedent of one Dr. saying he saw a withdrawl response from megace, that Dr was Dr Sartor. I think others have used it. I would suggest ensure or boost to get the things you need. That is all I can think of, keep in touch.

Dan

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Dan,

How did you trilate the time before taking Zytiga? I have my liver checked every 28 days, is that a good monitoring time if I try food with Zytiga? Did you begin with 15 minutes intervals, and how long did you take to work to an hour and then an half hour before taking Zytiga. I will have my MO monitor this effort. I don't need it now, but I like to keep my options open.

Rich

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Rich ,

It is a good plan, I think we monitored it all Monthly at the time. I began taking the pills in the middle of having my high fat breakfast. I was worried about side effects, but really it was a big non event.

Dan

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Dan,

Thank you for the information. Was there a requirement that the breakfast be high fat? I thought any food would do; so that, you had a full stomach of food.

Rich

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Dan,

The dosage for Zytiga was 4 pills, total 1000 mg. Is that correct, that you took with food?

Rich

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Rich , Yes, I took the full 1,000 mg which was 4 pills all at once with food. The high fat was for better absorption accordong to my MO

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Dan, You are a prince.

Thank you very much.

Rich

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There was a small-ish study involving 72 men which showed "Low-dose (250mg/day) abiraterone acetate with a low-fat breakfast is non-inferior to standard dosing in a fasted state..." with comparable ~14 months median time to PSA progression.

"A prospective international randomized phase II study evaluating the food effect on the pharmacokinetics (PK) and pharmacodynamics (PD) of abiraterone acetate (AA) in men with castration-resistant prostate cancer (CRPC)."

ascopubs.org/doi/abs/10.120...

clinicaltrials.gov/ct2/show...

cancertherapyadvisor.com/pr...

Although such changes may not have been made to the FDA Approved Full Prescribing Information for Zytiga, there are probably some Oncologists who may be using reduced dosages taken with food in Individual Situations involving severe patient insurance/cost/availability constraints for the very expensive Zytiga, while taking their individual side effects, disease response, and PSA/Testosterone trends into account.

I'm not doctor, but things like this might help guide/inform more meaningful discussions with one's own prescribing doctor.

Charles

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Interestingly Zytiga was actually invented by a professor here in my hometown of Leicester. He has said on several occasions you can take 250mg a day with food as bio availability is over 4 times greater when taken with food.

I'm sure nobody would be surprised to think of an unscrupulous pharmaceutical company using such tactics to sell more medication.

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With my oncologist's blessings, I've been taking my abiraterone with food for years now, knowing that food potentiates the effect. Over the last six to eight months, I've cut down to 50mg-with-food in order to stockpile against the future a year down the line -- my insurance situation may be changing, and I have no idea what backup might exist a year from now if I lose my insurance.

My experience so far has been fine. PSA has held steady at 0.03, unchanged from full-dose to half-dose-with-food abiraterone. Liver function is great. I tried cutting back on the prednisone, too, but my kidneys and energy level did odd things, so I resumed 5mg twice a day.

If my PSA should start going up, I'll increase my abiraterone to 750mg and see if that's sufficient to keep it in check.

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How long have you been on Zytiga now Paul?

And what kind of food do you take with th Zytiga ? 500mg with full fat yoghurt maybe? And then when do you take the prednisone?

Thanks :)

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I started Zytiga in 2015, so it will be three years this March.

Regarding food:

I don't pay much attention. I split my doses into two, and so I take 250mg Zytiga + 5mg prednisone shortly after breakfast, and then after dinner, I take another 250mg Zytiga + 5mg prednisone.

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My Father's oncologist has my Father on only 5mg a day.

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A journalist with CURE magazine is looking to interview men who are taking Abiraterone/Zytiga with low fat breakfast in order to reduce the cost of the drug. His name is Adam Smith. Contact is adsmith74@gmail.com The article is about a fabulous organization of professionals who are focused on reducing the cost of cancer drugs. Here's their website. vi3c.org/ Please contact if you are on a reduced dose with food.

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There are a lot of references to taking less Zytiga with food. The key is having a strong handle on the fat content. Taking it with a very high fat meal could result in 17x more Zytiga in the blood.

Listed below is a link to an article that may be of use to you.

uchicagomedicine.org/cancer...

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My husband started Zytiga with one pill a day due to cost (crappy insurance and not eligible for subsidies) with a lowfat breakfast. I think fat grams were about 4 or 5. PSA went up 40% first month. Second month went to full dosage (4 pills empty stomach). PSA stayed the same as 1st month. Third month took 4 pills with high fat breakfast, PSA went down to the PSA he started with. Serious fatigue, high sugar levels are his side effects. We will see what happens this month--he also had no scans during the time he's been on Zytiga.

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My husband has been taking Zytiga without Prednisone since starting it late last summer. Prednisone made his blood sugar rise over 600, and now he is a full blown insulin dependent diabetic. Docs discovered this spring he hasn't been on Prednisone with Zytiga, and believed he was bedridden. He is not. He does have serious pain. Thinking it was just arthritis, his scans light up the room. He is severely inflamed with pain in his hands, knees, feet, and legs especially. Docs won't say cancer is in his bones, and think it is only in his lymph nodes & prostate. No way to remove it, and all docs say nothing they can do. So, anti cancer hormone therapy drug, Zytiga, is his 4 pills a day drug to combat his cancer, and the every 3 months Lupron shot.

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Very interesting. What kind of things would your husband eat for a low fat or high fat breakfast ?

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Oatmeal and fruit or cereal and soy milk for low fat; added avocado toast, slice of cheese or nuts for high fat. (No eggs, bacon, butter, etc!)

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QUESTION:

Does chocolate chip ice cream count as High Fat? I could eat that for breakfast, lunch and dinner (and snacks).

Good Luck and Good Health.

j-o-h-n Thursday 12/28/2017 6:43 PM EST

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