Advanced Prostate Cancer
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How to enhance the efficiency of Zytiga

Hello Friends

These two articles describe how to enhance the efficiency of abiraterone (Zytiga) with low fat meal ( diet).

1-

health.usnews.com/health-ca...

2-

healio.com/hematology-oncol...

So please don't take Zytiga with a cheese burger and large Fry, it wouldn't work (joke, don't answer).

Bruce

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They got it wrong, as the media often does. It says to take with a HIGH FAT meal in the study:

meetinglibrary.asco.org/rec...

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He's right, the study is Abi with a low fat meal.

uchicagomedicine.org/cancer...

You were quoting from 2014, not most recent. My husband tried the low fat protocol, and the empty stomach protocol, and neither worked. He's been taking 4 pills with a high fat breakfast for several months and his psa is now 3. 7, the lowest it's been in years.

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Well, the University of Toronto trial was based on 111 men and tested a high fat meal vs fasting, while the University of Chicago trial was based on 72 men and tested a low fat meal vs fasting. No one tested a high fat meal vs a low fat meal. But since both resulted in blood levels using low-dose Zytiga that are equal to fasting and high-dose Zytiga, I guess it doesn't matter how much fat you consume with it, only that you consume some fat. So have the cheeseburger with bacon and fries or just have a protein bar - either would work fine. (I'd prefer the Happy Meal)

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As an aside, if boiled potatoes boost testosterone levels,and your on ADT; should they be eaten?

Rich

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If you are achieving castrate levels of testosterone, don't worry about potatoes.

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Thank you for the reply. Jansen Labs considers below 50 on the Testosterone blood test as castrate level; do you agree?

Rich

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More recent studies show more benefit with T lower than 32. Lower yet is better IMO.

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My testosterone got down to 16, then 22, then 27, 44, 49 then 34. All the while my PSA was decreasing; PSA now 3.4 No one could explain the mystery of increasing testosterone and declining PSA.

Rich

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"Below 50" is the consensus definition of castrate level. But most doctors would like to see it below 30, and ideally, below 20. T levels fluctuate naturally (always take it in the morning before 10AM). If your T levels won't stay down, consider switching to Firmagon.

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My testosterone got down to 16, then 22, then 27, 44, 49 then 34. All the while my PSA was decreasing; PSA now 3.4 No one could explain the mystery of increasing testosterone and declining PSA. My Hospital Cancer Center doesn't carry Firmagon.

I will take the test at 11:00 AM, I will try it before 10:00 AM, at your suggestion.

Rich

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I was wrong - there WAS a small (n=36) randomized study that compared low fat meals and high fat meals. They found "In mCRPC patients, abiraterone [plasma levels] was two-fold higher with a high‐fat meal and similar with a low‐fat meal versus modified fasting state."

accp1.onlinelibrary.wiley.c...

So if you're going to do this (under doctor supervision), you're better off taking it with a high fat meal.

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TA - to be precise, n=36 is he number if “healthy” participants. I don’t see a number for the mCRPC.

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My father will start Zytiga tomorrow. So is it low fat or higher fat meal? His MO recommended 2 pills with breakfast.

His DLL3 negative, still waiting for the results from somatostatin and foundation one.

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It looks like a 1000 mg fasting dose = 500 mg low fat dose = 250 mg high fat dose, but everyone will be different. I very much agree that this should only be done with medical oversight.

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If you do this, you should do it with your medical oncologist oversight; in that, you should have monthly blood tests to check your liver status.

Rich

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My Dr. at harvard medical said to do it with a high fat meal a few years back. I did full dose with bacon and eggs, with fried potates and high fat yogurt. First bacon and eggs I had in over 7 years up until that time.

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It's easy to miss the point. It isn't so much about the fat as the meal.

"We sought to test the hypothesis that low-dose AA (LOW; 250 mg with a low-fat meal) would have comparable activity to standard AA (STD; 1,000 mg fasting) in patients with CRPC."

"At 12 weeks, there was a greater effect on PSA in the LOW arm ... compared with STD (-1.19), and noninferiority of LOW was established according to predefined criteria." [1]

NOTE that there was no "HIGH" arm, so we can draw no conclusion about the cheese burger breakfast.

Noninferiority was established, so men can have the drug with food, & at quarter of the dose with the low-fat breakfast. We don't know what the dose would be with a high fat meal.

As with many food-related studies, there seems to be bias against fat. The researchers probably felt that high fat was bad. & traditional breakfasts can be high in fat. Hence we have the structure of the study & the inevitable misinterpretation of the findings.

Note that "a conventional low-fat breakfast" was not defined [2]. But they don't mean Dean Ornish.

-Patrick

[1] ncbi.nlm.nih.gov/pubmed/295...

[2] clinicaltrials.gov/ct2/show...

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You must have missed the University of Toronto study.

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... and this randomized trial:

accp1.onlinelibrary.wiley.c...

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Allen,

My point was that the new study showed that a meal taken with the drug allowed the dose to be lowered. The fact that it was a low-fat meal might lead some to think that the meal has to be be low-fat. Hence the cheeseburger comment by BBruce.

-Patrick

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Pat, and in the case of man doing all 4 pills while fasting, when he fails Zytiga, He can sometimes get more time by adding a high fat diet, either one is a benefit to different subsets of patients.IMO it is important to get all we can out of our limited treatments.Also I had previously posted in when failing zytiga sometimes we get more time by switching steroids from prednisone to dexamethasone.

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Low or high fat is secondary. The point (if proven true) is that we can achieve same/ better outcome with less chemical and financial toxicity.

There has to be a way to establish this without waiting for another 5years.

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Cut it out guys, all this is making me hungry...

Good Luck and Good Health.

j-o-h-n Friday 03/30/2018 2:06 PM EDT

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Is anyone trying this ? My husband currently follows his oncologists instructions and has it on an empty stomach at least an hour.. usually 2 hours before breakfast.

thanks!

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