{"entity":{"id":"idea-cost-low-dose-abiraterone-food","kind":"idea","name":"Prescribe a quarter dose of abiraterone with breakfast","aka":[],"tldr":"Taking 250 mg of abiraterone with a low-fat breakfast gives the same PSA response and testosterone suppression as the standard 1,000 mg fasting, because food increases absorption several-fold, so a quarter of the drug treats each man. The label still says fasting and no company promotes the food-effect dose, so adoption is patchy.","summary":"A randomised trial (Szmulewitz et al., JCO 2018) showed 250 mg abiraterone with a low-fat breakfast was non-inferior to 1,000 mg fasting on PSA response and testosterone suppression in metastatic castration-resistant prostate cancer, because food increases absorption several-fold. NCCN guidelines list the food-effect dose as an option. Adoption is patchy because the label still says fasting and because there is no commercial incentive to promote it. Generic abiraterone makes the absolute saving smaller in the US but large where the branded product is still used or where patients pay out of pocket.","asOf":"2026-09-10","links":[{"label":"Szmulewitz et al., JCO 2018: low-fat meal abiraterone","url":"https://doi.org/10.1200/JCO.2017.76.4381"}],"tags":[],"related":[],"cancers":["prostate"],"sections":["hormonal"],"technologies":["androgen-deprivation"],"targets":[],"drugs":["abiraterone"],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":["capitello-281","propel","nct05171816","nct01517802","nct03777982"],"people":[],"bottlenecks":["b-dose-optimisation","b-drug-pricing","b-global-access"],"keyPapers":["paper-szmulewitz-j-clin-oncol","paper-abiraterone-acetate-prostate-n-engl-j-med-2013","paper-abiraterone-acetate-prostate-lancet-oncol-2015","paper-abiraterone-acetate-prostate-lancet-oncol-2012"],"journals":[],"dependsOn":[],"notes":[],"hypothesis":"Guideline-endorsed low-dose-with-food abiraterone will reach more than half of eligible prescriptions in health systems that adopt it as default, with no loss in time to PSA progression.","rationale":"Level 1 randomised evidence already exists; the change needs only a prescribing default and patient counselling.","test":"Health-system default switch with monitoring of PSA response, time to progression and drug spend against the prior cohort; a pragmatic trial in India or Africa where the price matters most.","maturity":"being-tested-at-scale","actor":"clinic","cost":"small","horizonYears":1},"route":"/ideas/idea-cost-low-dose-abiraterone-food/","neighbours":{"cancer":[{"id":"prostate","kind":"cancer","name":"Prostate cancer","route":"/cancers/prostate/"}],"section":[{"id":"hormonal","kind":"section","name":"Hormonal Therapy","route":"/fronts/hormonal/"}],"technology":[{"id":"androgen-deprivation","kind":"technology","name":"Androgen deprivation & AR pathway inhibitors","route":"/technologies/androgen-deprivation/"}],"drug":[{"id":"abiraterone","kind":"drug","name":"Abiraterone acetate","route":"/drugs/abiraterone/"}],"trial":[{"id":"nct01517802","kind":"trial","name":"A Study That Provides Long-term Safety Follow-up and Examines Long-term Exposure to Abiraterone Acetate","route":"/trials/nct01517802/"},{"id":"capitello-281","kind":"trial","name":"CAPItello-281","route":"/trials/capitello-281/"},{"id":"nct03777982","kind":"trial","name":"Conventional Androgen Deprivation Therapy (ADT) With or Without Abiraterone Acetate + Prednisone and Apalutamide Following a Detectable PSA After Radiation and ADT","route":"/trials/nct03777982/"},{"id":"propel","kind":"trial","name":"PROpel","route":"/trials/propel/"},{"id":"nct05171816","kind":"trial","name":"Study on Olaparib Plus Abiraterone as First-line Therapy in Men With Metastatic Castration-resistant Prostate Cancer (China Cohort)","route":"/trials/nct05171816/"}],"bottleneck":[{"id":"b-global-access","kind":"bottleneck","name":"Most of the world has almost no cancer care","route":"/bottlenecks/b-global-access/"},{"id":"b-drug-pricing","kind":"bottleneck","name":"Prices and value","route":"/bottlenecks/b-drug-pricing/"},{"id":"b-dose-optimisation","kind":"bottleneck","name":"Wrong doses","route":"/bottlenecks/b-dose-optimisation/"}],"paper":[{"id":"paper-abiraterone-acetate-prostate-lancet-oncol-2012","kind":"paper","name":"Abiraterone acetate for treatment of metastatic castration-resistant prostate cancer: final overall survival analysis of the COU-AA-301 randomised, double-blind, placebo-controlled phase 3 study","route":"/key-papers/paper-abiraterone-acetate-prostate-lancet-oncol-2012/"},{"id":"paper-abiraterone-acetate-prostate-lancet-oncol-2015","kind":"paper","name":"Abiraterone acetate plus prednisone versus placebo plus prednisone in chemotherapy-naive men with metastatic castration-resistant prostate cancer (COU-AA-302): final overall survival analysis of a randomised, double-blind, placebo-controlled phase 3 study","route":"/key-papers/paper-abiraterone-acetate-prostate-lancet-oncol-2015/"},{"id":"paper-abiraterone-acetate-prostate-n-engl-j-med-2013","kind":"paper","name":"Abiraterone in metastatic prostate cancer without previous chemotherapy","route":"/key-papers/paper-abiraterone-acetate-prostate-n-engl-j-med-2013/"},{"id":"paper-szmulewitz-j-clin-oncol","kind":"paper","name":"Prospective International Randomized Phase II Study of Low-Dose Abiraterone With Food Versus Standard Dose Abiraterone In Castration-Resistant Prostate Cancer","route":"/key-papers/paper-szmulewitz-j-clin-oncol/"}]}}