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While there is room for a range of views, this is a situation where there must be room for clinical skill and judgment. Skilled clinical assessment and monitoring of cancer status, carried out by an expert oncologist would very likely capture the benefits of abiraterone even if dosed in an alternative fashion. Oncologists do not practice strictly “on label” in any disease. They integrate best available evidence and apply it to each individual patient’s unique circumstance. There is no question that the evidence is strongest for conventional food-free dosing, but there is now sufficient evidence to have a through discussion with individual patients about the option of alternative dosing when the economic consequences of not doing so may deny the patient access to the drug altogether.
I believe the difficulty here is not so much that a lower dose of drug when taken with a low-fat meal can produce a similar clinical effect, but rather, we are encouraging one to take their medications with food. The lower dose almost becomes a second issue. How many times are we telling patients to take their medication on an empty stomach e.g. antibiotics, biphosphonates? With that aside, in the patients who cannot afford their medication, this is an option. Education on a low-fat meal can serve 2 purposes: 1) offers an affordable option for abiraterone, and 2) promotes a more healthy diet.
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