Food can affect a drug's toxicity and in some cases make them stronger and some researchers say that could be a good thing.
They're now studying this effect to see if downing certain cancer pills along with food could make them safer, more effective and more cost efficient.
Mealtime is never a worry for Allen Andreasen. His wife is a wonderful cook and for the most part he can eat when he wants, even when it's time to take this new and powerful medication to combat his advanced prostate cancer.
"With mine, I take one pill and I eat immediately with the application with the medicine," he said.
But the standard instructions with this medication called Zytiga specifically warn and instruct patients to avoid food.
That's because food could increase the drug's effect, making it more powerful.
But once the patient has taken the drug, they may have to wait a couple hours before eating. For some, that can be hard to remember and the medication on an empty stomach can cause discomfort.
Andreasean is glad he gets to do the opposite.
He's doing so as part of a study under the watchful eye of researchers at University of Chicago Medicine.
They say the practice of prescribing anti-cancer pills to be taken while fasting is wasteful and potentially dangerous.
"The interesting thing about this medication is it is absorbed much better if you take it with food," said U of C Medicine oncologist Dr. Russell Szmulewitz. "When you take on a fasting stomach you excrete it out in your feces the majority of the medication."
The university is now funding its own study to see how patients do, taking a smaller dose of Zytiga, one pill a day with a low fat breakfast.
That compares with the current dosage of four pills a day with no food.
The idea being that if food increases the drugs potency, why not take less with food and still get the same effects?
They're hoping the research generates discussion.
"I'm trying to change the behavior of the pharmaceutical industry to make drugs safer to improve the therapeutic index," said Dr. Mark Ratain, cancer specialist at U of C Medicine.
Dr. Ratain is an authority on cancer drug dosing.
He's on a crusade of sorts to change the empty stomach labeling on oral cancer drugs, but the FDA says there is good reason to take certain cancer drugs on an empty stomach.
It's how they were studied and proven to be safe and effective.
Plus the agency says it's difficult to control what people eat and how much they consume and that can play a major role on how the drug works. Meaning, too much food or the wrong kind could increase the risk of a toxic exposure.
These researchers disagree and say patients need to be trusted.
But they warn patients not to launch their own experiment and to keep following the medications prescribed directions.
Andreasen is part of the U of C study and is being carefully monitored while he takes the drug with food. He says he's doing great and it seems the drug is working just fine.
A spokesperson with the FDA says the agency is constantly evaluating its review practice and changing it based on scientific advancement.
The study at U of C is ongoing and participants are still needed.
Experts stress patients follow approved labeling currently on medications and to always consult a physician.
Patients with prostate cancer who wish to have a full consultation with Dr. Szmulewitz and his colleagues can call the University of Chicago intake hotline at 1-888-UCH-0200.
