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BBC 16.7.07 Grapefruit link to breast cancer Eating grapefruit every day could raise the risk of developing breast cancer by almost a third, US scientists say. A study of 50,000 post-menopausal women found eating just a quarter of a grapefruit daily raised the risk by up to 30%. The fruit is thought to boost levels of oestrogen - the hormone associated with a higher risk of the disease, the British Journal of Cancer reported. But the researchers AND other experts said more research was still needed. The women had to fill in questionnaires saying how often they ate grapefruit AND how big their portions were. Oestrogen important The researchers, at the universities of South California AND Hawaii, found that women who ate one quarter of a grapefruit OR more every day had a higher risk of breast cancer than those who did not eat the fruit at all. Previous studies have shown that a molecule called cytochrome P450 3A4 (CYP3A4) is involved in metabolising oestrogen hormones. And grapefruit may boost blood oestrogen levels by inhibiting this molecule, allowing the hormones to build up. The researchers found that in women who ate at least a quarter of a grapefruit daily, levels of oestrogen were higher. They said: "It is well established that oestrogen is associated with breast cancer risk. "Therefore, if grapefruit intake affects oestrogen metabolism leading to higher circulating levels, then it is biologically plausible that regular intake of grapefruit would increase a woman's risk of breast cancer." More research And they said this was the first time a commonly eaten food had been linked to an increased risk of breast cancer in older women. However, they warned that more research was needed to confirm the findings which may have been affected because they only took into account intake of the fruit, but not grapefruit juice. Breast cancer accounts for almost a third of all cancers in women, AND previous lifestyle factors linked to the disease include drinking alcohol AND being overweight. Dr Joanne Lunn, a nutrition scientist at the British Nutrition Foundation said: "This is an interesting study of a large group of post-menopausal women whose diet AND health have been followed for many years. "However, this study is simply a piece of the jigsaw that will eventually help us to understand how our diets affect our health. "Although we are beginning to get a better awareness of how our diets can modify the risk of diseases such as cancer, we are still a long way from identifying particular foods that might specifically increase OR decrease risk." However, she said that some dietary patterns are associated with a reduced risk of certain cancers AND that a diet rich in a variety of different fruits AND vegetables cold help reduce the risk of heart disease AND some cancers.

Posted on: Monday, 16 July 2007, 21:15 CDT Study: Food Ups Cancer Drugs' Punch Regulating the food AND liquid taken with anticancer AND other drugs can increase absorption over 300 percent AND cut costs, say U.S. doctors. For example, a Dartmouth study found that taking the breast cancer drug lapatinib with food instead of on an empty stomach, as currently suggested, could increase the bioavailability of the drug by 167 percent. If the food had a high fat content, that number jumped to 325 percent. Since patients currently take five 250 mg lapatinib tablets on an empty stomach at a cost of $2,900 a month, taking the drug with a fatty meal could potentially lower costs by around 40 percent, OR $1,740 per month, said oncologists Mark Ratain AND Ezra Cohen of the University of Chicago in a commentary on their own research AND the study done at Dartmouth. If the patient washes everything down with grapefruit juice, which increases the amount of drug concentrated in the plasma, Ratain said he thought the savings might increase to 80 percent. The authors said many more common drugs should be studied this way to increase drug potency AND save drug costs. They are currently conducting a phase 1 trial of the effect of grapefruit juice on sirolimus (rapamycin), an antibiotic AND immunosuppressant drug used in organ transplants. The Dartmouth study was presented in June at a meeting of the American Society for Clinical Oncology. The commentary is published in the July 16 issue of the Journal of Clinical Oncology.

Would You Like Fries With That? Value Meal Could Lower Drug Costs 17 Jul 2007 Exploiting interactions between food AND drugs could dramatically lower the rapidly rising costs of several anticancer drugs, AND perhaps many other medications, two cancer-pharmacology specialists suggest in a commentary in the July 16, 2007, issue of the Journal of Clinical Oncology. University of Chicago oncologists Mark Ratain, MD, AND Ezra Cohen, MD, call attention to the flip side of recent studies showing how certain foods can alter absorption OR delay breakdown of precisely targeted anti-cancer drugs. Instead of seeing such studies as highlighting a dosing problem, Ratain AND Cohen argue that results like this one should point researchers toward a partial solution, a novel way to decrease medication costs while increasing benefits from these effective but expensive drugs. The commentary was inspired by a study presented in June at the American Society for Clinical Oncology. Researchers from Dartmouth showed that taking the breast cancer drug lapatinib (TYKERB) with food instead of on an empty stomach as suggested on the label resulted in more of the drug being absorbed AND available to treat the cancer. Patients currently take five 250 mg lapatinib tablets on an empty stomach. The study found that taking the drug with a meal increased the bioavailability of the drug by 167 percent. Taking the drug with a high-fat meal boosted levels by 325 percent. "Simply by changing the timing, taking this medication with a meal instead of on an empty stomach, we could potentially use 40 percent (or even less) of the drug," said Ratain. "Since lapatinib costs about $2,900 a month, this could save each patient $1,740 OR more a month." Topping off that meal with grapefruit juice, "which may also increase plasma concentrations" according to the package insert, could increase the savings to 80 percent, the authors suggest, "minus the cost of the food AND juice." "We expect the one 250 mg lapatinib pill accompanied by food AND washed down with a glass of grapefruit juice may yield plasma concentrations comparable to five 250 mg pills on an empty stomach," Ratain said. Such a "value meal," the authors add, may have other benefits. The major toxicity associated with lapatinib is diarrhea, probably caused by unabsorbed drug. So taking a lower dose with food should "reduce the amount of unabsorbed drug, AND therefore theoretically also reduce the frequency AND severity of diarrhea." Patients should NEVER launch such experiments on their own, the authors caution. Such food-drug combinations should be studied to assess the effects, note person-to-person variations, AND enable physicians to predict how individual patients will take up AND metabolize specific drugs in the presence of certain foods. "The one thing that should not be anticipated is an efficacy study by lapatinib's sponsor," the authors write. Such studies could be mounted by other entities, however, such as the Federal government, other payers OR advocacy groups. Ratain AND Cohen are currently conducting such a study, a phase I trial of the combination of oral sirolimus (rapamycin) taken with grapefruit juice, which contains substances that delay the breakdown of many drugs. Dozens, perhaps hundreds, of drugs ought to be studied in this way, the authors said. "If we understood the relationship between, say, grapefruit juice AND common drugs, such as the statins, which taken daily by millions of people to prevent heart disease, we could save a fortune in drug costs," Cohen said. "And patients would get a little vitamin C to boot." "The rapidly escalating price of medications (especially for cancer AND other life-threatening diseases) has provided incentives to explore pharmacological approaches to lower the costs of drugs," Ratain AND Cohen conclude. "As we enter an era of 'targeted' anticancer agents with a monthly cost measured in thousands of dollars, we should view drug-drug OR drug-food interactions as opportunities to lower costs."