it 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 d
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