Maximizing Regorafenib Absorption with Diet (For The Provider)

 

 

Regorafenib is a multi-kinase inhibitor used to treat colorectal cancer, hepatocellular carcinoma and gastrointestinal stromal tumors (GIST).  The approved oral dosage is 160 mg daily for 21 days followed by 7 days of no regorafenib1.  The medication’s ability to perform has been studied as it relates to nutrition.  Bayer Health Care conducted a 3-way cross over study with 24 male volunteers indicating that taking this medication with a low-fat meal consisting of < 30% calories from fat and < 600 calories has been shown to increase the effectiveness of Regorafenib when compared to not eating a meal or eating a high fat meal.  In the study, 2 different meals were used along with taking the medication in a fasted state to compare results. The low-fat meal consisted of 319 kcals and 8g of fat while the high fat meal consisted of 945 kcals and 55g of fat.

 

Breakfast has long been lauded as the most important meal of the day and plays a significant role in metabolism and awareness3.  However, according to a nonrandomized poll by ABC news showed that nearly one third of individuals 55-64 years old skip breakfast and 17% of those 65+ skip breakfast2.  Additionally, in our clinical practice we find that many veterans do not eat breakfast or eat primarily high fat, high calories meals for breakfast. A typical morning breakfast tends to be higher than 30% fat when it includes things like bacon, eggs, and sausage and using butter on things like toast and pancakes. Included are some examples of breakfast meals within target ranges for maximal Regorafenib absorption. For patients taking Regorafenib in the afternoon or evening, some additional meal and snack tips were also included.

 

 

BREAKFAST:

 

 

Egg and cheese muffin

  • 1 English muffin

  • 2 egg whites

  • 1 slice low fat Colby or cheddar cheese

  • 1 cup orange juice or fat free milk

  • 1 cup fruit

Nutrition: 418 kcal, 21.9% kcal from fat

 

Waffles with fruit

  • 2 Eggo waffles

  • 2 teaspoon butter or margarine

  • 1 cup strawberries or other fruit

  • 1 cup fat free milk

Nutrition: 461 kcal, 24.7% kcal from fat

 

Toasty bagel

  • Medium (3.5”) bagel

  • 2 tablespoons low fat cream cheese

  • 2 tablespoons green onion, optional

  • 1 cup juice or milk (any fatness)

  • 1 cup fruit

Nutrition: 579 kcal, 23% kcal from fat

 

Spinach and cheese omelet with oatmeal

  • 4 egg whites

  • 1 oz cheese

  • 1/3 cup spinach

  • 1 cup juice or milk

  • 1 cup fresh fruit

Nutrition: 349 kcal, 26% kcal from fat

 

 

Hot cereal and toast

  • 3/4 cup cooked cream of rice (or other hot cereal)

  • 2 teaspoons butter or margarine

  • 1 tablespoon sugar

  • 1 piece of toast

  • 2 tablespoons jelly

  • 1 cup fat free milk

Nutrition: 453 kcal, 24% kcal from fat

 

 

Muffin and Toast

  • Medium muffin (4 oz)

  • 1 egg

  • 1 cup fresh fruit

  • 1 cup fat free milk or juice

Nutrition: 557 kcal, 21% kcal from fat

 

 

Cold Cereal

  • 1 cup cereal (e.g. Raisin Bran)

  • 1 cup milk (any fatness)

  • 1 cup fruit

Nutrition: 411 kcal, 20% kcal from fat

 

 

Yogurt Parfait

  • 6 ounces lowfat Greek yogurt, any flavor

  • 1 cup fresh fruit

  • ¼ cup granola

  • 1 cup milk (2% or less fat) or juice

Nutrition: 486 kcal, 27.2% kcal from fat

 

 

LUNCH/ DINNER/ SNACKS:

 

Rice and bean bowl

  • 1/2 cup rice, cooked

  • 1/2 cup cooked beans

  • 1/4 cup cilantro

  • 1/3 cup diced tomatoes

  • 2 tablespoons low fat sour cream

  • Lime juice to taste

  • 14 tortilla chips

Nutrition: 555 kcal, 26% kcal from fat

 

 

Spaghetti with meat sauce and garlic bread

  • 1 cup cooked Spaghetti noodles

  • ½ cup meat sauce

  • 1 slice garlic bread

  • 1 cup steamed broccoli

Nutrition 600 kcal, 22.2% kcal from fat

 

 

Baked potato

  • 1 baked potato

  • ¼ cup sour cream

  • 3 tablespoons green onion

  • 2 tablespoons bacon bits

  • 1 cup steamed vegetables

Nutrition: 538 kcal, 25.9% kcal from fat

 

 

 

References:

1. Rey J-B, Launay-Vacher V, Tournigand C. Regorafenib as a single-agent in the treatment of patients with gastrointestinal tumors: an overview for pharmacists. Targeted Oncology. 2015;10(2):199-213. doi:10.1007/s11523-014-0333-x.

2.  http://abcnews.go.com/GMA/PollVault/story?id=762685

3.  Marangoni F, Poli A, Agostoni C, Di Pietro P, Cricelli C, Brignoli O, et al. A consensus document on the role of breakfast in the attainment and maintenance of health and wellness. Acta Biomed. 2009;80:166–71.

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