Expert Discusses Chemo Shortage: ‘Likely to Last’ 3 to 4 Months

The United States has recently been facing shortages of carboplatin and cisplatin, which are two chemotherapy agents that are commonly used to treat diseases such as lung, breast and gynecological cancers.

In fact, in a survey of 27 National Comprehensive Cancer Network (NCCN)-designated cancer centers, 93% reported a shortage of carboplatin, while 70% are experiencing a shortage of cisplatin. These shortages could lead to lower doses of the medications being prescribed as well as delays or changes in patients’ cancer therapy, explained Dr. Lee Wilke, author on the NCCN study and professor of surgery and senior director of clinical oncology services at the University of Wisconsin in Madison.

In an interview with CURE®, Wilke discussed the cancer drug shortage and what it may mean for patients who are on these regimens.

What are contributing factors to the current oncology drug shortage?

The reasons behind the chemotherapy shortage are multi-factoral, explained an expert.

It's multifactorial — actually an interesting combination of issues. Plant quality is my understanding, though I am not an expert in that space. Usually because these drugs are generic, there are not a large group of manufacturers making it. So one plant problem can lead to a larger issue.

They are very frequently used drugs, and we have an aging population and an increasing number of diagnosed cancers (leading to) an increased need for these drugs. The baby boomers have been aging up over the last several years and we're seeing more lung cancer, breast cancer and gynecological cancers just by population density.

Then we've also had — appropriately so — our pharmacy supply chains trying to predict where shortages would be. Some (places) have larger caches of these drugs while others do not, because the prediction tools aren't effective or well-known across all groups.

Your research found that over 90% of surveyed cancer centers are facing shortages. What can patients being treated at these centers expect?

The National Comprehensive Cancer Network is a large series of comprehensive cancer centers, so large cancer centers. And for the larger cancer centers, it may be actually more impactful than some of the smaller centers because we treat so many patients and have a higher demand. However, it is immensely scary to the patient to not know whether they're going to be getting the continuation of their treatment.

What we learned from this survey is that 90% were impacted and aware of the mitigation efforts, which means they were decreasing slightly the amount of drug they were giving patients. (Cancer teams would) save a little bit (of the drug) so you could treat another patient. We should actually be doing that at all times to make sure we're not wasting drugs. And so, we got very good at what we call mitigation efforts using a little less drug, but (the treatment) still is effective, and making sure we don't waste any drugs.

Then, at times, some groups were lengthening the time between the treatments to gain a little bit extra in terms of waiting for more drug to come in. Again, that doesn't necessarily, in the long run, impact outcomes. However, a few groups were actually having to reduce the number of patients they were treating or change to different regimens. The regimens may be equal, but they have different side effects. Several groups had to change regimens or change the treatment approach, and then reteach the patients about their side effects. Also, some centers — a few in the 20% range — had delays because the insurance companies had to reauthorize these new drugs. So there was a small group of patients who probably did get delays in their care, which is not what we want to see, nor do we want to have to reteach the patients about new drugs with different side effects.

Where do you predict or hope to see this go in the coming months or the rest of the year?

We hope that the plant or plants that have had quality problems get fixed and we're able to get back to a regular supply chain. Right now, what we're dealing with is an uncertain supply chain. So every week, we have to look and see what we have, and see if we have to change our approach again. (This is) taking time away from actually taking care of patients, doing research and trying to improve cancer care versus just maintain and stay above water.

We've been told from different sources that these problems are likely to last another three or four months for at least these two drugs, as well as another two drugs — methotrexate and 5FU — which are on that survey list. You could see 60% are having trouble with a different drug methotrexate.

We hope now with the public awareness and patient advocacy groups, that we can start to influence and support increased regulation associated with maintaining an adequate supply of generic chemotherapy agents.

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