Oncology Drug Shortage May Not Lead to Suboptimal Care

Drugs, such as vinblastine and topotecan, are two drugs that are in short supply but are in dire need, an expert told CURE®.

Last summer, supply shortages of the chemotherapy drugs, cisplatin and carboplatin made headlines across the United States.

While the cisplatin and carboplatin shortages have drastically improved, they “put the spotlight” on other cancer drugs that are in short supply, said Dr. Wui-Jin Koh. Koh is the chief medical officer at the National Comprehensive Cancer Center. He recently sat down with CURE® to discuss a recent survey of NCCN centers that revealed ongoing drug shortages in the cancer space.

CURE®: What is the current state of the oncology drug shortage?

Koh: In some ways, it's better in the fact that the two drugs, cisplatin and carboplatin, that raised all the alarms now are in better supply. While there are still some intermittent isolated shortages, we don't have the 75% to 90% shortage [that we saw last summer].

I think that it is not better in the broader scheme in that there have always been drug shortages affecting the cancer space, and in other areas of health care, which was brought into the national spotlight by the cisplatin and carboplatin [shortages] because it was such an acute situation. But what we have found is that there continues to be ongoing shortages of other drugs that are also important, some of which are perhaps not used as widely as cisplatin and carboplatin. … That really put the spotlight on these other drugs that continue to be in relatively short supply.

What are some of the most pressing needs regarding cancer drugs that are currently in short supply?

In our survey — which was specific to the NCCN member institutions, [which is] made up of 33 academic medical centers that are all [National Cancer Institute]-designated cancer centers, so these are large cancer programs — the ones that have reached a threshold where it has gained attention would be drugs like vinblastine. Vinblastine is used in treatments of many lymphomas, for example, and testicular cancer.

Another drug that's in short supply, or relatively short supply is topotecan, and that's used in treatment for certain other cancers [such as] ovarian cancer and certain types of lung cancer.

The last one that reached a certain level [of short supply] is etoposide [which] is used for lung cancers. And lung cancers carry a big weight because it's a common cancer.

So these drugs were reported to be in short supply in right about half of institutions. But other drugs that continued to [have short] supplies were things like dacarbazine and 5-fluorouracil. And 5-fluorouracil was a drug that's commonly used in [gastrointestinal] cancers and breast cancer. So that's a very important drug that is the backbone [of treatments]. Fourteen percent of our member institutions reported a shortage of methotrexate used in many leukemias and lymphomas.

So, they perhaps did not reach that high level, but it speaks to the fact that they continue to be in short supply because these shortages of these drugs are not new, they have been reported off and on for several years.

What would you say to patients who are concerned that a drug they are prescribed is in short supply?

We were fortunate that — at least in our survey — no patients within our NCCN institutions received suboptimal or inappropriate care, per the guidelines that are developed by NCCN. So NCCN, while it says a certain drug is recommended, it always provides alternatives.

MORE: Patient-Provider Communication Is Key During Chemo Shortage

Now, that may create extra work for the clinicians and the administrators. But patients, I think, should be reassured that they can still get treatment that is appropriate within guidelines. Within the hospital systems, they have developed waste-mitigation strategies, so making sure that they appropriately use [and] don't waste any drugs, for example. And they also do extra work, [such as] reach out to more suppliers to hopefully get in a substitute supplier.

So at this point, at least within the NCCN institutions, we have not seen a detriment or a withholding of care. What has happened is [that the drug shortage] caused a lot more administrative work, angst and concern on the part of hospitals. But we want to reassure patients that this point, thanks to the work of very motivated clinicians, administrators and hospital systems and cleaning, yes, it's extra work, but they will not change their treatment along [with] appropriate NCCN guidelines and therapy guidelines.

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