Chemotherapy drug shortage

There seem to be an awful lot of chemotherapy drug shortages right now. As a gastrointestinal oncologist, the one that impacts me the most is leucovorin, of course, but there are also ongoing shortages of bleomycin, cisplatin, cyclosporine, cytarabine, doxorubicin and mitomycin. And that, you know, sounds like a lot of drugs to me.

There was a discussion yesterday in my research group meeting about whether this was from some downstream effect of the economy. Company profits down ... can't hire as many workers ... not enough people to make the drugs ... shortage in the market. Now that's all just a theory on my part, but you could see it happening. The leucovorin shortage is particularly sticky — there is no clear endpoint to the shortage, and clearly some patients need it without question (curable colorectal cancer, high-dose methotrexate rescue patients, clinical trial patients). We have substituted oral leucovorin for some patients, but that ends up being a lot of pills. You can also substitute levoleucovorin (Fusliev, Spectrum Pharmaceuticals), but it is not a 1:1 substitution and I am not as familiar with levoleucorin as I don't think I ever used it in training (see here for a suggestion of how to dose: http://www.ashp.org/Import/PRACTICEANDPOLICY/PracticeResourceCenters/DrugShortages
/GettingStarted/CurrentShortages/Bulletin.aspx?id=488 ). One could also consider substituting capecitabine (Xeloda, Roche Laboratories Inc.) for 5-FU where appropriate.

This shortage was anticipated for some time, and through the grapevine I have now heard of practices which have been stockpiling leucovorin for their use. Although technically possible, this seems inherently unfair to me. One of my partners was at a site yesterday which had two years of leucovorin stored! The drug will likely expire before they can use it all! What a shame.