Platinum chemotherapy supply rises, but new concerns about cancer drug shortages emerge
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Two common platinum-based chemotherapies that had been in short supply for most of the past year are much more widely available this summer, according to results of a new National Comprehensive Cancer Network survey.
However, nine of 10 cancer centers report ongoing shortages of other therapies and supportive care medications, prompting concerns about their potential impact on treatment decision-making, clinical trials and development of new cancer treatments.
“The current situation underscores the need for sustainable, long-term solutions that ensure a stable supply of high-quality cancer medications,” Alyssa Schatz, MSW, senior director of policy and advocacy for NCCN, said in a press release. “The federal government has a key role to play in addressing this issue. Establishing economic incentives — such as tax breaks or manufacturing grants for generic drugmakers — will help support a robust and resilient supply chain, ultimately safeguarding care for people with cancer across the country.”
NCCN released data twice last year that illustrated the effects of drug shortages at cancer centers across the country.
Data from a survey of 27 U.S. cancer centers released in June 2023 showed 93% reported shortages of carboplatin and 70% reported inadequate supplies of cisplatin.
Data from a follow-up survey released in October 2023 showed 86% of centers reported experiencing a shortage of at least one oncology drug, with 72% experiencing a carboplatin shortage and 59% reporting a cisplatin shortage.
Supplies of both have rebounded considerably, according to results of a new survey of 28 U.S. cancer centers.
The results — based on responses collected from May 28 through June 11 — showed only 11% of centers still report a carboplatin shortage and only 7% still report a cisplatin shortage.
However, new challenges related to availability of other chemotherapies have emerged.
The majority (89%) of centers report shortages of at least one drug, and 75% reporting shortages of two or more drugs.
More than half (57%) of responding centers reported a shortage of vinblastine. Nearly half reported shortages of etoposide (46%) or topotecan (43%).
Other chemotherapies or supportive care medications reported in short supply included dacarbazine (18%), 5-fluorouracil (14%) and methotrexate (14%).
“Critical drug shortages were not a new problem last year and they continue to be a problem now,” Crystal S. Denlinger, MD, FACP, CEO of NCCN, said in the release. “The dual carboplatin and cisplatin shortage was particularly severe, and we were able to help sound the alarm during its peak.
“Despite a renewed attention to drug shortages over the past year, 89% of the responding centers in the latest survey are still reporting shortages of various important anticancer agents and supportive care medications,” Denlinger added. “Most of them are still managing shortages for more than one type of medication right now. These shortages not only put a burden on patients, caregivers and providers, but they could also delay vital clinical trials and slow the pace of progress for new cancer therapies.”
Most centers (93%) indicated they have been able to treat all patients currently receiving agents in short supply according to the intended dose and schedule; however, 56% had enacted mitigation strategies to accomplish this goal. The most commonly implemented mitigation efforts included waste management strategies (80%), limiting use of current stock (53%), using the range minimum for recommended dose (33%) and using the range maximum for recommended treatment interval (33%).
Ongoing shortages have affected clinical trials at 43% of responding centers, with the most common impacts being increased administrative burden (83%), enrollment reductions (58%) or reduction in the number of open trials (17%).
About one-quarter (27%) of centers reported treatment delays because shortage-related changes required additional prior authorization.
Many survey respondents expressed concerns about how the current marketplace incentivizes unsustainable practices. Three-quarters (75%) of respondents indicated they want economic incentives in place to encourage high-quality manufacturing of medications, particularly generic versions that often are in short supply. Two-thirds supported a broad buffer stock payment like one previously proposed by CMS, as well as better information systems to accredit or rate generic suppliers so hospitals can contract with those that use high-quality practices (64% each).
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NCCN Best Practices Committee. New information and survey results from June 2024. Published June 26, 2024.
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