Chemotherapy drug shortages hitting area hospitals
Doctors at UPMC Hillman Cancer Center facilities are using alternative drugs for certain cancer patients in an effort to conserve drugs the Food and Drug Administration are classifying as currently in shortage.
Dr. Stanley Marks, chairman of UPMC Hillman Cancer Center, said some patients are receiving alternative drugs in treatment. Meanwhile, hospital staff members are shifting the network’s supply of drugs like carboplatin, methotrexate and cisplatin, to keep the shortage from stifling treatment.
“There are cancers where there are not alternative drugs; we're trying to prioritize those drugs for the patients,” Marks said. “Part of it depends on their diagnosis; what type of cancer they have, what their liver and kidney function is. We look at this on a case-by-case basis.”
Several drugs used in chemotherapy treatments, including carboplatin, methotrexate and cisplatin, are on the U.S. Food and Drug Administration’s list of drug shortages. Marks said these drugs are primarily used to treat specific types of cancer like lung, ovarian and testicular, and are overall used to treat about 25% of all cancer patients.
Marks said these shortages are due in part to there being a limited number of manufacturers, and one particular factory in India being shut down in December. Easing these shortages efficiently may require the FDA to allow importation of these drugs from other sources in other nations, according to Marks.
“These drugs are tested to make sure that they are safe. It has just been an FDA policy for some time,” Marks said. “To relieve this public health emergency we really need the FDA to step up.”
The FDA lists 137 drugs as “currently in shortage” on its website as of June 7. The market is considered covered when supply is available from at least one manufacturer to meet total market demand. However, some manufacturers may not have all presentations available, according to the FDA.
Dr. Nathan Bahary, division chief of medical oncology at Allegheny Health Network, said supply chain issues have led to many drug shortages in recent years. He said AHN heard around February that chemotherapy drugs may become less available, so its staff began planning for a possible shortage.
“We have been able to set aside supply so that nobody in AHN that has these curable cancers has been denied the drug,” Bahary said. “What we have done as an institution is ask a few simple questions: Where is there a substitute? And where is there not?”
According to Marks, some of the side effects of substitute drugs may differ from the main drugs used for treatment.
“In some cases there could be heart damage, there may be greater bone marrow suppression, or an issue with neuropathy,” he said. “Where they are getting one in short supply, the physicians and nurses have direct conversation with patients; depending on which drug is chosen they may have more side effects.”
Marks said some of the drug substitutes have similar side effects to the regularly used treatments. Bahary said administering substitute drugs, at least for the time being, to patients keeps health care personnel from having to choose which patient receives doses.
“We don't want to have to end up in the scenario when we say, ‘One 20-year-old female, is she more important than a 30-year-old with testicular cancer, or a 70-year old (that) we are trying to cure,’” Bahary said.
Marks said the supply of these drugs is changing every day, but he could see the situation becoming dire soon if the U.S. is unable to get cancer treatment drugs from other sources while the main manufacturers are down.
“Our pharmacists believe it's possible this situation will get worse before it gets better,” Marks said. “If we can put pressure on the FDA — we are encouraging our patients, doctors, nurses to all reach out to try to push the FDA. But in the short-term our pharmacists are concerned.”
Marks added that the pharmacists of Hillman are “working around-the-clock” to make sure the center’s facilities have enough drugs to treat its current patients.
Still, Marks and Bahary both said they would like federal agencies to be more proactive in the future to prevent drug shortages from coming along.
“I'd like to see some sort of prescience from the FDA in identifying things ahead of time,” Bahary said. “Try to figure out how many of these drugs are in shortage, how can we ensure that there is more than one manufacturer so that we don't end up that way in the future.”
Marks said the shortage will hurt patients the most, and he is urging the FDA to allow imports of these chemotherapy drugs from other sources.
“Each patient who is on one of these drugs, we have a frank discussion with them, explain the shortage, but also we go over mitigation strategies,” Marks said. “We try to reassure them that they're going to get the best treatment possible.
“We have been working with government folks, but it's really up to them to alleviate the situation.”
