Cancer centers ration chemo amid new shortages
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Doctors are reporting new shortages of widely used generic cancer drugs, prompting fears that some treatments will need to be delayed or rationed.
Why it matters: The shortage is reminiscent of a cancer drug crisis three years ago that affected oncology patients' ability to get timely access to chemotherapies.
- While experts say the current shortages could resolve far more quickly, they say the situation still highlights the continued fragility of the supply chain for critical generic medicines.
Driving the news: Cancer centers around the country have been closely monitoring supplies of such treatments as carboplatin, cisplatin and ifosfamide over the last two months, per the New York Times.
- Physicians at NYU Langone's Perlmutter Cancer Center have been regularly reviewing whether some patients have to stick with the standard treatment or whether they could tolerate alternatives, Naomi Ko, section chief for breast medical oncology, told Axios.
- "I don't want to have to tell patients I have to be creative because I just can't get the drug I actually prefer because it's an older drug and they aren't producing it anymore," Ko said.
By the numbers: Hospital fill rates — reflecting how much of a drug order is received — fell to 66% for cisplatin in June, according to group purchasing organization Premier.
- It considers a fill rate of less than 80% a "danger zone." Cisplatin is an injectable used for advanced cancer of the bladder, ovaries or testicles.
- The fill rate for ifosfamide — used to treat lymphoma, sarcoma, and lung cancer — fell even further to 37%.
The big picture: The situation is a further sign of how razor-thin margins, raw material cost spikes, and rigid pricing rules make the market for older generics so fragile, said Mike Ganio, senior director of pharmacy practice and quality at the American Society of Health-System Pharmacists.
- Soaring platinum prices — a key ingredient in carboplatin and cisplatin — seem to have sparked panic-buying among some purchasers, to build larger-than-usual inventories to avoid a 2023 scenario, Ganio said.
- While there may be continued spot shortages, inventories of those drugs are expected to ease within the next month, he said.
- Ifosfamide, on the other hand, could remain in short supply for six months to a year, Ganio said. Premier pointed to a slower than expected recovery from manufacturing disruptions at leading supplier Baxter, while Fresenius has discontinued production and Hikma has the drug on backorder.
What they're saying: The Food and Drug Administration is aware of the shortages and "actively working with manufacturers and other stakeholders to help mitigate the impact," spokeswoman Emily Hilliard said in an email.
- That includes working with manufacturers to understand supply constraints and ways to increase inventories, as well as considering temporary importation to bridge supply gaps, she said.
What to watch: Shortages aren't limited to drugs. Three different types of contrast agents used for diagnostic scans are also in high demand, raising the prospect of delays.
