S.Ara Evans considers herself a lucky ovarian cancer survivor but is battling a second recurrence of the disease since being first diagnosed in February 2018.
She is grateful that her cancer was still responding to carboplatin treatment after her third round of chemotherapy in March of this year. Carboplatin treatment is the most common first-line treatment for ovarian cancer, and Evans tolerates it without intolerable side effects. Patients often develop resistance to carboplatin and require other drugs that are less effective or have more side effects, especially after repeated treatments.
But in May, Evans, 68, who has stage 3 cancer, got a call from the hospital. She was told there was no carboplatin available to her due to the nationwide shortage of generics. She was now treated with cisplatin.
“I was shocked when I got the call,” said Evans, who lives in Syracuse, New York. […] I never really thought it would happen to me. ”
Cancer patients, physicians, and patient advocates alike suffer the pervasive effects of the ongoing shortage of chemotherapy drugs. The platinum-based drugs carboplatin and cisplatin have had difficulties in securing inventories in recent months. Affects most cancer centers in the United States: 93% reported carboplatin deficiency and 70% reported cisplatin deficiency.
Patients with various types of cancer are affected by the deficiency, but ovarian cancer patients are one of the most affected groups. This is because the disease is relatively common, with a 1 in 78 chance for a woman to develop it during her lifetime. The most effective drugs for its treatment are currently in short supply.
There are alternatives to using platinum to treat ovarian cancer, but none are very effective. Carboplatin, in particular, in combination with the chemotherapy drug paclitaxel, remains uncontroversial as the drug of choice for ovarian cancer, especially when treatment may be curative rather than palliative.
The lack of a good alternative to platinum for ovarian cancer patients “reflects the fact that platinum works so well,” said Michael Biller, director of the Winthrop Rockefeller Institute for Cancer Research at the University of Arkansas for Medicine. says Mr. The response rate for platinum as a single agent is close to 60% or 70%, and when combined with paclitaxel, it can reach 80%, he said. There are no new treatments to date with similar results. “Platinum is so good that it drives the whole sector and no one wants to question it,” he said.
“These are first-line drugs. They are the cornerstone of cancer care,” said Stephanie Blank, Director of Gynecologic Oncology at Mount Sinai Health System. “The evidence shows that these are the most important agents for treating ovarian cancer.”
Difference Between Carboplatin and Cisplatin
Both carboplatin and cisplatin have been used for decades.Cisplatin Receives Food and Drug Administration Approval for Treatment of Ovarian Cancer in 1978. Approved by the FDA in 1989, carboplatin was developed as a cisplatin analogue with less kidney toxicity.
Carboplatin tends to cause less vomiting and less side effects than cisplatin. In some cases, doctors also use cisplatin to treat patients. For example, patients with hypersensitivity to carboplatin. However, this is not a preferred option as it puts more strain on the body.
For Evans, switching from carboplatin to cisplatin meant taking steroids before treatment and then changing his habits to include electrolytes every time he drank water. Permanent side effects were even more difficult.
“I just didn’t feel well,” she said. “It took me almost two weeks to get back to my normal routine. […] I was more tired and just foggy. “After her carboplatin treatment, she typically experienced her three levels of discomfort for 10 minutes, she said. When she took cisplatin, her mood worsened, 7 out of 10 worse.
Retired single mother Evans worked the night shift for 12 years while raising her three sons after working in the postal service for 30 years since she was first diagnosed with ovarian cancer, but struggled to maintain a normal life. I have tried. She has a rich social life, making sandwiches for 100 people every Saturday with the homeless. But when her friends came to visit her from out of town shortly after her cisplatin treatment, she was reluctant to leave her house.
Thankfully, carboplatin was available again for her next treatment in June and July. “I don’t know how they figured it out, but I was really happy because I didn’t want to suffer for another month.” [cisplatin side effects]”It was an even more negative experience for me,” she said.
Why Platinum-Based Drugs Are Still the Standard of Ovarian Cancer Treatment
The causes of cancer drug shortages are systemic and require policy reforms that, even if approved, will take time to implement. More than a decade after the first shortages in the United States, there is no end in sight.
This shortage means that physicians are faced with a difficult choice as to whether carboplatin or cisplatin is in greater need for their patients. “People who are being treated for ovarian cancer are probably our priority and hopefully they can get treatment,” Blank said. However, I have heard stories of patients who were unable to adhere to a stable schedule due to delays in the supply of medicines.
In addition, patients may have to undergo completely alternative treatments. In such cases, doctors may use other drugs, such as bevacizumab, especially for patients with recurrent cancer and treatment is unlikely to be curative. It’s really disappointing to see the results in this situation,” Blank said.
The efficacy of platinum-based drugs in treating ovarian cancer is unparalleled, and strong alternatives are unlikely to emerge anytime soon, Biller said. “Unfortunately, when it comes to randomized trials and the direction of the field, there aren’t many trials out there that can replace platinum,” he says. “I don’t think the shortage has changed the situation.”
Biller says it shouldn’t. The solution to the platinum shortage, he said, is for some government intervention to improve the portfolio of companies that can provide cheap oncology drugs, rather than focusing on new drugs that are equally effective but more expensive. Stated. Therefore, it becomes more profitable for pharmaceutical companies.
This does not mean that there is no value in researching new ovarian cancer treatments, especially for certain situations such as patients with BRCA gene mutations. “Advanced treatment for ovarian cancer is still in its infancy, and we’re trying to make it better,” said Biller.
And there are reasons beyond scarcity to seek platinum alternatives. Relapses in carboplatin-treated patients can result in death from so-called “platinum-resistant disease.” This is because platinum can mutate the bone marrow as it targets cancer cells. “And when resistant clones grow, those tumors are so highly mutated that they’re less responsive to other things. So it’s a double-edged sword,” Biller said. Told.
Oncologists, meanwhile, are finding a delicate balance in how they explain the problem of drug shortages to patients. On the one hand, patients need to be reassured. “There are guidelines put together by some of the brightest minds in the field to minimize interruptions in care,” says Blank.
On the one hand, it is difficult to know with certainty whether these interruptions have a real impact on treatment success. It may take up to two years to see if people who are unable to complete initial treatment with carboplatin or cisplatin because of deficiency have worse outcomes and more relapses than those who have full access to the drug. , she said. she said.
Tracy Moore, who heads the patient program at the Ovarian Cancer Research Alliance (OCRA), said she’s spoken to patients who, like Evans, had to switch from carboplatin to another treatment and experienced worse side effects. Ta. This shortage is a cause for concern, at least among patients who are not yet personally affected.
“They may be able to get their hands on this drug, but the notion of a shortage is taking an emotional toll on many,” Moore said, noting that the shortage would affect hundreds of people in the organization. He points out that this is a common theme for mono support groups.
fighting the unknown
Evans still wonders if cisplatin’s side effects will linger, and even after returning to taking carboplatin, recovery from chemotherapy sessions seems to take longer than usual. She doesn’t know if what she’s feeling is something like a cisplatin hangover or if it’s just an impression, but that’s exactly the problem, she doesn’t know. She was “a little bit damaged mentally,” she said in July.
There are other things she doesn’t know. The treatment may not be as effective this time, and she may have to undergo additional chemotherapy after what would normally be her last sixth treatment. Is it because she’s older than she is? Has her cancer become resistant to carboplatin? Or has having to take cisplatin once make the treatment less effective? I’m not sure if it has anything to do with it, probably nothing, but it’s still on my mind,” Evans said. “I can never say.”
Before her new chemotherapy regimen, she often worries that she will be called again to go early to prepare for her cisplatin infusion because there is no carboplatin available. She tries not to guess too much and this has been her approach to therapy so far.
But just days before her latest session, she was feeling lucky again. “There was no call this time, so I’m just keeping quiet and watching.”
