Colorado cancer centers try to manage chemotherapy drug shortage

In this May 25, 2017 file photo, a patient is being given chemotherapy drugs at a hospital in Chapel Hill, North Carolina.

Two of the mainstay chemotherapy drugs are becoming increasingly difficult to obtain, and Colorado Cancer Centers are trying to address the shortage while minimizing the impact on patients.

in May A survey of 27 US cancer centers Twenty-five were found to be deficient in carboplatin and 19 were found to be deficient in cisplatin (a generic drug). Using the metal platinum to stop cancer cells from growing. About 36% of centers reported that: Failure to provide carboplatin rapidly and at optimal doses to all eligible patients.

Dr. Leslie Busby, president of the American Oncology Network of Medicines and Therapeutics, which manages medicines for 19 Colorado locations at Rocky Mountain Cancer Center, said limited doses of cisplatin could be used in patients with testicular disease during the worst period of cisplatin deficiency. He said he gave priority to administering to Because cancer can be cured.

Busby said some people with other cancers and less likely cures have been switched to carboplatin or other drugs. that is, Recommendation from the American Society of Clinical Oncology Prescribe to patients who have a good prognosis if they receive the missing drugs.

Now, of the two infusions, cisplatin has some easing shortages, but carboplatin is more difficult to obtain, Busby said. Because cisplatin can cause kidney damage, the American Oncology Network urges physicians to save doses of carboplatin in patients at high risk of kidney disease and give them smaller doses every 4 weeks instead of 3 weeks. He said he was warned to seek treatment.

“Our biggest fear is that[the drug]will be completely out of stock and we won’t be able to treat it,” he said.

Other anticancer drugs are also in short supply, but the lack of availability of carboplatin and cisplatin affects most patients.of National Cancer Institute estimates Between 10% and 20% of cancer patients take platinum-based drugs. They are used for breast cancer, lung cancer, ovarian cancer, testicular cancer, etc.

Physicians routinely replace chemotherapeutic drugs or adjust dosing schedules according to patients’ individual needs, but there is little research into why chemotherapeutic drugs must be changed due to shortages. has not progressed, Mr. Busby said. Uncertainty is adding to the stress for some patients who are already facing difficult diagnoses, he said.

“Cancer can already cause anxiety to spike,” he says.

‘Constantly out of stock’

Intravenous drugs administered for chemotherapy are not the only drugs in short supply.

Over the past year, patients have reported difficulty getting treatment. Drugs to treat attention deficit hyperactivity disordercertain antibiotics, antipyretics for children, growth hormone for children their bodies don’t produce it naturally. Each situation was slightly different, with some shortages mainly due to manufacturing issues and others due to high demand.

Generic drug supply chains can be fragile. Manufacturers have little incentive to maintain existing facilities or invest in new facilities, as generic drugs are not particularly profitable to manufacture. Industry watchers sounded the alarm After a tornado blew off the roof of a Pfizer facility in North Carolina in July, the facility produces about a quarter of the sterile injectable drugs the company sells to U.S. hospitals. Although the damaged facility was a warehouse, not a factory, Pfizer said it still held 30 pharmaceuticals. may be in short supply in the next few months.

After a Pfizer facility was hit, UCHealth formed a team to investigate how it would affect the supply of injectable drugs, said Amy Gutierrez, the health system’s chief pharmacy director. Generic drugs are cheaper and manufacturers want to use that space for the most profitable drugs, especially when that space is set aside for the more complex manufacturing process of sterile drugs, he said. she said.

“There’s probably no shortage of expensive branded drugs,” she says. (exception new weight loss pillsWe are facing overwhelming demand. )

So far, UCHealth has been able to address current shortages by predicting the doses of chemotherapy drugs it will need in the near future and moving inventory between hospitals as needed, Gutierrez said. rice field.

“Knock on the wood, we don’t have to deny patients drugs yet,” she said.

Chris Nagy, drug procurement and supply pharmacist at Intermountain Health, said chemotherapy doses were delayed or changed at the system’s hospitals in Colorado and other Western states. He said he did not know the patient. Being part of a larger group helps, he said, because hospitals can always send and deliver medicines depending on who needs what.

But given the recurring shortages, just moving drugs isn’t always enough, Nagy said. He estimates that Intermountain stockpiles about 150 of the 3,000 drugs held by general hospitals, including multiple formulations of some drugs, for about 30 days. there is Deciding which to keep on hand was based on how commonly the drug was used and how serious the impact would be if hospitals ran out of it, he said.

a Report to Congress on Drug Shortages By the end of 2022, 295 medicines were found to be in short supply, an increase of around 30% from 2021. The average shortage lasts about 18 months, but a small number of medicines are listed as being in short supply for more than a decade.

The report attributes rising shortages to an over-reliance on a small number of suppliers, particularly those based in China and India. Limitations in the US Food and Drug Administration’s ability to collect data to help predict shortages and difficulties in using the data it holds. And the demand for some medicines increased.

The shortage has been an issue for 20 years, Nagy said, but the public has only recently become aware of it.

“We are getting tired of doing this without anyone knowing,” he said. “Shortages are always happening.”

no government aid

A shortage of chemotherapy drugs cisplatin and carboplatin began After FDA inspectors found trash bags containing shredded papers The study found quality problems with the Indian manufacturer, which produces about half of the cisplatin used in the United States. Carboplatin was also produced at this facility.

The FDA has allowed Chinese suppliers who are registered with the FDA but have not completed the full process to temporarily ship cisplatin to U.S. suppliers; I left the door open.