Authored by Dylan Cochin
Cancer patient Robert Landfair was diagnosed with Stage 4 prostate cancer in 2018 [1]. He experienced many unsuccessful rounds of chemotherapy, and his doctor recommended switching to oncology drug Novartis [1]. Yet, this life saving treatment was delayed months due to oncology drug scarcity. Is Robert the only patient with this issue?
The answer is no. Throughout the country, there has been a shortage of more than a dozen cancer drugs, including carboplatin and cisplatin [2]. These old school, generic products are popular in chemotherapy, assisting patients with many types of cancer including the brain, ovary, lung, and throat [3]. Acting as the backbone in many treatments, carboplatin and cisplatin are also coupled with modern therapies [2].
Even methotrexate, another chemotherapy drug used to treat numerous childhood cancers, is limited within the United States. As a result, children with cancer are vulnerable to the drug shortage issue, in addition to adults; according to a survey from the Children’s Oncology Group, about three-fourths of 67 pediatric oncology centers claim to be negatively influenced by this scarcity [3].
While people may be considering the possibility of substitute drugs, doctors have assured that this will not be a permanent solution. Amanda Nickles Fader, gynecological oncologist at Johns Hopkins, explains, “We've sometimes had to make some adjustments in terms of the dosing or the interval of the drugs, or we might switch a patient to a drug that is in the same class and works just as well as the drug that's in shortage, but perhaps it has a higher side effect profile, or it takes longer to administer, so the patient has to spend more time in the hospital to get the treatment” [2].
This had led many individuals to ask the same question: how did a shortage occur? To begin, competition among manufacturers plays a large role in oncology drug scarcity. Specifically, if numerous companies are aiming to sell the same product with competitive prices, there is no incentive to invest in new machinery or renovations — this frequently leads to production issues [2].
COVID-19 also influenced drug scarcity. Many of the essential ingredients to produce limited drugs are made abroad in India and China, and pandemic-related concerns resulted in restricted exports to the United States [4]. Additionally, generic drug creators in the United States halted production of products they struggled to sell, with natural disasters and inspections slowing down drug production resulting in the closing of numerous plants [3, 4].
Adding onto these complications, there are individuals within the gray market heightening the drug shortage dilemma. Taking advantage of economic conditions, gray market vendors obtain drugs from unauthorized channels including retail pharmacies and physician groups, unlike major distribution companies [5]. With the drugs in possession, members of the gray market sell these highly demanded products at inflated prices.
As critical drugs such as carboplatin become more expensive, doctors are faced with difficult decisions regarding patient treatment. Debbie Davis, director of clinical operations at the Pacific Cancer Center in Monterey, California, claims that carboplatin prices have risen significantly, increasing from $50 per vial to $500 per vial [4]. While larger hospitals can frequently absorb these higher prices, small hospitals and clinics tend to suffer at greater costs; whether this means altering doses or failing to treat patients, doctors are frustrated with current conditions [5].
With all of these obstacles in mind, the federal government took steps to lessen the drug shortage problem. To increase their efficiency and capacity, the FDA worked with cancer drug manufacturers, importing 14 lots of cisplatin from abroad and attempting to increase methotrexate injection to ensure that approximately 400,000 patients receive their treatment each month [6]. Although this is a step in the right direction, the FDA recognizes that there is more work to be done within the industry.
Clearly, the shortage of life-saving drugs is a major issue within the United States. With numerous suggestions from doctors and actions taken within the government, there is hope for improvement. Oncology drug scarcity is an urgent issue that requires immediate attention, so how can we promote additional advances?
Works Cited
Lovelace, Robert, and Marina Kopf. “Shortage on 4 Cancer Drugs Creates Dire Scenarios for Patients.” NBCNews.Com, NBCUniversal News Group, 11 Apr. 2023, www.nbcnews.com/health/health-news/shortages-cancer-drugs-fda-rcna77913
Sharfstein, J. (2023, July 18). Drug Shortages Are Affecting Cancer Treatments | Johns Hopkins | Bloomberg School of Public Health. Publichealth.jhu.edu. https://publichealth.jhu.edu/2023/drug-shortages-are-affecting-cancer-treatments
Christensen, J. (2023, September 26). Cancer centers, hospitals still feeling effects of ongoing cancer drug shortages. CNN. https://www.cnn.com/2023/09/26/health/cancer-drugs-shortage-still/index.html
Barlow, R. (2023, June 14). What’s Behind the Critical Shortage of Drugs for Cancer and Other Diseases | BU Today. Boston University. https://www.bu.edu/articles/2023/whats-behind-shortage-of-cancer-drugs/#:~:text=That
Lovelace Jr., B., Herzberg, J., & Kopf, M. (2023, August 17). Price gouging of cancer drugs in short supply hits some hospitals hard. NBC News. https://www.nbcnews.com/health/cancer/cancer-drug-shortage-price-gouging-chemo-drugs-hits-hospitals-hard-rcna98041
Strengthening the supply chain for cancer drugs | OSTP. (2023, September 12). The White House. https://www.whitehouse.gov/ostp/news-updates/2023/09/12/strengthening-the-supply-chain-for-cancer-drugs/#:~:text=Unfortunately%2C%20the%20United%20States%20is