A nurse hangs chemotherapy bottles
Toni L. Sandys | The Washington Post | Getty Images
Robert Landfair, 76, was diagnosed with Stage 4 prostate cancer in 2018.
After several unsuccessful rounds of chemotherapy, his doctor, Alan Tan of Rush University Medical Center in Chicago, really helpful that he switch to Pluvicto, a recent medication for advanced prostate cancer.
However the drug’s manufacturer, Novartis, has had supply problems. Landfair is now on a waitlist for the medication, which is not expected to be widely available for several more months.
“I definitely need that drug,” Landfair, of Chicago, said. “It is the only way I see my life.”
His family says his cancer is “aggressive and still growing.”
“We realize the cancer just isn’t on a hold period, it isn’t on hiatus,” Raymond Jackson, Landfair’s son-in-law, said. “We’re very concerned.”
Landfair’s not alone: A shortage of cancer medications has created dire circumstances for a lot of patients diagnosed with the disease, forcing them — together with their doctors — to make difficult decisions.
Based on the Food and Drug Administration, there are 4 cancer drugs in shortage: Pluvicto, for advanced prostate cancer, in addition to methotrexate, cisplatin and fluorouracil, common chemotherapy drugs used to treat a broad range of cancers from the skin to the bones and lungs. A fifth drug, a bladder cancer therapy called BCG, can be said to be in shortage, in response to Dr. Vignesh Packiam, a urologist on the University of Iowa Hospitals and Clinics.
In places where cancer medications are running low, some patients could also be forced to show to options that will not work as well, experts say. Others may die waiting for the medications in shortage to change into available. Every single day counts: A study published in 2020 in The BMJ found that each month delayed in cancer treatment can raise the danger of death by around 10%.
“We’re sort of handcuffed here as oncologists,” said Tan, who’s the director of genitourinary medical oncology at Rush.
Tan’s hospital faces a shortage of Pluvicto and cisplatin.
“This can be a patient’s life,” he said, adding that patients are “going to die” in the event that they do not get the drugs they need.
What’s causing cancer drug shortages?
Michael Ganio, the senior director of pharmacy practice on the American Society of Health-System Pharmacists, which tracks nationwide drug shortages, blamed the cancer drug shortage on an absence of investment from manufacturers.
Most of the cancer drugs in shortage are generic medications, which save the nation’s health care system money overall but should not very profitable for drugmakers.
“There’s little incentive to speculate in generic manufacturing, oftentimes, especially for these much older drugs — the margins aren’t very big,” Ganio said. “It’s almost a disincentive.”
Erin Fox, senior pharmacy director on the University of Utah Health, said poor manufacturing practices at U.S. factories have also contributed to drug shortages overall.
The shortage of medicines, including lifesaving cancer drugs, could worsen in the approaching years as more drug production moves overseas, Fox said.
“A key challenge in evaluating drug shortages is that drug corporations should not required to reveal exactly which company is making the product in addition to the situation,” she said, noting that manufacturing is commonly outsourced abroad.
Sarah Ryan, a spokesperson for Pharmaceutical Research and Manufacturers of America, the drug industry’s trade group, said manufacturers have “extensive measures” to assist prevent and mitigate drug shortages.
A report published in March by the Senate Committee on Homeland Security and Governmental Affairs found that recent drug shortages within the U.S. increased by nearly 30% from 2021 to 2022. The medications included pharmaceuticals and youngsters’s cold and flu medicine in addition to medications used to treat cancer, in response to the report.
The FDA is working to curb the trend. This month, the agency released 17 pages of draft guidance intended to stop drug shortages. It might require drugmakers to present the agency more advance notice — at the least six months — about potential shortages or discontinuation of a drug in addition to more details about what’s causing the issue.
Lower than ideal care
Within the meantime, more cancer patients may get lower than ideal care, said Packiam, of the University of Iowa Hospitals and Clinics.
Packiam learned inside the last week that his hospital had run low on cisplatin, a chemotherapy drug that is often used for bladder cancer and improves the likelihood that surgery shall be successful.
It’s “generally considered the gold standard treatment for one of these cancer,” he said.
The shortage of cisplatin means he’ll have to perform surgery without chemotherapy.
“Alternative chemotherapies that don’t use cisplatin don’t yield pretty much as good of a response,” he said. “So quite than give a suboptimal chemotherapy, the subsequent most suitable choice is to proceed directly with surgery.”
The hospital will even should prioritize what cisplatin it has left for those most in need, he said.
For individuals who do not get their cancer medications immediately, all they’ll do is hope.
Landfair, the cancer patient who’s waiting for Pluvicto, is optimistic, though doubt sometimes creeps in.
“My biggest fear is I won’t get that medication began,” he said.
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