US faces worst chemotherapy drug shortage in 30 years, affecting 100,000 patients

Toni Dezomits, a 55-year-old retired law enforcement officer, faces a difficult battle with stage 4 ovarian cancer. Just before her third round of chemotherapy last month, she was informed of a nationwide shortage of the generic chemotherapy drug carboplatin, one of the three medications she was scheduled to receive. Left with no choice, the North Carolina resident is completing her final three chemotherapy sessions with only two of the recommended drugs. This shortage of chemotherapy drugs is considered one of the worst in the US in the past three decades.

Dezomits is among the estimated 100,000 patients affected by the shortage over the past several months, according to Dr Julie Gralow, the chief medical officer at the American Society of Clinical Oncology. The US Food and Drug Administration (FDA) currently lists over 130 drugs in short supply, with 14 of them being cancer treatments. A multitude of factors has contributed to the shortages, which have heavily impacted two front-line therapies, carboplatin and cisplatin, used to treat various cancers, including head and neck, gynaecologic, and gastrointestinal cancers.

“You have these two sub-optimal choices,” she said. “I’m worried, because I know the drug I’m not getting is the one my cancer responded to very well [the first time].”

The most recent shortage occurred after a plant in India, which supplied cisplatin materials for all US manufacturers, shut down due to quality concerns. This increased the demand for a substitute drug, carboplatin, explained Dr Gralow. Consequently, some providers have had to extend the time between patients’ chemotherapy sessions, while some patients have had to travel several hours to receive treatment at different cancer centres.

“It’s like triage on the battlefield,” said Dezomits, who was a soldier in the Persian Gulf war. “This country should be a little better than that. We should be able to get life-saving drugs that cost about US$9 or US$10 a dose.”

The low cost of generic front-line cancer drugs has contributed to the recurrent chemotherapy drug shortages. While the medications are inexpensive to produce, pharmaceutical companies lack the incentive to manufacture them due to the low profits, according to Dr Karen Knudsen, CEO of the American Cancer Society. The drug shortage issue has also been exacerbated by the increasing US life expectancy, resulting in more people developing cancer.

To alleviate the supply chain issues, the FDA recently began working with a Chinese manufacturer to import one of the chemotherapy drugs. Although this move may help resolve some short-term supply constraints in the coming months, it does not address the more cyclical problem of chemotherapy drug shortages, as Dr Knudsen pointed out.

“An emergency solution is being put into place, but we are at a moment in time where there needs to be a more durable solution,” she said.

Medical experts suggest that the US government should collaborate with the private sector to develop long-term solutions. The US government could use its drug purchasing power to create national strategic reserves of critical medicines and incentivise higher-quality pharmaceutical companies to manufacture them, said Dr Gralow.

Dezomits is concerned that without further action, people across the US may continue to face challenges in accessing the cancer care they need. “It’s already stressful enough to deal with cancer and your own mortality,” she said. “This is just another obstacle in front of patients that now they’ve got to think about.”