Shortage on 4 cancer drugs creates dire scenarios for patients

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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, recommended that he switch to Pluvicto, a new medication for advanced prostate cancer.

But the drug’s manufacturer, Novartis, has had supply problems. Landfair is now on a waitlist for the medication, which isn’t expected to be widely available for several more months.

“I definitely need that drug,” Landfair, of Chicago, said. “It’s the only way I see my life.”

His family says his cancer is “aggressive and still growing.” 

“We realize the cancer is not on a hold period, it’s not on hiatus,” Raymond Jackson, Landfair’s son-in-law, said. “We’re very concerned.”

Robert Landfair is waiting for the cancer drug Pluvicto, which is currently in shortage.
Robert Landfair is waiting for the cancer drug Pluvicto, which is in shortage.Raymond Jackson

Landfair’s not alone: A shortage of cancer medications has created dire circumstances for many patients diagnosed with the disease, forcing them — along with their doctors — to make difficult decisions. 

According to the Food and Drug Administration, there are four cancer drugs in shortage: Pluvicto, for advanced prostate cancer, as well as 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, is also said to be in shortage, according to Dr. Vignesh Packiam, a urologist at the University of Iowa Hospitals and Clinics.

In places where cancer medications are running low, some patients may be forced to turn to options that may not work as well, experts say. Others may die waiting for the medications in shortage to become available. Every day counts: A study published in 2020 in The BMJ found that every month delayed in cancer treatment can raise the risk of death by around 10%.

“We’re kind of handcuffed here as oncologists,” said Tan, who is the director of genitourinary medical oncology at Rush. 

Tan’s hospital faces a shortage of Pluvicto and cisplatin. 

“This is a patient’s life,” he said, adding that patients are “going to die” if they don’t get the drugs they need. 

What’s causing cancer drug shortages?

Michael Ganio, the senior director of pharmacy practice at the American Society of Health-System Pharmacists, which tracks nationwide drug shortages, blamed the cancer drug shortage on a lack of investment from manufacturers.

Many of the cancer drugs in shortage are generic medications, which save the nation’s health care system money overall but are not very profitable for drugmakers.

“There’s little incentive to invest 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 at the University of Utah Health, said poor manufacturing practices at U.S. factories have also contributed to drug shortages overall.

The shortage of medications, including lifesaving cancer drugs, could get worse in the coming years as more drug production moves overseas, Fox said.

“A key challenge in evaluating drug shortages is that drug companies are not required to disclose exactly which company is making the product as well as the location,” she said, noting that manufacturing is often 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 help prevent and mitigate drug shortages.

A report published in March by the Senate Committee on Homeland Security and Governmental Affairs found that new drug shortages in the U.S. increased by nearly 30% from 2021 to 2022. The medications included prescription drugs and children’s cold and flu medicine as well as medications used to treat cancer, according to the report.

The FDA is working to curb the trend. This month, the agency released 17 pages of draft guidance intended to prevent drug shortages. It would require drugmakers to give the agency more advance notice — at least six months — about potential shortages or discontinuation of a drug as well as more information about what’s causing the problem. 

Less than ideal care

In the meantime, more cancer patients may get less than ideal care, said Packiam, of the University of Iowa Hospitals and Clinics.

Packiam learned within the last week that his hospital had run low on cisplatin, a chemotherapy drug that is commonly used for bladder cancer and improves the likelihood that surgery will be successful. 

It is “generally regarded as the gold standard treatment for this type of cancer,” he said. 

The shortage of cisplatin means he’ll need to perform surgery without chemotherapy. 

“Alternative chemotherapies that do not use cisplatin do not yield as good of a response,” he said. “So rather than give a suboptimal chemotherapy, the next best option is to proceed directly with surgery.” 

The hospital will also have to prioritize what cisplatin it has left for those most in need, he said.

For those who don’t get their cancer medications immediately, all they can do is hope.

Landfair, the cancer patient who is waiting for Pluvicto, is optimistic, though doubt sometimes creeps in. 

“My biggest fear is I won’t get that medication started,” he said.

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