During the shortage of generic platinum chemotherapy drugs, cisplatin and carboplatin, which began in early 2023, there were no differences in mortality rates among patients with advanced cancer compared to the previous year, and prescription rates of the two drugs fell less than three percent overall. – and 15.1 percent at the peak – according to an analysis published this week in the Magazine of the National Cancer Institute by researchers at the Perelman School of Medicine at the University of Pennsylvania and the Abramson Cancer Center at Penn Medicine.
Cisplatin and carboplatin, which have been approved for more than 30 years, are widely used to treat a variety of cancers, including lung, head and neck, breast, bladder, ovarian, uterine, and testicular cancers. When the FDA announced a cisplatin shortage in February 2023, followed by a carboplatin shortage in April 2023, it drew attention to the ongoing challenge of generic drug shortages and prompted leading national oncology societies to recommend best practices. for priority use and alternative medicines. .
“At the time, national surveys showed that most cancer centers in the US were reporting shortages of these platinum chemotherapies, but it was unclear how the shortages were actually affecting patients,” said lead author Jacob B. Reibel, MD, a third-year Hematology-Oncology Fellow. “When we analyzed data on prescribing practices during the shortage period, compared to the previous year, we found that although reports of shortages were widespread, it did not affect as many patients as we feared.”
Reibel, senior author Ronac Mamtani, MD, section chief of Genitourinary Cancers, and colleagues analyzed data from 11,797 adults across the United States with advanced solid cancers for whom platinum-based chemotherapy is recommended as first-line treatment and who They began treatment during the first trimester. period of one year before or during the shortage of platinum chemotherapy. Because cisplatin and carboplatin were prioritized for patients with curable cancers during the shortage, researchers expected that patients with advanced cancers would be hardest hit by drug availability.
From February 2023 to January 2024, there was a 2.7 percent decrease in the use of platinum chemotherapy compared to the previous year. This translates to 137 fewer patients than expected in this advanced cancer cohort receiving platinum-based chemotherapy, and the researchers estimate around 1,000 patients affected overall in the US, based on rates seen in the study. At the peak of the shortage in June 2023, the decrease was 15.1 percent compared to the previous year. With a median follow-up of 7.6 months after starting treatment, there was no difference in mortality compared to the previous year.
Alternative therapies help mitigate the crisis, but they are not the first option
The researchers hypothesized that the limited impact on mortality was likely due to the use of effective alternative medications recommended by medical societies, such as immune checkpoint inhibitors, targeted therapy, or other forms of chemotherapy. The study did not evaluate the potential drawbacks of alternative medications, including the financial burden of more expensive non-generic alternatives and the side effects of different medications.
“We always want to prioritize the best treatments we have for patients, and it turns out that platinum chemotherapies are also very cost-effective because they are generic and have been around for decades,” Mamtani said. “While alternative options can be effective, we want to be able to provide the ‘standard of care’ medications to any patient who needs them. Even a hundred patients who cannot receive the preferred chemotherapy for their type of cancer due to supply chain issues “There are too many.”
The FDA listed the cisplatin shortage as resolved by the end of June 2024 and carboplatin remains on the shortage list, although the research team found that prescribing levels have returned to normal.
The study was funded by the National Institutes of Health (T32CA009679).