Majority of US Cancer Centers Report Shortages of Cisplatin/Carboplatin Chemotherapy

David M. O’Malley, MD

A survey conducted by the National Comprehensive Cancer Network (NCCN) Best Practices Committee found that 93% of United States cancer centers polled in the report are experiencing a shortage of carboplatin, and 70% currently have a shortage of cisplatin.¹

In polled results gathered from 27 NCCN member institutions between May 23 and 31, 2023, the survey showed that 100% of cancer centers were still able to treat patients who need cisplatin without any delays or claim denials. However, only 64% of centers said they were able to keep all patients receiving carboplatin on their current regimen. Additionally, 20% of surveyed institutions said they could continue this prescription for some but not all patients.

The need to reobtain prior authorization from modified treatment plans led to treatment delays at 16% of institutions. However, none have been met with outright denials.

“This is an unacceptable situation. We are hearing from oncologists and pharmacists across the country who have to scramble to find appropriate alternatives for treating their patients with cancer right now,” Robert W. Carlson, MD, chief executive officer of NCCN, stated in a news release. “We were relieved by survey results that show patients are still able to get life-saving care, but it comes at a burden to our overtaxed medical facilities. We need to work together to improve the current situation and prevent it from happening again in the future.”

The survey followed alerts from the FDA regarding shortages of cisplatin, which was first reported on February 10, 2023, and carboplatin, which was reported on April 28, 2023. Both drugs remain in shortage, according to the regulatory agency.^2,3 The shortages for both agents have been attributed to manufacturing delays and increase in demand.^4,5

As a result of these shortages, David M. O’Malley, MD, a professor in the Department of Obstetrics and Gynecology at the Ohio State University College of Medicine and the director of the Division of Gynecologic Oncology at the Ohio State University Comprehensive Cancer Center – James, said his institution has implemented strategies to navigate the current treatment landscape.

"We've had to come up with prioritization with regard to which patients we treat; we're prioritizing patients who are [in the] curative-intent [setting, meaning] first-line therapy. We also try to prioritize patients who are being treated on clinical [trials] to maintain the integrity of that research when possible,” O’Malley said in an interview with OncLive. “After that, depending on the supply—at our institution, we have more cisplatin than carboplatin—[we look for] where there is an alternative regimen in which cisplatin has been shown to be equally efficacious.”

He also noted non–platinum-based regimens have been considered for patients if platinum-based chemotherapy is not associated with a survival advantage. He added that regular consultation occurs between departments that rely on platinum-based chemotherapy as a backbone of treatment, allowing leaders discuss supply management and treatment strategies.

The chemotherapy shortages have also led to difficult discussions with patients to determine the best treatment approach, given the current climate of shortages across the United States.

"I just had to have that conversation. I was open and honest with the patient. Many of these [treatment options] come down to shared decisions. Right now, we still have shared decisions. In the future, [if we do] not have platinum, then there will be no shared decision,” O’Malley said. “The best way is to be open and honest with the patient with regard to the challenges that we are facing, the options that we have, and come together with a shared decision when possible, within the limitations that we are all facing.”

In April, the Society of Gynecologic Oncology (SGO) recommended that clinical practices minimize ordering of non-essential platinum chemotherapy, increase the interval between cycles and reduce the total platinum dose when clinically acceptable, consider minimizing or omitting cisplatin or carboplatin for patients with recurrent platinum-resistant ovarian and other cancers, and round doses down to the nearest vial size to ensure efficient use.⁶

SGO also recommended reserving platinum-based chemotherapy for curative-intent treatment or for patients where sustained clinical benefit is expected. Each healthcare system’s supply should also be identified, and communication between local providers could allow for referrals when necessary. The organization also recommended select alternative, evidence-based treatment options when available.

FIGURE. SGO Recommendations for Cisplatin/Carboplatin Shortage⁶

In SGO’s statement, the organization said the shortage of cisplatin and carboplatin will likely last at least several months. The FDA is currently coordinating with Qilu Pharmaceutical in China, and the company has initiated temporary importation of CISplatin injection (50 mg/50 mL) into the United States market. CISplatin injection is marketed and manufactured in China and is not approved by the FDA.⁷

O’Malley said that until the shortages are resolved, institutions need to work with local, state, and national agencies to ensure the most vulnerable patients receive proper care in a timely fashion, and actions are needed to prevent other drug shortages in the future.

“The best care [for] patients [means] having the drugs available that have been shown to be curative-intent [therapy],” O’Malley said. “I hope that we can find ways to make sure our patients are protected moving forward. [Drug shortage] is a problem that we have faced intermittently over the last decade.”

References

1. NCCN releases statement addressing ongoing chemotherapy shortages; shares survey results finding more than 90% of cancer centers are impacted. News release. National Comprehensive Cancer Network. June 7, 2023. Accessed June 7, 2023. https://www.nccn.org/home/news/newsdetails?NewsId=3970
2. Current and resolved drug shortages and discontinuations reported to FDA. FDA. Accessed June 7, 2023. https://www.accessdata.fda.gov/scripts/drugshortages/dsp_ActiveIngredientDetails.cfm?AI=Cisplatin%20Injection&st=c
3. Current and resolved drug shortages and discontinuations reported to FDA. FDA. Accessed June 7, 2023. https://www.accessdata.fda.gov/scripts/drugshortages/dsp_ActiveIngredientDetails.cfm?AI=Carboplatin%20Injection&st=c
4. Cisplatin injection. American Society of Health-System Pharmacists. June 2, 2023. Accessed June 7, 2023. https://www.ashp.org/drug-shortages/current-shortages/drug-shortage-detail.aspx?id=903&loginreturnUrl=SSOCheckOnly
5. Carboplatin solution for injection. American Society of Health-System Pharmacists. June 2, 2023. Accessed June 7, 2023. https://www.ashp.org/drug-shortages/current-shortages/drug-shortage-detail.aspx?id=930
6. SGO statement: carboplatin and cisplatin shortages. News release. Society of Gynecologic Oncology. April 21, 2023. Accessed June 7, 2023. https://www.sgo.org/news/drugshortage/
7. Temporary importation of CISplatin injection with non-U.S. labeling to address drug shortage. FDA. May 24, 2023. Accessed June 7, 2023. https://www.fda.gov/media/169001/download