Platinum Chemotherapy Shortages Create Additional Burden for Patients With Cancer

Jacob Sands, MD

The ongoing shortage of cisplatin and carboplatin in the United States has underscored the need to ensure all patients with cancer have adequate access to important treatments, according to Jacob Sands, MD, who noted drug shortages only create additional burden for patients already grappling with a difficult diagnosis.

“This is a very unfortunate scenario for our patients that, frankly, just feels unacceptable when we have backbone drugs that are important to the care of such an important diagnosis, and these [drugs] should be accessible and available as we provide top-level care to our patients,” Sands said in an interview with OncLive®.

In the interview, Sands discussed how the ongoing shortages of carboplatin and cisplatin have presented new challenges to patient care, how he and colleagues at Dana-Farber Cancer Institute are navigating these shortages, and how these limitations could ultimately have an impact on patients.

Sands is a physician, associate medical director of Patient Safety, and associate oncology medical director of the International Patient Center Physician at Dana-Farber Cancer Institute, and an instructor in Medicine at Harvard Medical School, both in Boston, Massachusetts.

OncLive: How has the shortage of cisplatin and carboplatin affected clinical practice and ongoing research efforts within the cancer realm?

Sands: Rather than talk about our local experience, I’ll talk more about the national experience. As the principal investigator of the national, adjuvant non–small cell lung cancer [phase 3 ALCHEMIST] trial [NCT04267848], where we’re treating [patients] with a goal of cure, I can say that [the availability of] cisplatin was initially a concern.

Now, more recently, [there has] been much more of [a concern] about carboplatin shortages and what regimens people can use. It has affected different areas and different hospitals to different degrees, but it is globally affecting the care of patients. It’s concerning, especially when we’re talking about treatment with a goal of cure and there being some limitations. It’s an added challenge to what is already a really challenging scenario for patients. For patients, in some cases, there’s a lot more anxiety around any challenges to treatment when it is such a high-stakes scenario.

At Dana-Farber Cancer Institute, what guidance has been provided regarding how to navigate these shortages?

Within the institution, we’ve had a lot of discussions around it. I’m fortunate to be at an institution where we set pathways, we set guidelines, and we are often involved with the guidance around challenges in cancer care. Within each department, we have had these discussions and patient-to-patient; it’s something where we then have discussions within the group. Fortunately, I have not had any scenarios where I wasn't able to treat somebody in a way that I strongly felt was important for that person.

I can say that within our institution, care has not been horribly disrupted; although, we do have to make considerations and think about some patients [who could be] treated with cisplatin or carboplatin. That has been a consideration, but we have not been without carboplatin, which is what some institutions have faced.

For our patients, we do have multidisciplinary involvement with pharmacy and physicians within each group, and [we have set] up pathways within our own individual departments as to what makes the most sense for our patients. We’ve still been able to provide the highest quality care, even with limitations, but that is requiring individual assessment for each patient and each scenario within each disease group.

Within different departments where platinum chemotherapy is a mainstay of treatment, how have these groups communicated to navigate these shortages?

At a higher level within the institution, there are individuals keeping track of how much [carboplatin and cisplatin] we have and [they are] working on getting more. As far as the treatment, there has been a lot of support around making sure that patients are getting the care that they need. Thankfully, I’m fortunate to have that support and the extra resources that we have within the institution around optimized care.

When you are talking to a patient who may have carboplatin or cisplatin as part of their potential treatment regimen, how do you approach that conversation to inform them about the shortages and how they might affect them?

It’s hard to answer that, because I have not had anyone that I’ve had to give a treatment that I didn’t think was the right treatment for them. Maybe just more broadly, I can say that for physicians across the country who are facing this challenge and not being able to use the regimen that they think is best for the patient, this is an added stressor.

It’s important that we as a country and [beyond] find ways of providing the best drugs for patients who need them in those scenarios. It’s unfortunate right now. [Platinum chemotherapy] is a drug that is not generally expensive. It’s not [about] cost, it’s limitations of the product itself. This is a hard thing to accept. [Platinum chemotherapy] is the backbone [of treatment]. This is such an important drug for our patients and one that has typically been affordable. The only limitation is the availability of the drug, and frankly, that just feels unacceptable.

Cancer drug shortages aren’t a new phenomenon. What are some things that need to be done to ensure that these types of shortages are avoided?

I’m certainly not an expert in drug production or the [supply] chain, so it’s hard for me to make comments on that. However, I can say that it’s just very unfortunate for patients to have this added to the challenges of just having a cancer diagnosis and coming in and needing treatment. Oncologists, nurses, and other ancillary staff are doing the best they can to provide care for all these patients, so to have a limitation like this is unfortunate.