An evaluation of national statistics revealed that the short-term mortality of patients with advanced cancers was unaffected during the shortage of the generic platinum chemotherapies, cisplatin and carboplatin, which began in early 2023.
During the shortage of the generic platinum chemotherapy drugs, cisplatin and carboplatin, starting in early 2023, the mortality rates for patients with advanced cancer remained unchanged compared to the previous year. Additionally, the overall prescription rates for these drugs dropped by less than three percent—reaching a peak decline of 15.1 percent, as reported in an analysis published this week in the Journal of the National Cancer Institute by a research team from the University of Pennsylvania’s Perelman School of Medicine and the Abramson Cancer Center.
Cisplatin and carboplatin, both of which have been in use for over 30 years, are commonly employed to treat various cancers, including lung, head and neck, breast, bladder, ovarian, uterine, and testicular cancers. The shortage of cisplatin was first announced by the FDA in February 2023, followed by the announcement of a shortage for carboplatin in April 2023. This situation highlighted the persistent issue of generic drug shortages and led prominent national oncology organizations to issue recommendations for priority use and alternative treatments.
“At that time, national surveys indicated that numerous cancer centers across the U.S. were experiencing shortages of these platinum-based chemotherapies, but the actual impact on patients was unclear,” stated lead author Jacob B. Reibel, MD, a Hematology-Oncology fellow. “Our examination of prescription data during the shortage period, compared to the previous year, revealed that despite widespread reports of shortages, the number of patients affected was not as significant as we feared.”
Reibel, along with senior author Ronac Mamtani, MD, who leads the Genitourinary Cancers section, and their colleagues, reviewed data from 11,797 adults in the U.S. with advanced solid tumors for which platinum chemotherapy is the recommended first-line treatment. These patients began therapy during the one-year period surrounding the platinum chemotherapy shortage. The researchers anticipated that patients with advanced cancers would face the most significant challenges due to the prioritization of cisplatin and carboplatin for patients with curable cancers amid the shortage.
From February 2023 to January 2024, there was a 2.7 percent reduction in the use of platinum chemotherapy compared to the prior year. This equates to approximately 137 fewer patients within this advanced cancer group receiving platinum chemotherapy than what would typically have been expected. Based on the observed rates in the study, the researchers estimate around 1,000 patients were affected nationwide. At the height of the shortage in June 2023, the decline reached 15.1 percent compared to the previous year. With a median follow-up of 7.6 months after treatment initiation, there was no noticeable difference in mortality rates in comparison to the prior year.
Alternative therapies help mitigate the crisis but are not first choice
The researchers theorized that the minimal impact on mortality could be attributed to the availability of effective alternative treatments recommended by medical groups, such as immune checkpoint inhibitors, targeted therapies, or other chemotherapy options. The study did not explore the potential downsides of these alternatives, such as the financial burden of more costly non-generic treatments or the side effects associated with different medications.
“Our goal is always to deliver the best available treatments for patients. Platinum chemotherapies are particularly desirable as they are generic and have been effective for decades,” noted Mamtani. “While alternative therapies may be beneficial, we aim to provide standard-of-care options to every patient in need. It’s troubling that even a hundred patients might be unable to access their preferred chemotherapy due to supply chain challenges.”
By the end of June 2024, the FDA declared the shortage of cisplatin as resolved; however, carboplatin continues to be listed as in short supply, although the research team found that prescribing levels have since normalized.
This study was funded by the National Institutes of Health (T32CA009679).
