Global Courant 2023-04-11 14:00:40
Robert Landfair, 76, was diagnosed with stage 4 prostate cancer in 2018.
After several unsuccessful chemotherapy treatments, his doctor, Alan Tan of Rush University Medical Center in Chicago, recommended that he switch to Pluvicto, a new drug for advanced prostate cancer.
But the drug’s manufacturer, Novartis, has had it supply problems. Landfair is now on a waiting list for the medication, which is not expected to be widely available for several months.
“I absolutely need that medicine,” said Landfair of Chicago. “It’s the only way I see my life.”
His family says his cancer is “aggressive and still growing.”
“We realize the cancer has no waiting period, it’s not on hiatus,” said Raymond Jackson, Landfair’s son-in-law. “We are very concerned.”
Robert Landfair is waiting for the cancer drug Pluvicto, which is in short supply.Raymond Jackson
Landfair is not alone: A shortage of cancer drugs has created difficult conditions 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 is a shortage of four cancer drugs: Pluvicto, for advanced prostate cancer, as well as methotrexate, cisplatin, and fluorouracil, common chemotherapy drugs used to treat a wide variety of cancers, from the skin to the bones and lungs. A fifth drug, a bladder cancer therapy called BCG, is also said to be deficient, according to Dr. Vignesh Packiam, a urologist at the University of Iowa Hospitals and Clinics.
In places where cancer drugs are running low, some patients may be forced to turn to options that may not work as well, experts say. Others may die while waiting for the deficient drugs to become available. Every day counts: a study published in 2020 in The BMJ found that every month of delay in cancer treatment can increase the risk of death by about 10%.
“We’re kind of enthralled here as oncologists,” said Tan, who is the director of genitourinary medical oncology at Rush.
Tan’s hospital suffers from a shortage of Pluvicto and cisplatin.
“This is a patient’s life,” he said, adding that patients “die” if they don’t get the drugs they need.
What Causes A Shortage Of Cancer Drugs?
Michael Ganio, the senior director of pharmacy practice at the American Society of Health-System Pharmacists, which tracks drug shortages nationwide, blamed the shortage of cancer drugs on a lack of investment from manufacturers.
Many of the cancer drugs in short supply are generic drugs, which save money for the nation’s health care system overall, but are not very profitable for drug makers.
“There’s often little incentive to invest in generic manufacturing, especially for these much older drugs — the margins aren’t very big,” Ganio said. “It’s almost a discouragement.”
Erin Fox, senior pharmacy director at the University of Utah Health, said poor manufacturing practices in US factories have also contributed to the widespread drug shortages.
The shortage of drugs, including life-saving cancer drugs, could get worse in the coming years as more drugs are produced abroad, Fox said.
“A key challenge in evaluating drug shortages is that pharmaceutical companies are not required to disclose exactly which company makes the product and where it is located,” she said, noting that production is often outsourced abroad.
Sarah Ryan, a spokesperson for Pharmaceutical Research and Manufacturers of America, the drug industry trade group, said manufacturers have “extensive measures” in place to help prevent and mitigate drug shortages.
a report published in March found by the Senate Homeland Security and Government Affairs Committee that new drug shortages in the US increased by nearly 30% between 2021 and 2022. The drugs include prescription and cold and flu medicines for children, as well as drugs used to treat cancer, according to the report.
The FDA is working to curb the trend. This month, the agency released 17 pages of design guidelines intended to prevent drug shortages. Medications should give the agency more advance notice — at least six months — of any potential shortages or discontinuation of a drug, as well as more information about the source of the problem.
Less than ideal care
In the meantime, more cancer patients may be receiving less-than-ideal care, said Packiam of the University of Iowa Hospitals and Clinics.
Packiam learned last week that his hospital was running low on cisplatin, a chemotherapy drug commonly used for bladder cancer that increases the chances of successful surgery.
It is “widely regarded as the gold standard treatment for this type of cancer,” he said.
The lack of cisplatin means he has to have surgery without chemotherapy.
“Alternative chemotherapies that don’t use cisplatin don’t produce such a good response,” he said. “So instead of giving suboptimal chemotherapy, the next best option is to go straight for surgery.”
The hospital will also have to prioritize the amount of cisplatin it has left for those most in need, he said.
For those who don’t get their cancer medication right away, all they can do is hope.
Landfair, the cancer patient waiting for Pluvicto, is optimistic, though sometimes doubt creeps in.
“My biggest fear is not getting that medication going,” he said.
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