Research shows that mortality has not changed despite the lack of platinum chemotherapy

Research shows that mortality has not changed despite the lack of platinum chemotherapy

During a shortage of the generic platinum chemotherapy drugs cisplatin and carboplatin that began in early 2023, there was no difference in mortality rates among patients with advanced cancer compared to the previous year, and prescription rates for the two drugs fell by less than three percent overall - and 15.1 percent at the peak - according to an analysis published this week in theJournal of the National Cancer Instituteby 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 various types of cancer, including lung, head and neck, breast, bladder, ovarian, uterine and testicular cancers. When the FDA announced a shortage of cisplatin in February 2023 and a shortage of carboplatin in April 2023, it drew attention to the ongoing challenge of generic drug shortages and prompted major national oncology societies to recommend best practices for priority use and alternative medicines.

National surveys at the time showed that most U.S. cancer centers reported shortages of these platinum chemotherapies, but it was not clear how the shortages actually affected patients. When we looked at data on prescribing practices during the shortages compared to the previous year, we found that while reports of the shortages were widespread, they did not affect as many patients as we had feared.”

Jacob B. Reibel, MD,main author,Third-year fellow in hematology-oncology

Reibel, senior author Ronac Mamtani, MD, division chief of genitourinary cancer, and colleagues analyzed data from 11,797 U.S. adults with advanced solid cancers for whom platinum chemotherapy is recommended as the first line of therapy and who started treatment over a year before or during the platinum chemotherapy shortage. Because cisplatin and carboplatin were prioritized for patients with curable cancers during the shortage, researchers expected that patients with advanced cancers would be most affected 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 means that in this advanced cancer cohort, 137 fewer patients will receive platinum chemotherapy than expected, and the researchers estimate that a total of about 1,000 patients will be affected in the U.S. based on the rates observed in the study. At the peak of the shortage in June 2023, the decline was 15.1 percent compared to the previous year. At a mean follow-up time of 7.6 months after the start of treatment, there was no difference in mortality compared to the previous year.

Alternative therapies help to alleviate the crisis, but are not the first choice

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 assess the potential disadvantages of alternative medications, including the financial burden of more expensive non-generic alternatives and the side effects of various medications.

“We always want to prioritize the best treatments we have for patients, and platinum chemotherapies also happen to be very cost-effective because they are generic and have been around for decades,” Mamtani said. "While the alternative options may be effective, we want to be able to provide the 'standard medications' to every patient in need. Even hundreds of patients who are unable to receive the preferred chemotherapy for their type of cancer due to supply constraints." There are far too many chain problems.”

The FDA classified the cisplatin shortage as resolved at the end of June 2024 and carboplatin remains on the shortage list, although the research team noted that prescription levels have returned to normal.

The study was funded by the National Institutes of Health (T32CA009679).

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