U.S. cancer drugs shortage has doctors scrambling

Cancer medicines desperately needed by sick children and adults are in short supply, undermining the ability of U.S. doctors to administer treatments, top oncologists warned this week.

Many drugs are scarce because there is no incentive for drugmakers to manufacture low-cost generics, which have slim profit margins for pharmaceutical companies. Doctors do not expect that equation to change any time soon, making them scramble to find acceptable alternatives, or to ration or delay treatment when they cannot.

Generic chemotherapy drugs are in particularly tight supply at the nation's hospitals, including mainstay cancer treatments such as cisplatin, doxorubicin, cytarabine and leucovorin.

"These are chestnuts. These are not old-fashioned drugs. They remain incredibly important drugs which serve as the backbone for treating many of the most common and treatable cancers," said Dr. Robert Mayer of the Dana-Farber Cancer Institute in Boston and a past president of American Society of Clinical Oncology (ASCO) which held its annual meeting in Chicago this week.

Cisplatin is used to treat testicular, bladder and ovarian cancers that have spread. The drug, also used to treat lung cancers, is sold under multiple brand names, originally by Bristol-Myers Squibb. A generic form is sold by Teva Pharmaceutical Industries Ltd, among others.

Doxorubicin, also available under multiple brands and as a generic from Teva and others, is used to treat non-Hodgkin's lymphoma, multiple myeloma, acute leukemias and other cancers.

Cytarabine, produced by Hospira Inc and others, is used to treat certain types of leukemia. Leucovorin, also sold by Teva, is used along with certain chemotherapy drugs to treat colorectal, head and neck and other cancers.

Dr. Michael Link, a pediatric oncologist at Lucile Packard Children's Hospital at Stanford and current ASCO president, called it a disheartening crisis.

"Here we have highly effective drugs, they've been shown they work and to think we don't have them available is almost unconscionable," Link said. "We don't see an end in sight."

In some cases, doctors can substitute another drug for one that is in short supply.

"It's still uncomfortable to say that this is ideally what we'd like to do, but unfortunately we don't have it," Link said. "You can imagine the conversation and I'm sure they're going on all over - doctors have to tell their patients or their patients' parents that we can't give them the proven drug because we don't have it."

NO SUBSTITUTE

For some of these medicines in short supply, there may not be acceptable alternatives.

"One could say that substituting Pepsi for Coca-Cola doesn't make a difference. Maybe it does and maybe it doesn't," Mayer said. "But more often it might be substituting 7-UP for Coca-Cola, and that might make a difference."