Chemotherapy Shortages Trouble Study Investigators

Roby Thomas, MD, a medical oncologist, and hematologist at UPMC Hillman Cancer Center, discusses chemotherapy shortages and the impact these shortages have had on oncology research.

Thomas explains that an important agent for the treatment of gastrointestinal and genitourinary oncology is nab-paclitaxel. The chemotherapeutic is standard treatment for pancreatic cancer, breast cancer, and non–small cell lung cancer. Nab-paclitaxel is also being investigated in studies of patients with gastric cancer, and breast cancer with brain metastases. Thomas explains that continuing these studies was a big challenge back when there was a shortage of nab-paclitaxel

Many oncologists used the combination of leucovorin calcium (folinic acid), fluorouracil, irinotecan hydrochloride, and oxaliplatin (FOLFIRINOX) in place of nab-paclitaxel, says Thomas. FOLFIRINOX is the only alternative treatment for these patients, but for older patients, it may be too toxic.

Other necessary agents include gemcitabine and cisplatin, which are currently short of supply.

TRANSCRIPT:

0:08 | We've had multiple issues with drug shortages over the last couple of years, primarily because of supply chain issues. In the fields that I focus on, gastrointestinal and genitourinary oncology, we had a shortage of nab-paclitaxel for quite some time, and that was in the United States. What made it so challenging is we use that drug often in pancreatic cancers. At UPMC Hillman Cancer Center, we have a high volume of pancreatic cancers, and it's 1 of our standard-of-care therapies.

0:51 | What made it uniquely challenging for us was that we have many different phase 1 and phase 2 clinical trials in which nab-paclitaxel would be part of a standard-of-care regimen. People might be randomized to get gemcitabine and nab-paclitaxel with or without another study drug or placebo, for example, but we couldn't recruit people because we just didn't have the study medication. It did not just have a direct effect in terms of less nab-paclitaxel availability, but also in terms of accrual and clinical trials. It was a challenging time for pancreatic cancer in general.