Navigating Through the Carboplatin Shortage

Joshua K. Sabari, MD, pssistant Professor, Department of Medicine at NYU Grossman School of Medicine, and director of High Reliability Organization Initiatives at the Perlmutter Cancer Center, discusses the shortage of the chemotherapy drug, carboplatin, and how oncologists can navigate through it.

0:08 | I think for oncology, specifically thoracic medical oncology and some of the other solid tumors, carboplatin has really been a major issue. We know that carboplatin is a standard-of-care agent in curative intent, adjuvant therapy for thoracic malignancies, as well as ovarian cancer. And this is a drug approved in the metastatic setting in other histologies as well, such as head and neck cancer, breast cancer, colorectal and others.

0:37 | So, thinking about how do we move forward with with, you know, a lower sort of availability, these agents for our patients. So, really, we need to reprioritize non essential use of these therapies, particularly given the limited supply. If there's an alternative agent available for our patients, we should use that agent, right. So, you know, in the metastatic setting, there ar egimens that don't require platinum backbone. For example, a CTLA4 inhibitor and a PD-1 inhibitor, one should consider that as an option to increase the supply of this medication. Another thing to consider is to use other medicines right, where carboplatin may be able to be replaced by cisplatin in patients who are fit, have good renal function obvioulsy, and don't have any hearing issues or hearing loss. We do try to use cisplatin if available over carboplatin.

1:35 | We also know unfortunately that cisplatin is in shortage though at the moment, we also are thinking about increasing the interval between cycles to reduce the total treatment dose when this is acceptable. So, in the adjuvant or curative intent setting, I highly recommend against changing the dosing or the guidelines. But you know, if you look at the ASCO or NCCN guidelines, if the guidelines allow for either a 3-or 4-week infusion, I would recommend considering a 4 week infusion over a 3 week infusion as to allow us to have more supply for our patients.

2:04 | And then clearly, we can minimize waste. Unfortunately, a lot of vials of medication are you know only utilized one time per patient. If we can look at you know, vial optimization, so vial size as well as dose rounding and potential opportunity. We moved away from multi-use vials. But if we could move back towards that in order to save drug, I think that could be a very effective strategy for our patients.