“We Worry about Our Ability to Cure Cancer” Amid Drug Shortages, BU Oncologist Naomi Ko Says
BU oncologist Naomi Ko assesses the crisis and discusses the impact it’s having on patients
Shortages of drugs and ingredients from overseas makers are imperiling cancer patients in the United States in need of chemotherapy drugs and those requiring other treatments. Photo by Marcelo Leal/Unsplash
What’s Behind the Critical Shortage of Drugs for Cancer and Other Diseases
BU oncologist Naomi Ko assesses the crisis and discusses the impact it’s having on patients
A throttled supply chain of many pharmaceuticals, including critical cancer drugs, will worsen and imperil many patients’ treatment and health. That’s the consensus of experts and the concern of Naomi Ko, an associate professor of medicine at the Chobanian and Avedisian School of Medicine and a medical oncologist at Boston Medical Center, the school’s teaching hospital and Boston’s safety net hospital.
Critical shortages have affected familiar pharmaceuticals, from children’s Tylenol to Adderall, used for treating ADHD. But they’re also creating a scarcity of lesser-known but essential drugs, including carboplatin and cisplatin—often used together—that have been effective in treating leukemia, lymphoma, and lung, breast, and prostate cancers. Up to a half million new cancer patients use those chemotherapies annually. Antibiotics against bacterial infections are also in short supply.
What a Johns Hopkins School of Medicine professor calls “a public health emergency” has multiple causes. Most of the ingredients necessary to produce the scarce drugs are made abroad, typically in India and China. Likewise, many finished drugs are made overseas for shipment here. During the pandemic, India restricted pharmaceutical exports to ensure an adequate supply for Indians. COVID-19 also shuttered Chinese factories that manufactured drug ingredients. Then the supply of several chemo drugs dried up after Indian manufacturer Intas suspended production following quality problems highlighted by the US Food and Drug Administration.
Yet even before the pandemic, broader economic forces periodically made some medicines unavailable. (Propofol, an often-used surgical sedative, “has gone in and out of shortage” for 15 years, a recent US Senate Committee report noted.) That’s because generic drug makers are struggling with low profit margins and competition for sales with lower-labor-cost manufacturers in India. US companies have stopped making drugs they have trouble selling. For example, Akorn Pharmaceuticals, which made albuterol, used to help children with impaired breathing, recently filed for bankruptcy amid predictions more companies would fall.
Ko discussed what she and colleagues are confronting in the hospital and how they’re trying to find workarounds for their patients.
Q&A
with Naomi Ko
BU Today: How many of your patients have had their treatment affected by the shortage and in what ways?
Ko: According to our oncology pharmacy team, we are having treatment affected by approximately 15 to 20 patients per week—mostly with the chemotherapy drug carboplatin, but also with patients who need cisplatin and 5FU [used to treat breast, colon, rectum, stomach, and pancreatic cancer and a skin condition that can become cancerous].
BU Today: Are patients with particular cancers at risk?
Ko: Most patients who are affected include those with breast, lung, and ovarian cancer.
“We worry about our ability to cure cancer if we don’t have access to the chemotherapy that has been proven in clinical trials to be the best option.”
BU Today: Are there alternative drugs to the ones you’d normally prescribe available? What about other treatment, or advice, that you’re giving your patients?
There are not good alternatives. Carboplatin is used for curative intent treatment in patients with Her2+ [a type of metastatic] breast cancer and triple negative breast cancer. These are the patients we worry about and preserve the chemotherapy for. If patients are in the non-curative treatment—i.e., palliative chemotherapy—we will choose alternative therapy if possible.
Sometimes, we can see if patients can use an alternative but similar chemotherapy, cisplatin. This can occur more commonly in lung cancer patients, but is not ideal, due to trade-offs in side effects, including more nephrotoxicity [kidney function deterioration].
Another alternative is to increase treatment intervals, giving the drug every four weeks instead of every three weeks, if possible.
BU Today: Experts predict the shortage could get worse. What is the potential fallout on patients you’re treating if this crisis continues?
Patient prognosis is the biggest challenge. We worry about our ability to cure [cases of] cancer if we don’t have access to the chemotherapy that has been proven in clinical trials to be the best option.
BU Today: Any suggestions for fixing the problem?
Rethinking the reimbursement of medications and patients. Reconsidering how profit influences manufacturing of life-saving cancer medications. Coming up with policy and strategies on how to ensure the profitability and availability of essential medications.
A pharmacist on our team suggested that “state and federal government officials need to be more stringent with pharma/generic manufacturers about how long these shortages last.”
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