9 in 10 US Cancer Centers Face Shortage of at Least 1 Cancer Drug

Almost 60 percent reported a shortage of vinblastine, which is used to treat breast cancer and testicular cancer.

A woman shops in the pharmacy area of a Wal-Mart store in Mount Prospect, Ill., on Sept. 21, 2006. Tim Boyle/Getty Images

Shortages of cancer drugs plague the United States, impacting patient treatment and impeding progress of new therapies, according to a recent survey by the National Comprehensive Cancer Network (NCCN).

Among the 28 cancer centers that took part in the survey, 89 percent continued to report shortages for at least one type of cancer medication, according to a June 26 NCCN press release.

This is up from 86 percent of centers reporting shortages in October. In the current survey, 75 percent experienced a shortage of two or more drugs.

“Critical drug shortages were not a new problem last year and they continue to be a problem now,” said Crystal S. Denlinger, chief executive officer at NCCN.

“These shortages not only put a burden on patients, caregivers, and providers, but they could also delay vital clinical trials and slow the pace of progress for new cancer therapies.”

Among survey respondents, 57 percent reported a shortage of vinblastine, which is used to treat breast cancer, testicular cancer, and Hodgkin’s lymphoma.

Etoposide, a drug used to treat testicular tumors, was in short supply at 46 percent of the centers. Ovarian cancer drug topotecan was reported by 43 percent of centers to be in shortage.

Several other medications like methotrexate and dacarbazine were also found to be scarce. Many of these drugs make up the “backbones of effective multi-agent regimens” in cancer treatments, NCCN noted.

According to the nonprofit group breastcancer.org, a shortage of cancer drugs is the combined result of the COVID-19 outbreak, ongoing supply chain issues, and financial challenges involved in manufacturing low-cost generic drugs.

Two cancer drugs, cisplatin and carboplatin, faced extreme shortage after a main plant producing the generic drugs shut down in India in 2022 following quality issues. Since the profit margin on these two drugs is low, it becomes harder for producers to manufacture them in the United States, the group said.

NCCN pointed out that up to 93 percent of surveyed centers experienced shortages of carboplatin a year ago, with cisplatin shortage in 70 percent of the facilities.

In the latest June 2024 survey, this shortage has fallen to 11 percent for carboplatin and 7 percent for cisplatin. However, the supply of other key cancer drugs continues to pose a challenge.

“The current situation underscores the need for sustainable, long-term solutions that ensure a stable supply of high-quality cancer medications,” said Alyssa Schatz, senior director of policy & advocacy at NCCN.

“The federal government has a key role to play in addressing this issue. Establishing economic incentives, such as tax breaks or manufacturing grants for generic drugmakers, will help support a robust and resilient supply chain.”

Rationing Cancer Drugs

A March 2023 report from the U.S. Senate Committee on Homeland Security and Governmental Affairs said that drug shortages, including cancer medications, rose by almost 30 percent between 2021 and 2022. By the end of 2022, active drug shortages were at a record five-year high.

In an interview with the Johns Hopkins Bloomberg School of Public Health in July last year, gynecological oncologist Amanda Nickles Fader said that a shortage of cancer drugs may force institutions to start rationing them.

“We have to be responsible in terms of how we use the drug supply that we have,“ she said. ”Sometimes that means using practices at the pharmacy level, to preserve every last drop of chemotherapy and make sure that none of it goes wasted.”

“We’ve sometimes had to make some adjustments in terms of the dosing or the interval of the drugs, or we might switch a patient to a drug that is in the same class and works just as well as the drug that’s in shortage, but perhaps it has a higher side effect profile, or it takes longer to administer.”

In September, the White House announced that the United States had a shortage of 15 cancer drugs. The Food and Drug Administration (FDA) worked with drug manufacturers to boost manufacturing capacity of generic carboplatin and cisplatin.

In addition, the agency exercised “enforcement discretion” for a manufacturer so that it could import 14 lots of cisplatin from an FDA-registered facility outside the country. These actions minimized the supply shortages of cisplatin and carboplatin, the White House stated.