'We have to ration:' These common cancer drugs are now in short supply in Tennessee, U.S.

Julie Eaton's road to recovery from breast cancer had been progressing well after four rounds of chemotherapy this spring and summer. Then, last month, her doctors could no longer get a common, but needed, cancer drug that was part of her treatment cocktail.

The medication, carboplatin, is now one of two frequently used cancer drugs in short supply in Tennessee and across the United States. Like the other platinum-based drug in short supply, cisplatin, it is a generic used to treat a long list of cancers and is a staple of chemotherapy treatments.

Shortages, the result of a supply-chain breakdown, are expected to continue for the foreseeable future.

"Mentally, it's been tough because we knew that the drug was working — we'd had a scan that showed it was working," said Eaton, 54, of Cookeville. "So, to not get the final two doses, it's kind of a blow. That was really rough."

Eaton's doctors have provided her with substitute drugs. But she said it's still too soon to know if they're working. She is scheduled to soon get surgery and will resume chemotherapy after she recovers. She said she hopes the drug will be available then, but there's no way to know for sure.

"We know for sure (the previous drugs) were working," Eaton said. "We won't know until I have surgery if it's been undone or if either (drugs) work. Hopefully, it's held steady. It's just a lot of uncertainty."

Her story has become all too common this summer as cancer providers scramble to find the drugs. Doctors say they have had to pick and choose who gets them. Other patients are delayed treatment or given available, but often less-proven, substitutes.

"It's been crazy. We ran out, and then we get little supplies (of the drug), and you almost have to ration which patients get it," said Stephen Schleicher, an oncologist who practices in Nashville. "It's just incredibly challenging when patients are already going through this and then you have to tell them, 'Hey, we don't have your chemotherapy today.'"

More than 135 other drugs were in short supply nationally as of this week, according to the Food and Drug Administration. And cancer drugs have been in short supply before. But experts say this summer's bottleneck has been unprecedented and puts at risk patients getting treatment for breast, cervical, uterine, testicular, lung and other cancers.

Schleicher, who is also the chief medical officer for Tennessee Oncology, one of the nation's largest cancer-care providers, said the shortages are likely to continue for months.

The FDA announced in May that it was working with a drug maker in China to import more cisplatin into the United States. Meanwhile, the Society for Gynecologic Oncology put out a statement this spring advising doctors dealing with shortages to give priority to patients for whom the drugs are most likely to cure.

Shortages locally seem to be uneven. Vanderbilt University Medical Center, for instance, is not reporting any such drug shortages, said spokesman Craig Boehner. Even so, a national survey published in June found that more than 90% of cancer centers had been hit with shortages. More specifically, it found that 93% of the centers had shortages of carboplatin and 70% reported low supplies of cisplatin.

For Tennessee Oncology, which treats roughly half the state's cancer patients, the situation remains dire, Schleicher said. Roughly 20% of its patients use the drugs, he said. Rationing earlier this year became extreme at times, he added.

For instance, he said the company had to limit use of cisplatin for a while to patients with testicular cancer, which can be cured by the drug. It was later expanded to other cancers, but supplies remain limited, he said.

"Basically, we ran out," he said. "And then with the little supply we have, we have to ration it. And it's horrible."

So, what happened?

In a recent message this month to Congress, the American Hospital Association noted that the COVID-19 pandemic "exacerbated" existing drug shortages by filling hospitals with critically ill patients. Generic drugs have been hard to keep stocked because they are not as profitable as newer pharmaceuticals and fewer manufacturers are producing them.

"In recent months, the situation has worsened, with the abrupt shutdown of Akorn Pharmaceuticals, which made about 100 essential hospital medications, such as albuterol used in children with breathing difficulties, as well as Accord Pharmaceutical’s temporary suspension of manufacturing of certain cancer drugs (methotrexate, carboplatin and cisplatin) due to serious quality issues at Intas, their contract manufacturer in India," the AHA noted.

Intas supplied about half of the U.S. market share of cisplatin, USA TODAY recently reported.

Frank Gluck is the health care reporter for The Tennessean. He can be reached at fgluck@tennessean.com. Follow him on Twitter at @FrankGluck.

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This article originally appeared on Nashville Tennessean: Common cancer drugs are now in short supply in Tennessee and the U.S.