Cancer Drug Shortages Continue With No Immediate Path Toward Relief

All members of the National Comprehensive Cancer Network (NCCN) that responded to an annual survey reported shortages of commonly used generic chemotherapy drugs, topped by ifosfamide, which was in critically short supply at all but one.

Responses from NCCN members’ pharmacy directors and clinical leadership showed that seven of 31 centers had shortages of five or more drugs, and more than half reported low supplies of at least three commonly used drugs. Much of the concern about the drug shortages has centered on ifosfamide, which is used in protocols to treat multiple types of cancer, including bladder, ovarian, testicular, uterine, soft-tissue sarcoma, osteosarcoma, and adult and pediatric leukemias and lymphomas, according to an NCCN press release. Recently, the FDA announced a temporary relaxation of restrictions on imports from India to help relieve the shortage.

Beyond ifosfamide, 71% of the cancer centers had shortages of carboplatin, and cisplatin, an alternative to carboplatin, was in short supply at 16% of the centers. More than half of the responding NCCN members reported shortages of Bacillus Calmette-Guérin, widely used to treat bladder cancer. The shortage has not encompassed all commonly used cancer drugs, as no NCCN member reported low supplies of amifostine, hydrocortisone, methotrexate, topotecan, vinblastine, or vincristine.

When asked whether the shortage has improved or worsened since the first survey in 2023, 4% of pharmacy directors said the situation has improved and the rest said no change had occurred.

“It was sad to see. As I was looking back at the surveys over the years and the different drugs, there’s a recurring theme,” NCCN chief medical officer Renuka Iyer, MD, of Roswell Park Comprehensive Cancer Center in Buffalo, New York, told MedPage Today. “It’s the same players, the same issues, the same drugs. A few new ones come and go, but the common drugs are the same. When you see a problem, you hope that after so many years, with all the work that everyone is trying to do, that some progress would have been made.”

Although the overall picture remains unchanged, individual NCCN members have made some headway toward alleviating shortage issues at their respective centers. For example, pharmacy personnel at Moffitt Cancer Center in Tampa, Florida, proactively identified drugs with historic vulnerability to shortages and implemented inventory management plans to maintain stock levels above routine needs.

“By closely monitoring national shortage trends, forecasting demand, and leveraging strategic purchasing strategies and supplier partnerships, we work to stay ahead of potential supply disruptions,” Irvin Alfonso, PharmD, director of the inpatient pharmacy, told MedPage Today. “Our efforts have translated into measurable results [with] only one active critical drug shortage, placing us among the organizations with the lowest reported shortage burden in the survey. This outcome reflects our ongoing focused work to build supply chain resiliency, maintain strategic inventory reserves, and proactively manage high-risk oncology medications.”

“We have built our processes around a simple goal: ensuring that drug availability never becomes a barrier to care,” he added. “By maintaining appropriate inventory reserves, diversifying procurement strategies, and planning proactively for potential shortages, we can continue providing uninterrupted treatment and high-quality cancer care. Our commitment is that we never want to delay treatment or turn a patient away because a critical medication is unavailable.”

The shortage evolved from a commonality among the drugs most affected: intravenous formulations of generic drugs that are produced in sterile environments, not very profitable to produce, and generally produced overseas.

“There are 200-300 of these drugs, but a few of them, like carboplatin, are used across many types of cancer,” said Iyer. “The [profit] margins are small. With drugs produced overseas, there are supply-chain issues, which can also happen with drugs produced within the U.S. — weather-related things, geopolitical issues. We see this over and over again.”

For many types of cancer, NCCN offers multiple treatment options, allowing oncologists to turn to alternate drugs or different protocols to address shortages of specific drugs.

“Depending on the type of cancer, there are options, but often the drug that we’re turning to or trying to use is the one that’s proven and probably has the best efficacy and safety data,” said Iyer. “That’s probably why we’re looking for that particular drug.”

“When you start a patient on a particular regimen, you would like to keep them on that regimen,” she added. “In particular, if a patient has stage IV cancer, you want to continue to treat them as long as they’re responding, and there is no way to predict whether the patient will need the drug for 6 months or 2 years.”

The shortages have had an impact on treatment planning and scheduling. Of 29 centers that responded to questions on that issue, five reported treatment delays related to drug shortages — often because of having to submit new prior authorization requests after switching drugs or protocols. Treatment modifications may require a new informed consent and rescheduling treatment at an infusion center, said Iyer.

“All of this puts a strain on the entire system,” she said.

As the search for solutions continues, NCCN joined over a dozen other cancer organizations in the End Cancer Drug Shortages Coalition, which recently issued a consensus statement that identified three immediate priorities for addressing the shortages: increasing transparency across the drug supply chain; strengthening incentives for manufacturers to invest in high-quality, redundant supply systems; and stabilizing the generic drug market.

“We still have a long way to go. We need to get all of the stakeholders in the same room and have the necessary conversations,” said Iyer.