SPOTLIGHT
The
Drug Shortages
Dilemma
In hematology / oncology , drug shortages typically affect older , less expensive drugs , but when no alternatives are available , clinicians may struggle to provide the best care .
● IT ’ S BEEN MORE than a year since the U . S . was hit with a prolonged shortage of the critical chemotherapy agent vincristine , but pediatric hematologist / oncologist Lauren Pommert , MD , clearly remembers its aftermath . She and her partners at Children ’ s Wisconsin would review a list of all their leukemia and lymphoma patients to coordinate who would receive their therapy on time and who would not .
“ Basically , every week we would go over the list to see who was coming into clinic and decide who would get vincristine based on their diagnosis , where they were in therapy , and their overall risk stratification ,” said Dr . Pommert , who is now a pediatric oncologist at Cincinnati Children ’ s Hospital and an assistant professor in the department of pediatrics at the University of Cincinnati .
The vincristine shortage was a perfect storm of manufacturing issues : at the beginning of 2019 , two companies were making vincristine – the brand manufacturer Pfizer and the generic producer Teva Pharmaceuticals . Then , in the middle of 2019 , Teva exited the market and stopped production of the drug . Though Teva said its share of the market was just 3 %, Pfizer ran into manufacturing problems around the same time , putting the drug into shortage . The crisis resolved in 2020 after Teva reentered the market and Pfizer was able to successfully ramp up production .
The shortage of vincristine , an older and inexpensive chemotherapy agent , was felt acutely in the pediatric setting . It is part of nearly every childhood cancer therapy regimen and there is no alternative therapy that can be substituted for it .
That type of critical shortage leaves hematologists and oncologists with few options . Dr . Pommert said that she and her colleagues prioritized patients in critical phases of therapy and those with high-risk disease . They reduced , delayed , or completely omitted vincristine doses for lowrisk patients or those in the maintenance phase of therapy . They also adjusted doses so that none of the vials of the medication opened went to waste . “ We were forced to ration the medications that we had ,” she said .
The impact of this type of rationing on patient outcomes is largely unknown . “ We know the outcomes data if patients receive all of their intended
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