Impact of Drug Shortages, Including Chemo Drugs, Explored
(HealthDay News) – A number of drugs, including chemotherapeutic agents that have been available for many years, have recently been in short supply, which may have serious consequences for patients, according to a perspective piece published in the Dec. 27 issue of the New England Journal of Medicine.
Noting that patients and caregivers have faced an increasing number of drug shortages over the past several years, predominantly generic injectable agents, Monika L. Metzger, MD, from St. Jude Children's Research Hospital in Memphis, TN, and colleagues examined the implications of shortages of the anticancer agent mechlorethamine. The impact of its substitution with cyclophosphamide in a chemotherapy regimen for Hodgkin's lymphoma (vinblastine, mechlorethamine, doxorubicin, vincristine, bleomycin, etoposide, and prednisone; Stanford V regimen) was assessed.
According to the report, in a retrospective comparison, treatment with a cyclophosphamide-based chemotherapy regimen (40 patients) was significantly less effective than the original mechlorethamine-based Stanford V regimen (181 patients; two-year event-free survival, 75 vs. 88%; P=0.01). The patients in the cyclophosphamide cohort did not have more unfavorable clinical features than those in the mechlorethamine cohort, indicating that the drug switch likely accounted for the difference in event-free survival.
"These shortages are likely to have devastating effects on patients with cancer and must be prevented. For many of these agents, no adequate substitute drugs are available," the authors write. "Our results suggest that even promising substitute regimens should be examined carefully before adoption; what might appear to be a suitable alternative regimen may result in an inferior outcome – an intolerable situation for young people with curable diseases."
One author disclosed financial ties to Seattle Genetics and Pfizer.