The shortage of cancer drugs puts patients and oncologists in check: "They will die without medication"

By Berkeley Lovelace Jr. and Marina Kopf -

Robert Landfair, 76, was diagnosed with stage 4 prostate cancer in 2018. 

After several unsuccessful rounds of chemotherapy, his doctor, Alan Tan, of Chicago's Rush University Medical Center, recommended that he switch to Pluvicto, a new drug for advanced prostate cancer.

But the drug's maker, Novartis, has had supply problems.

Landfair is now on a waiting list to receive the drug, which won't be available for a few months.

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"I need it.

It's the only way I see my life," said Landfair, of Chicago.

His family says his cancer is "aggressive and continues to grow." 

“We realize that cancer is not on a waiting period, it is not on pause,” said Raymond Jackson, Landfair's son-in-law.

“We are very concerned,” he added.

Landfair isn't alone: ​​Cancer drug shortages have created dire circumstances for many patients diagnosed with the disease, forcing them—along with their doctors—to make difficult decisions. 

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According to the Food and Drug Administration (FDA), there are four cancer drugs in short supply: Pluvicto, for advanced prostate cancer, as well as methotrexate, cisplatin, and fluorouracil, common chemotherapy drugs used to treat a wide range of cancers, from skin to bone to lung.

According to Dr. Vignesh Packiam, a urologist at the University of Iowa Hospitals and Clinics, a fifth drug, a bladder cancer treatment called BCG, is also in short supply.

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In places where cancer drugs are in short supply, some patients may be forced to turn to options that may not work as well, experts say.

Others may die waiting for medicines in short supply to become available.

Every day counts: a study published in 2020 in The BMJ revealed that each month of delay in cancer treatment can increase the risk of death by around 10%.

“We oncologists are tied hand and foot,” said Tan, who is the director of genitourinary medical oncology at Rush. 

Tan hospital is facing a shortage of Pluvicto and cisplatin. 

“This is about the life of a patient,” he said, adding that patients “are going to die” if they don't get the drugs they need. 

What is the cause of the shortage of cancer drugs?

Michael Ganio, senior director of pharmacy practice at the American Society of Health-System Pharmacists, which tracks drug shortages across the country, blamed the cancer drug shortages on the Lack of investment from manufacturers.

Many of the cancer drugs in short supply are generic, which saves money for the national health system as a whole, but is not very profitable for manufacturers.

“There is often little incentive to invest in generic manufacturing, especially when it comes to much older drugs: the margins are not very large,” explains Ganio.

“It's almost a disincentive,” he added.

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Erin Fox, director of pharmacy at the University of Utah Health, said poor manufacturing practices at US factories have also contributed to general drug shortages.

Drug shortages, including lifesaving cancer drugs, could worsen in the coming years as more drug production moves overseas, Fox said.

“One of the main problems in assessing drug shortages is that pharmaceutical companies are not required to disclose exactly which company makes the product and where it makes it,” he explained, noting that manufacturing is often outsourced abroad.

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Sarah Ryan, a spokeswoman for the Pharmaceutical Research and Manufacturers of America, the pharmaceutical industry's trade group, said manufacturers have "extensive measures" in place to help prevent and mitigate drug shortages.

A report released in March by the Senate Homeland Security and Government Affairs Committee found that the shortage of new drugs in the United States increased by nearly 30% between 2021 and 2022. According to the report, the drugs included prescription drugs and children's medicines for cold and flu, as well as medicines used to treat cancer.

The FDA is working to curb this trend.

This month, the agency has released 17 pages of preliminary guidelines aimed at preventing drug shortages.

It requires manufacturers to notify the agency earlier - at least six months - of possible shortages or discontinuations of a drug, as well as more information about the cause of the problem. 

Less than ideal care

Meanwhile, more cancer patients may receive less than ideal care, according to Packiam of the University of Iowa Hospitals and Clinics.

Last week, Packiam learned that his hospital had run out of cisplatin, a chemotherapy drug commonly used for bladder cancer that increases the chances of surgery success. 

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In general, it is considered the gold standard treatment for this type of cancer,” he explained. 

The shortage of cisplatin makes it necessary to operate without chemotherapy. 

“Alternative chemotherapies that don't use cisplatin don't produce as good a response,” he explained.

"So instead of giving suboptimal chemotherapy, the next best thing is to go directly to surgery," he added.

The hospital will also have to prioritize what cisplatin it has left for those most in need.

For those who don't get cancer drugs right away, all they can do is wait.

Landfair, the cancer patient waiting for Pluvicto, is optimistic, although doubts sometimes assail him. 

"My biggest fear is that they won't give me the medication," he said.