Too Small to Succeed?

Too Small to Succeed?

David L. Graham, MD, FASCO

Dec 13, 2011

I had a phone call last week that I was expecting but dreading. Like many oncologists, I travel to smaller area hospitals for outreach clinics. This was a call from one of those hospitals telling me that they could not get one of the chemotherapy drugs for a patient there. This is a patient being treated with intent to cure.

Our lead chemotherapy pharmacist has been telling us about this possibility for many months. These shortages mainly involve generic drugs that we all use on a daily basis including leucovorin, paclitaxel, doxorubicin, vinblastine, and dozens of others. I list these drugs because they are all commonly used with curative intent. Interestingly enough, these are also some of the least expensive drugs in our armamentariums as well.

One of the largest contract manufacturers of generic drugs announced in August that they were transitioning out of the business but took a more dramatic step of ceasing manufacturing and distribution last month due to overdue maintenance and recertification of equipment. It is not clear when production is to resume.

Our institution is fortunate to have a dedicated, resourceful, and tenacious chemotherapy pharmacy staff. This staff, however, has to take 10-15 hours a week just to track down supplies and make sure that we have needed stocks of these commonly used agents. This is over and beyond the usual time needed to prepare, mix, and dispense the drugs.

Luckily, my patient is able to travel to our main institution and receive his therapy. It is, however, an hour and 20 minutes in each direction to get that therapy. Winter in Illinois may also add to the difficulty.

It’s been easy to hear our pharmacist and read the articles about the looming shortages and leave it at that. Not being able to get a curative drug drives the point to an entirely new level. The impact on clinical trials is also becoming a very concerning part of the problem. These shortages may not only interfere with our ability to cure patients but also with our ability to define new therapies and new standards of care.

I don’t have the answer, and I expect any answer will be neither easy nor quick in coming. I doubt that I am the only oncologist to get a call like the one I described. I do have to wonder, though, how many such calls have to be heard and brought to public attention before some concrete action occurs.

Does this represent the opposite of “too big to fail”…“too small to succeed”?


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Michael A. Thompson, FASCO, MD, PhD

Dec, 14 2011 11:01 AM

David - Great to see you blogging. Despite the press, we haven't had much problem at my site, but I expect everyone will see this at some point. I think Doxil recently got replenished, but some common and potentially curative chemo shortages are a tragedy.

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