Doctors Faced With Tough Decisions Due To Shortage Of Drug Used To Treat Cancer

NPR's Audie Cornish speaks with Dr. Yoram Unguru, a hematologist and oncologist in Baltimore, about a shortage of vincristine, a drug used to treat childhood cancer.

AUDIE CORNISH, HOST:

A vital chemotherapy drug used to treat many types of childhood cancer is now in short supply. It's called vincristine, and it only has one manufacturer, Pfizer, which the Food and Drug Administration says has been experiencing production delays. Doctors say they may have to begin rationing doses to make the current supply last.

Dr. Yoram Unguru is a pediatric oncologist in Baltimore. He joins us now to explain more. Welcome to the program.

YORAM UNGURU: Thank you.

CORNISH: First, tell us a little bit about this drug. What does it treat?

UNGURU: Leukemias, lymphomas, bone tumors. With rare exception, nearly every child with cancer requires vincristine.

CORNISH: Are there alternatives that you can prescribe?

UNGURU: I wish. Unfortunately, when it comes to childhood cancer, we don't have substitutions when we're faced with a shortage. And when you're talking about a drug like vincristine that is so widely used, it really hits home.

CORNISH: Why are we down to one manufacturer? And what have you heard about the reasons behind the shortage?

UNGURU: So vincristine, like many of the chemotherapy drugs that are used to treat children with cancer, belongs to a class of drugs called sterile generic injectables. Invariably, these are drugs that have been around for decades. They're generic. They're cheap. And over the past decade, there have been fewer and fewer of these companies that want to make these types of drugs.

CORNISH: I understand that shortages like this are frequent with chemotherapy drugs used to treat acute lymphoblastic leukemia. At the same time, the survival rate is fairly high, right? So how do these two things square? Do shortages get resolved, or is this scenario somehow different?

UNGURU: Yes. So you have the ability to cure children of these diseases, but then you're faced with very frequent shortages. What makes the current situation more difficult is we're talking about a drug like vincristine that is so widely used, and we don't have any redundancy. And as a result, now clinicians are forced to ration.

So imagine that you're faced with a number of children, all of whom require vincristine, but you don't have enough vincristine to treat each of them. How do you make that decision?

CORNISH: How do you make that decision?

UNGURU: Well, so this is what I and colleagues have been working on for the past several years, and we've developed guidance based on medical and ethical indications about how best to do this, but that doesn't make it any easier. This is - and this is a devil's choice. The fact that we are forced to pick which child with cancer is worthy of getting a drug, essentially, is a horrible position to be in for that family, for that child, but also for the providers.

CORNISH: Have you reached that point at this moment?

UNGURU: At this exact moment at my particular institution, thankfully, no, I have not. But the concern is that we may reach that point. And although the announcement by Pfizer is that the shortage will hopefully be resolved by the end of the year, sometimes that gets extended longer.

Or we have enough drug right now for our current patients, but we will have new patients who walk through our hospital doors. And so it's possible that even though we appear to have enough supply right now, and my colleagues at other hospitals may or may not, that could change very quickly.

CORNISH: That's Dr. Yoram Unguru. He's a pediatric oncologist and hematologist at Children's Hospital at Sinai in Baltimore and Johns Hopkins University.

Thank you for speaking with us.

UNGURU: My pleasure. Thank you.

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