Cancer drug shortage arrives

DOXORUBICIN: Treatments are already affected in Anchorage.

November 20, 2010 

Cancer doctors say a national shortage of a chemotherapy drug has hit Anchorage, is already disrupting treatment for local patients, and could affect dozens more if it continues.

Doxorubicin, a generic drug also known as adriamycin, is a common choice to treat certain breast cancer patients, said Dr. Greg Marino, director of hematology-oncology at Alaska Native Medical Center. It can make a difference in the risk of the cancer coming back, he said.

There are alternatives that also work for breast cancer patients. But doxorubicin is vital to helping cure lymphoma, another form of cancer, Marino said. "This is the agent that has revolutionized our treatment of Hodgkins and some of the non-Hodgkins lymphomas."

Other choices for lymphoma are second tier, not backed by the same level of evidence or are more toxic, he said.

"This is terrible," Marino said. "You don't expect this is 2010 in the United States of America."

Drug shortages have been an ongoing problem in the U.S. But the federal Food and Drug Administration is seeing "a record number of shortages" this year, said Valerie Jensen, associate director of the FDA's drug shortage program.

Most shortages are for injectable drugs, including three used to treat cancer, she said. In an MSNBC online story Oct. 27, Jensen was quoted saying about 40 percent of the shortages are attributable to manufacturing problems, 20 percent are because a firm just stops making a particular drug, and 20 percent are because of production delays.

Underlying all the causes, she said, is that the drugs are not as profitable as other newer ones.

Jensen just became aware of the doxorubicin shortage within the last week from a hospital pharmacists organization, she said.

The FDA lists shortages and their causes, and works with drug companies to address them, but it can't compel companies to produce any particular drug. In the case of doxorubicin, one of three firms making it had manufacturing delays, and the other two have been trying to take up the slack, Jensen said.

At Katmai Oncology Group in Anchorage, Dr. Jeanne Anderson said she and her colleagues met this week to decide which among their patients most need their diminishing store of the drug.

"The small supply we have left we have to keep for our lymphoma patients," she said. "We're OK for this week."

"In a week or two it's quite possible we will have to tell our lymphoma patients ... that it's possible the top-line treatment isn't available," Anderson said.

Even for breast cancer patients, who have alternative drugs, it means changing course in the middle of chemotherapy treatments, and making a judgment call about the right dosage, she said.

Anderson said the substitute drug for breast cancer patients "is similar but different. Most studies use different dosages and schedules."

A woman recently diagnosed with breast cancer said she was shocked when Anderson told her Thursday that doxorubicin, one of her main chemotherapy drugs, isn't available.

"I looked at her and said, 'You gotta be kidding me,' " said the woman, who did not want to be identified because many people she knows are unaware that she has cancer. "This one kind of slapped me right in the face."


Find Rosemary Shinohara online at adn.com/contact/rshinohara or call her at 257-4340.

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