The ABC News Medical Unit and Dr. Richard Besser recorded a series of reports about shortages of medications used to treat cancer. They noticed that about 80% of children who have cancer can be successfully treated with therapies, which are commonly used currently. And most of those effective treatments rely on the older drugs such as mechlorethamine (used since the 60’s), while some other drugs for those purposes were used only as a short supply.
Despite the studies, drugs shortages reasons are not that clear. It seems to be a combination of different factors, like lagging production time, limited manufacturing quotas, lack of financial benefits from those medications. Dr. Link pointed out a substitute medication was always ready to take over its competitor in case if the medication was no longer produced.
Authors of the New England Journal said that the shortage of mechlorethamine ended up without any explanation right after their study finished. However, it is impossible to predict if another shortage will occur later.
Dr. Amy Billet, of Dana-Faber, said that they needed a global effort to fight the issue of shortages, rather than trying to resolve the issue by one event at the time.
Possible reasons for drugs shortages were mentioned in this article.
There were some tries to stop the shortages. For example, the Food and Drug Administration tried to resolve the issue, after President Obama issued an order in 2011. That order was issued to reduce drug shortages in the U.S., so the FDA stopped to report about shortages and started to make reviews, which made shortages even worse.
Abby’s story
9-year-old patient, Abby Alonzo, was into Hodgkin lymphoma treatment for eight weeks and she was doing great. Unfortunately, one of the ingredients for her medications was no longer available, so her doctors had to use another medication as the substitution to an unavailable one. She had to use even more chemotherapy, radiation, and bone marrow transplant, as she relapsed in one month after the medication change.
Abby’s doctors from Saint Jude Children’s Research Hospital in Memphis, Tennessee, explained her medication change and so her relapse by the shortage of nitrogen mustard or mechlorethamine.
Now Abby is 13 and she successfully fought cancer. However, her lungs were damaged because of the treatment. According to her mother, doctors could not tell for sure if it was because of the treatment Abby had received through after the mechlorethamine shortage and her relapse. Abby’s mother said they would not ever know that for sure. She added that they did know for sure was other children have to go through extra treatment and get a lot of damage to their body simply because the medications had not been made. She found it not right.
Substitute drugs are not the same
Along with the colleagues from the cancer institute of Dana-Farber (Massachusetts) and Stanford’s Lucile Packard Children Hospital (California), St. Jude doctors highlighted in the New England Journal of Medicine how the shortage of the medication was related to the increasing rate of relapse among children with Hodgkin lymphoma.
The first study conducted to compare the differences in treatment results between cyclophosphamide, which was used as the substitution, and mechlorethamine. The study reported about the twice higher rating of complications in 40 patients who received cyclophosphamide, compared to those 181 patients who used mechlorethamine and did not change it during the whole study process. There were no deaths among the patients, but scientists said that patients were on their medications for one and a half year and they may be experiencing different kinds of adverse effects lately.
A pediatric oncologist at Dana-Farber Cancer Institute, Dr. Amy Billet, said there was a possible shadow of a doubt that the drug switching caused the relapse rate increase among the patients, but not she, nor her colleagues could think of any other explanation. She added that it was impossible to predict what would happen to one individual patient, but you could say about the increased risk in the group of patients who switched the medications and took the substitute drug for treatment.
Conclusion
This study confirmed what oncologists have been suspecting for years. Switching one medication to another one, which is similar, it not always ideal, according to Dr. Link. He also said that they have thought the drug swapping was not an issue they should think of because medications were similar. But they have discovered that the substitution has not worked as well, which made the issue clearer, and now healthcare professionals could tell which patients were affected by the shortage the most.
Stanford University pediatric oncologist and one of the lead investigators, Dr. Michael Link, said that it was too soon to knew about issues and success rates. He added that even if they were cured, they have undergone intensive treatment that could be avoided in another case. He explained that they were at higher risk for long-term effects. Secondary cancer is one of them.
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