Dr. Emamekhoo on how his institute is addressing the cancer drug shortage

Video

“One of the things we do is communicate with our teams and help them with some guidance about how to make decisions about which patients can potentially be treated with alternative approaches,” says Hamid Emamekhoo, MD.

In this video, Hamid Emamekhoo, MD, explains how his institute is addressing the ongoing drug shortage affecting patients with genitourinary cancers and other solid tumors. Emamekhoo is a medical oncologist with a clinical and research focus on genitourinary malignancies at the University of Wisconsin-Madison School of Medicine and Public Health.

Transcript

For GU cancers, we use cisplatin a lot in bladder cancer treatment, for example. Platinum is one of the oldest drugs that we have been using for treatment of bladder cancer in different settings. In the neoadjuvant, adjuvant, or metastatic disease setting, it’s still one of the most effective drugs. The same with carboplatin, although we use it mostly in the metastatic disease setting. And in the prostate cancer setting, we use carboplatin in combination with cabazitaxel; that's for later stages of the disease. This combination is specifically used for patients with prostate cancer if they have neuroendocrine differentiation; this combination has a better response than just single-agent chemotherapy with taxanes.

So, the drug shortage has impacted the treatment of these patients with GU cancers. In the short term, we had to figure out how we were going to address this situation. At our institution, we put together a committee and fully evaluated the situation: What is the extent of the shortage? How much cisplatin and carboplatin do we have on hand? How many patients do we have on these treatments? How long can we continue providing treatments to these patients? And how are we going to try to obtain more carboplatin and cisplatin from the different resources? And it wasn't specifically for just the GU cancers; we had to consider all the different diseases treated with platinum agents. Many things had to be considered in that decision making and determining how we can extend the time that we can continue treating patients with these agents at the time of this shortage.

Many factors come into place when strategizing about the shortage. We have to think about the treatment goal and the intent of treatment. Is this curative intent treatment, are we using it for the neoadjuvantor adjuvant settings? Or is this for a life-extending treatment in the palliative setting, for example, palliative intent in the metastatic disease setting. How much of an impact does this treatment has on the patient's survival? Is it a patient that has had a treatment before and had some progression—platinum refractory disease, per se, and we are trying to retreat them or not. We brought all of these factors into our decision-making process. We communicated with our teams, with our providers, with everyone who is involved very clearly, and tried to help them with some guidance about how to make decisions about which patients could be treated with alternative treatment approaches. Are there any alternative regimens that could be used and have similar or maybe even better efficacy in the setting? So we decided to see how many of these patients have to get this treatment, which ones are in the curative setting, how many of them might have an alternative regimen that could be considered in this situation, and then created a list of patients that are on these treatments and communicated directly with each and every one of the providers and asked them to review the cases and see if they can make some adjustments or change the treatment plan to another alternative regimen, if possible, and then provided some even talking points for the providers.

These are very tough discussions, and it's a hard decision to make, and hard having these discussions with patients. So we try to make it as smooth as possible by providing some talking points and even direct support for the providers when needed.

Transcript has been edited for clarity.

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