Oct. 23, 2019 -- “It’s appalling that we’ve had to do this. It’s just unimaginable that we’re forced to ration cancer drugs for children in the U.S., but it is happening today with vincristine.”
That’s Peter Adamson, MD, a pediatric oncologist at Children’s Hospital of Philadelphia and chair of the Children’s Oncology Group, talking about the recent shortage of the children’s cancer drug vincristine.
The chemotherapy drug, which is given by IV, was discovered about 60 years ago and is the most widely used treatment for many types of childhood cancer, including the most common one, acute lymphoblastic leukemia, or ALL.
Adamson says some children have already had their vincristine dose delayed, and it’s possible some may have missed a dose. He says rationing has already begun.
“While we’re hopeful that the number of children who have delayed doses is minimal, different hospitals have different levels of drug supply available. A few hospitals are reporting that they’ll run out of drug within the next 2 weeks and already are taking steps to stretch their drug supply.”
ALL is a cancer of the blood and bone marrow, and vincristine is part of the standard treatment. It’s also part of the treatment for some types of kidney, muscle, nervous system, liver, and pediatric brain tumors. And it’s standard treatment for many adult cancers.
The drug’s only maker, Pfizer, says relief may be coming soon. In a letter dated Oct. 18, Pfizer said the next delivery of the drug is expected in late October and will meet current patient needs for the rest of the year. It expects full product recovery by January.
“Pfizer is now the only supplier of vincristine, and we are committed to providing this important medicine to patients. We have scaled up production to fully meet the need for vincristine over the long term. We have also expedited additional shipments of vincristine, which are now in transit to healthcare providers so they can treat patients.”
Until this summer, two pharmaceutical companies manufactured vincristine: Pfizer and TEVA Pharmaceutical Industries. In July TEVA, according to the FDA, made a “business decision” to discontinue the drug. That left Pfizer as the only supplier, and it has had manufacturing delays.
“We are working closely with Pfizer and exploring all options to make sure this critical cancer drug is available for the patients who need it,” an FDA spokesperson said.
TEVA did not respond to requests for comment.
According to the American Cancer Society, more than 11,000 children under the age of 15 will be diagnosed with cancer this year. While not all of them will receive vincristine, most will. Cancer is the second leading cause of death in kids in that age group, after accidents.
The organization says the rates have been rising over the last few decades, but because of major advances in treatment, more than 80% of these children now survive 5 or more years.
A 2017 study, which included a survey of pediatric hematologists and oncologists, found 65% of doctors had patients affected by drug shortages.
Adamson says there is no substitute for vincristine when it is part of a patient’s treatment plan. He called the shortage unacceptable and infuriating.
“In 1960, a child with ALL would have had less than a 10% chance of being cured. That same child born today has an almost a 90% chance of being cured. And it’s all come through research. If one were to lose vincristine for a significant period of time, a great deal of that progress would be wiped out. That’s where the anger and emotion come in.”
He believes several steps need to be considered, the most immediate being getting vincristine to all children who need it. He also suggested creating a national stockpile of essential drugs while the causes of frequent drug shortages are addressed.
He believes that solving the problem of this and other drug shortages is going to take help from Congress.
“To lose the national supply of a drug that’s less than $10 a dose in the U.S., perhaps the wealthiest nation in the world? The system is failing when we cannot maintain a supply of a $10 drug; it’s mind-boggling. Having cancer is hard. Solving a shortage of a $10 drug ought not to be; we just have to fix it.”