Cancer experts demand action to end ongoing drug shortage: ‘People’s lives are really at stake’

By Jacqueline Howard, CNN

(CNN) — Cancer experts have made two calls for action from US lawmakers this year: fix the ongoing cancer drug shortage, and increase funding for cancer research.

The American Association for Cancer Research, in its annual cancer progress report released Wednesday, highlighted the recent improvements that the United States has made in reducing cancer deaths and advancing treatment, as well as the challenges of an ongoing shortage of chemotherapy medications and growing concern about the future funding of cancer research.

“The drug shortages are an enormous, complex problem and in part reflect an economic challenge, where essentially the low profit margin for some of these generic drugs disincentivizes companies from committing to producing them,” said Dr. Philip Greenberg, president of the association and an author of the new report.

He said the shortage means some cancer patients are not able to access medications that have been maintaining their fight against the disease, and others are not able to start treatment regimens that they may need.

“That is an obstacle, and it needs to be addressed, and I don’t think a lot of these things can just be left to the private sector to solve. Some of this is going to have to require regulation to fix,” he said. “People’s lives are really at stake here, both in terms of quality of life and duration of life.”

Greenberg and his colleagues plan to meet with lawmakers in Washington this week to discuss the report and what its findings mean.

The report champions how over the years, advances in cancer therapeutics have played a role in helping reduce the rate of cancer deaths in the United States by 33% between 1991 and 2020, which translates to about 3.8 million deaths from cancer being averted.

Among the advances detailed in the report are the 14 new anticancer therapeutics that the US Food and Drug Administration approved between August 2022 and July 2023, including a novel gene-therapy-based immunotherapy for bladder cancer, an antibody-drug conjugate for ovarian cancer and four new T-cell engaging antibodies for certain blood cancers. But treatments like those can only make an impact if patients have access to them.

“Unfortunately, there have been record shortages of cancer drugs this year. In December 2022, there were 295 prescription medications in short supply,” Greenberg and his colleagues wrote in the new report. “The underlying causes of the shortages are varied and incredibly complex, and include supply chain disruptions, manufacturing quality issues, limited economic incentives to manufacture generic drugs, and increasing reliance on fewer manufacturers.”

The report said that shortages of the chemotherapy drugs cisplatin and carboplatin are particularly having significant impacts on patients. Those medications are prescribed for about 10% to 20% of people with cancer, according to the report.

These drugs “form the bedrock” of cancer treatment, Dr. Vamsi Velcheti, director of thoracic medical oncology at NYU Langone’s Perlmutter Cancer Center and professor of medicine at NYU Grossman School of Medicine, said in an email.

The drug shortage “invariably leads to postponed interventions, necessitates suboptimal therapeutic alternatives, and foists undue psychological strain upon our patients,” wrote Velcheti, who was not involved in the new report. “The AACR’s clarion call serves as both a reminder and a rallying cry; it accentuates the profundity of this issue and underscores our collective responsibility to safeguard the well-being of patients with cancer throughout the United States.”

In 2016, when then-Vice President Joe Biden launched the Cancer Moonshot initiative to “accelerate the rate of progress against cancer,” cutting-edge research was supposed to become a national priority. But now, with a record number of cancer drugs in shortage, it’s become extremely difficult to conduct even basic research.

Novel drugs typically aren’t the problem for researchers, because pharmaceutical companies can usually supply those to investigators. The problem lies with the drugs that scientists often use in comparison or conjunction with the novel treatment. They’re the medicines that doctors currently use to treat patients, and they’re often generics.

The National Cancer Institute, the federal government’s main agency for cancer research and training, told CNN in July that at least 174 of its 608 trials may be affected by the shortages. However, that number can’t account for other trials that rely on these drugs or possible trials that researchers would like to start but can’t.

So the question remains: “If you bring together industry and academia and government and advocacy groups, how do we solve the shortage problem? Because this is affecting everybody and it’s not just in primary care drugs. It’s also in the secondary drugs that are given to people to help with the side effects of the primary treatments,” said Dr. David Fenstermacher, senior director of research and medical affairs at the nonprofit Colorectal Cancer Alliance, who was not involved in the new report.

He added that the common corticosteroid dexamethasone, sometimes used to help prevent nausea in people undergoing chemotherapy, has been affected by shortages.

“To me, it’s important to bring everyone together on the solution of ‘how do we solve this,’ ” Fenstermacher said. “What we need to do is come up with a path forward on how do we reduce these shortages.”

‘We have a real concern’

There is also concern that momentum may be lost in cancer research and in reducing the rate of cancer deaths in the United States if Congress doesn’t do more to invest in research, Greenberg said. From 2010 to 2019, federal funding contributed to the development of 354 of 356 new drugs, including many cancer drugs, that were approved by the FDA, according to a study discussed in the new report.

But “we’re very concerned, not only about not sustaining the momentum but of potentially losing some of that momentum,” Greenberg said. “This is a time when investing in the cancer enterprise would be enormously appropriate, and I think we have a real concern that that’s not necessarily where Congress is right now.”

In the report, Greenberg and his colleagues called for Congress to increase funding for the National Institutes of Health, the National Center Institute, the White House’s Cancer Moonshot initiative and cancer prevention programs at the US Centers for Disease Control and Prevention.

“One of the calls to action here was for Congress to increase the funding for NIH and NCI as well as the preventive programs that are run out of CDC,” Greenberg said. “These are all programs that are under scrutiny now for potential cuts, and that’s an enormous problem. So we’re talking about building them and expanding them and making them more capable. I think every one of these programs is at risk of having cutbacks.”

Michael Sapienza, chief executive officer of the Colorectal Cancer Alliance who was not involved in the new report, agrees with the report’s call for more cancer research funding – especially at a time when cancer cases are rising among people younger than 50.

“Understanding the reasons behind rising cases of early-onset colorectal cancer is an area of intensive research,” the report notes.

In the United States, some national guidelines for certain cancer screenings have shifted to recommend starting screening at younger ages. In 2021, the US Preventive Services Task Force lowered the recommended age to start screening for colon and rectal cancers from 50 to 45. And in May, the task force proposed in a draft recommendation that all women at average risk of breast cancer start screening at age 40 instead of 50.

But that doesn’t mean younger adults are getting screened or are even aware that they may be eligible for screening early.

“So the colorectal cancer screening has lowered to age 45, but just so you know, the screening rates for people 45 to 49 is only 22.5% of that population,” Sapienza said. “Those are the probably most important things that we can highlight, at least in the near term, both for the screening perspective and for the treatment, of colorectal cancers.”

Inequities in cancer

The new report also highlights the disparities that racial and ethnic minorities and other groups that have historically been underserved continue to face in their likelihood of receiving cancer screenings or follow-up tests. Inequities remain in overall cancer incidence, treatment options and death rates among Black and Brown patients compared with their peers.

“Individuals who are Black have the highest death rates and lowest survival rates of any racial or ethnic group in the U.S. for most cancers, largely driven by structural and systemic inequities,” according to the report.

There are also inequities across different types of cancer. The report highlights how progress in understanding and combating cancer has not been uniform against all types or stages of a given type.

“While progress is evident in areas like lung, melanoma, and breast cancers, disparities remain, notably in cancers such as pancreatic and uterine,” Velcheti wrote in his email.

“These disparities, coupled with the increasing burden on health systems, make it paramount to sustain and amplify funding for medical research, especially for the NIH,” he said. “A consistent investment trajectory is vital to further breakthroughs and to fortify the multifaceted approach to cancer – from understanding its genesis to survivor support. The call for sustained federal funding by the AACR is both pertinent and crucial.”

CNN’s Jen Christensen contributed to this report.

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