SGO Statement: Carboplatin and Cisplatin Shortages
Currently, a U.S. shortage of carboplatin and cisplatin exists that will likely last several months and possibly longer.
Platinum drug shortages were first reported to the U.S. Food and Drug Administration (FDA) on February 10, 2023. The recommendations below address how we can conserve carboplatin and cisplatin and allocate the limited supply to those patients who will experience the most significant benefit.
Effective immediately, the SGO recommends the following:
- Minimize ordering of non-essential platinum. If an alternative agent with comparable efficacy and safety is available, then cisplatin or carboplatin should not be ordered.
- Increase the interval between cycles and reduce the total platinum dose when clinically acceptable to do so. Where National Comprehensive Cancer Network (NCCN) guidelines state a range for cycle duration, default to the longer end of that range (e.g., if platinum is recommended every 3 to 4 weeks, default to every 4). Where guidelines state a range of dosing, default to the lowest therapeutically appropriate dose.
- Consider minimizing or omitting cisplatin or carboplatin for recurrent platinum-resistant ovarian and other cancers.
- Round dose down to the nearest vial size as a first step to ensure efficient use. If the shortage becomes more critical, consider reserving carboplatin and cisplatin for curative intent treatment or when prolonged clinical benefit is anticipated.
- Consult with your oncology pharmacy to determine your healthcare system’s current supply of these platinum agents and escalate any shortages promptly along the supply chain and to your clinical teams. We encourage our oncology community to communicate with other local providers regarding drug availability and to consider referrals for select patients if clinically indicated.
- If adequate supplies are unavailable, select an alternative, evidence-based regimen and consider a consultation with oncology/hematology colleagues.
A list of current and resolved drug shortages and discontinuations can be found on the FDA website.
Finally, we recognize the potential impact of these drug shortages on gynecologic cancer patients, especially our more vulnerable populations. The SGO is collaborating with colleagues nationally to advocate for our patients and is in contact with the FDA Office of Drug Shortages. Communicating to the FDA regarding where the shortages are impacting patient care is critical. The SGO and the FDA want to hear from our members to understand how local chemotherapy shortages affect you and your patients.
We hope this guidance will help SGO members determine the most efficient use of these agents while experiencing supply shortages. We will continue to advocate for our members and patients until this drug shortage is resolved.
Additional communiques will follow shortly, providing greater detail about alternative chemotherapy agents to consider in this setting and addressing clinical trials that include platinum-based drugs.
For questions or further guidance, please email firstname.lastname@example.org.
The SGO wishes to acknowledge the following members and professionals for their contributions to this rapid communique: Roisin O’Cearbhaill, MD; Renata Urban, MD; Wendy Brewster, MD, PhD; Mark Einstein, MD, MS; Amanda Fader, MD; Erin Medlin, MD; Bobbie J. Rimel, MD; Angeles Alvarez Secord, MD; Stephanie Shuey, PharmD; Ms. Elizabeth Kix; Ms. Katie Martino; Ms. Erika Miller; Ms. Jessica Oldham; and Ms. Traci Schwendner
*These recommendations are not meant to be a substitute for clinical judgment at the individual patient level, nor should they supersede other policies at the institutional level. All decisions should be made in the context of the unique circumstances where members practice, including other local resource considerations. We encourage members to work closely with their institutions to ensure that patients’ needs are being met.