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October 23, 2019

This popular childhood cancer-fighting drug is in short supply. Here's how doctors are responding.

Daily Briefing

    Vincristine, a drug used to treat the vast majority of childhood cancers, is becoming less and less available, and doctors say that if the shortage continues, they may have to ration the drug.

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    Details on the shortage

    Vincristine is used to manage many childhood cancers, including acute lymphoblastic leukemia, the most common childhood cancer, according to the New York Times.

    Yoram Unguru, a pediatric oncologist and hematologist at Children's Hospital at Sinai and Johns Hopkins University, said, "With rare exception, nearly every child with cancer requires vincristine."

    Michael Isakoff, clinical director at Connecticut Children's division of hematology and oncology estimated that roughly 80% of his hospital's patients use vincristine at some point in their treatment. "We completely rely on vincristine," he said. "Our patients rely on it. It's a critical drug to the treatment of children with cancer."

    However, the drug has become increasingly rare, in part because drugmaker Pfizer, which is the only manufacturer of the drug, has been experiencing manufacturing problems, the Times reports.

    Formerly, Teva Pharmaceuticals also manufactured the drug. However in July, Teva made a "business decision to discontinue the drug," according to FDA. Teva, in a statement to NBC Connecticut, said, "Availability of Teva product has not contributed to the shortage that is being experienced today."

    FDA said the agency is "working closely with [Pfizer] and exploring all options to make sure this critical cancer drug is available for the patients who need it."

    Jessica Smith, a spokesperson for Pfizer, said the company will expedite shipments of the drug over the coming weeks to "support three to four times our typical production output."

    How providers are handling the shortage 

    But in the meantime, doctors say they may have to start rationing the drug. "There is no substitution for vincristine that can be recommended," Unguru said. "You either have to skip a dose or give a lower dose—or beg, borrow, or plead."

    Unguru called the shortage "a nightmare situation" and "a devil's choice." He said, "The fact that we are forced to pick which child with cancer is worthy of getting a drug, essentially, is a horrible position to be in for that family, for that child, but also for providers."

    Michael Link, a pediatric oncologist at the Stanford University School of Medicine, said "We are all devastated." He added that, without vincristine, a number of children with acute lymphoblastic leukemia will still be cured of the disease, but added that "this is a difficult disease to treat in general, and with one hand tied behind your back, it makes it much more difficult."

    Meanwhile, the Children's Oncology Group, a collaboration of researchers at hospitals and cancer centers, has released recommendations for changing protocols around clinical trials using vincristine. The recommendations include checking a hospital's pharmacy supply before trial enrollment, considering using just half a dose if a full dose isn't available, skipping doses during the treatment's maintenance portion, and in some cases, not using the drug at all.

    Peter Adamson, chair of the Children's Oncology Group, said, "This shouldn't be happening in the United States. It's hard enough for any family having a kid with cancer, and having a child with cancer likely to be cured except we can't give them the drug is beyond the imagination. How can we do that to families?" (Rabin, New York Times, 10/14; Gutierrez, NBC Connecticut, 10/15; NPR, 10/16).

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