By: Paolo Tarantino, MD
Paolo Tarantino, MD, researcher, the European Institute of Oncology, clinical research fellow, Dana-Farber Cancer Institute, discusses typical conversations oncologists should have with patients regarding the platinum chemotherapy shortage, as well as the importance of honest communication about treatment regimen changes.
According to a survey conducted by the National Comprehensive Cancer Network (NCCN) in May 2023, 93% and 70% of 27 participating NCCN member institutions in the United States reported shortages of carboplatin and cisplatin, respectively.
Although Tarantino notes that most patients receiving cancer treatment at Dana-Farber Cancer Institute have had access to the platinum chemotherapy they need, oncologists discuss the platinum chemotherapy shortage with all patients who may be affected. If patients who would normally receive platinum chemotherapy are unable to receive a standard regimen because of this shortage, their oncologists should discuss alternative treatment strategies with them, Tarantino says.
For instance, cancer centers experiencing a lack of carboplatin may instead prescribe cisplatin, although this agent can be more difficult to use than carboplatin because it requires more hydration and more treatment time in the clinic, and is associated with more adverse effects, Tarantino explains. Because of these differences, patients should understand why they are receiving cisplatin rather than carboplatin, Tarantino emphasizes.
Patients receiving an entirely platinum-free regimen because of the platinum shortage should also be aware of the reasons for this change, according to Tarantino. Of all patients with breast cancer, patients with triple-negative breast cancer (TNBC) may be most affected by this shortage, because platinum chemotherapy is the standard of care in the neoadjuvant TNBC setting, Tarantino says. The phase 3 BrighTNess trial (NCT02032277) demonstrated that the addition of carboplatin with or without veliparib (ABT-888) to neoadjuvant paclitaxel followed by doxorubicin and cyclophosphamide improved long-term event-free survival in patients with TNBC.
As other clinical trials have validated the use of platinum-free regimens in patients with breast cancer, avoiding platinum chemotherapy is an option for some patients, especially those who are frail and may better tolerate anthracyclines plus taxanes alone, Tarantino explains. Since these treatment decisions can be difficult, clear communication with patients is crucial. Patients should know why they are receiving certain regimens and be aware of the efforts their cancer centers are making to minimize the effects of this platinum shortage, Tarantino concludes.
Barbara Jacoby is an award winning blogger that has contributed her writings to multiple online publications that have touched readers worldwide.