Shortages of essential cancer medicines:who is responsible and what are the possible solutions?

Widespread shortages of essential cancer medications are increasing in the USA, 1 with the US Food and Drug Administration (FDA) reporting cancer drug shortages to be the worst in three decades. Generic medicines are particularly affected, which has resulted in a scarcity of numerous highly effective chemotherapies—such as cisplatin, carboplatin, dacarbazine, and methotrexate—which are recommended by the National Comprehensive Cancer Network (NCCN) in the management of over a dozen cancers. Of the 40 cancer medicines currently included in the US FDA Shortages Database, nearly all are listed in NCCN guidance as category 1 or 2A treatments (figure 1), denoting a high level of supporting evidence for their efficacy and panel consensus of their essential value. Over half are listed on the WHO Model List of Essential Medicines. This situation has forced clinicians to modify or withhold cancer treatment to ration medicines, with more than 100 000 patients affected and more likely to be affected if no action is taken.