ASCO has issued new clinical guidance for best treating patients with gastrointestinal (GI) cancer amidst a nationwide shortage of carboplatin and cisplatin.
The two chemotherapy agents are in extremely short supply and are essential to treating an array of GI cancers, including esophageal, pancreatic, and colon cancer. 
The guidance provides 5 general principles outlining reasonable drug substitutes and how to prioritize patient needs.

The guidance focuses on: 

 
• Upper gastrointestinal malignancies 
• Pancreato-biliary malignancies 
• Small intestine malignancies 
• Colorectal cancer
• Anal cancer
 
ASCO will soon issue guidance for treating breast, genitourinary, and lung cancers, and endorsed guidance from the Society of Gynecologic Oncology for treating gynecologic cancers, including cervical and ovarian. ASCO also published overarching guidance for all cancers that may be affected by the shortage, and clinicians waiting for additional disease-specific guidance can consult the full complement of published treatment guidelines on ASCO’s website in the interim.
 
“This shortage is among the most severe we have seen in a long time and its ripple effects are being felt across the country,” said Dr. Julie Gralow, ASCO’s Chief Medical Officer and Executive Vice President. “The clinical guidelines are essential to helping clinicians deliver the best possible care for the best patient outcomes despite these dire shortages.”
 
The Association of Clinical Oncology, an affiliated professional organization of the American Society of Clinical Oncology, is actively working with policymakers to help mitigate the shortages as well as prevent similar situations from occurring in the future. Clinicians are encouraged to report shortages to the Food and Drug Administration and to contact their member of Congress to make clear the urgent need for action.
 
Among the short-term policies ASCO is supporting is for the U.S. Food and Drug Administration (FDA) to continue importing drugs from other countries as necessary and require manufacturers to notify FDA if they notice an increased demand for any of their products.
 
In the long-term, U.S. regulators should create a comprehensive list of critical drugs needed for emergency response and saving lives, and every drug on the list should be evaluated for availability, quality, manufacturer reliability, and potential weaknesses in the supply chain. Additionally, legislators need to develop incentives for drug manufacturers to make sure critical products stay available.
 
“There is no single solution to this serious problem, but doing nothing is not an option,” Dr. Gralow said. “We need government and manufacturers to come together to do the hard work necessary to prevent these crises.”
 
Oncology professionals are encouraged to monitor ASCO’s drug shortage webpage for the latest updates. 
This news release was published by the American Society of Clinical Oncology on June 5, 2023.