What are best practices for oncologists during the national platinum shortage?

In breast cancer, we are prioritizing patients with curable disease in which platinum agents are a critical part of the regimen or have actually shown a clear advantage (the only example of this is shown below in bold).

Use an alternative to a carboplatin-based regimen whenever possible. If no altern...

For thoracic malignancies, there are a number of ways one could address the platinum shortage:

1. In extensive-stage - small cell lung cancer (SCLC), the NCCN recommends 4-6 cycles of therapy. However we recognize that there is no evidence that 6 cycles are required, therefore, the use of only 4 cycle...

During the chemotherapy drug shortage, I recommend utilizing the resources from the Society of Gynecologic Oncology on platinum and methotrexate drug preservation strategies (applicable for any oncology field) and gynecologic cancer-specific chemotherapy recommendations. These recommendations were d...

We all hope that shortages in platinum agents, BCG, etc. will be resolved soon. In the interim, regarding GU cancers, we prioritize cisplatin in:

1. Curative intent settings, e.g. germ cell neoplasms, neoadjuvant (or adjuvant) setting before (or after) radical cystectomy in MIBC.
2. Patients who already...

In genito-urinary cancers, there are clinical situations where cisplatin has clearly shown to have higher efficacy with the potential for cure.

I would prioritize the use of cisplatin in eligible patients with

1. Germ cell tumor
2. Urothelial cancer in neoadjuvant and adjuvant setting.
3. Localized small...

In the setting of urothelial carcinoma, would make the following observations regarding platinum-based chemotherapy:

1. Prioritize cisplatin for neoadjuvant/adjuvant therapy in cisplatin-eligible patients.
2. Prioritize cisplatin for metastatic cisplatin-eligible patients with curable disease (nodal/soft ...

Thanks to Dr. @Dr. First Last for providing excellent guidance for thoracic cancers. Currently, we are in shortage and have to begin rationing cis and carbo to those who are most in need, those who are receiving curative-intent therapy. If the shortage gets worse, we will have to come up with altern...

Cisplatin is on the WHO Model List of Essential Medicines for Children and is a core part of treatment for many pediatric malignancies, such as Osteosarcoma, Germ Cell Tumors, Hepatoblastoma, and CNS tumors. In 2013, a Working Group on Chemotherapy Drug Shortages in Pediatric Oncology was formed, in...

In GU oncology, there are several situations where carboplatin is commonly used:

1. Metastatic urothelial cancer, cisplatin-ineligible patients. A suitable alternative is the enfortumab-pembrolizumab regimen, now FDA approved, which can provide durable disease control in patients without the need for c...

Best practice in the setting of any chemotherapy shortage:

1. Identify those patients for whom the drug is being used in curative intent and prioritize that use.
2. For other lines of therapy or for palliative intent, identify if there are other regimens that may be substituted in that setting.

In lymph...

Regarding osteosarcoma management, the questions have circled around the methotrexate shortage. Now with both cisplatin and carboplatin shortages, it is difficult to effectively treat these patients until one of these drugs becomes available.

You could do ifos/dox cycles so that you’re using somethin...

Fortunately, cisplatin/carboplatin continues to be available so far, but in case there is a shortage or complete unavailability of platinum agents, options for NSCLC patients in the first line setting can be.

1. Ipi/Nivo alone (Hellmann et al., PMID 31562796).
2. Ipi/Nivo with 2 cycles of platinum double...