1996P - The impact of an etoposide shortage on patients with extensive-stage small cell lung cancer (ES-SCLC): Results of a natural experiment

Background

Shortages of oncology therapeutics are becoming increasingly prevalent. A shortage of IV etoposide lasted from 2018 until 2020 in Ontario, Canada, allowing for a "natural experiment" in which external factors (IV etoposide availability) dictated patients' assignment. The purpose of this study was to evaluate the impact of this etoposide shortage (ES) on patient outcomes in ES-SCLC.

Methods

ES-SCLC patients treated at the London Regional Cancer Program during a “pre-ES” (Nov 2017 – Oct 2018) and “ES” (Nov 2018 – Oct 2019) time interval were retrospectively reviewed. Information was gathered on patient demographics, treatment, hospitalizations and survival. The primary endpoint was rate of hospitalization. Statistical analysis was performed using descriptive statistics, Kaplan Meier estimates and multivariable logistic and Cox proportional hazards regression models.

Results

A total of 119 patients with ES-SCLC were assessed, 49 in the pre-ES interval and 70 in the ES interval. Mean ± SD age was 68 ± 8 years, 48% were male, 33% had central nervous system (CNS) metastases and 69% received first-line systemic therapy. Alternate regimens used for ES cohort included platinum-oral (PO) etoposide (51%), platinum-irinotecan (24%), and PO etoposide monotherapy (16%). There was a significantly increased rate of hospitalizations during the ES vs. pre-ES (49% vs. 29%, p=0.029) but no significant differences in PFS (median: 2.8 vs. 4.5 months, log-rank p = 0.504) or OS (median: 3.1 vs. 5.5 months, log-rank p=0.600) in univariable analyses. In our multivariable model adjusting for age, sex, baseline Charlson comorbidity index, CNS metastases and receipt of first-line chemotherapy, we observed a significant increase in hospitalization (OR=2.30, 95% CI: 1.01-5.24, p=0.047) and shorter PFS (HR=1.79, 95%CI: 1.19-2.68), p=0.005) in the ES treatment interval.

Conclusions

This single-institution retrospective analysis during an IV ES shows increased rates of hospitalization and decreased PFS among ES-SCLC patients treated with alternate chemotherapy regimens. The oncology community must advocate for reliable supplies of essential chemotherapy drugs and utilize appropriate substitute therapies when necessary.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Medical Oncology Research Fund, London Health Sciences Centre.

Disclosure

D.A. Palma: Financial Interests, Personal, Other, Consultant: Need Inc (digital oncology startup company); Financial Interests, Personal, Writing Engagement, Royalties for UpToDate article written: Uptodate.com; Financial Interests, Personal, Stocks/Shares: Need Inc (digital oncology startup). J. Raphael: Financial Interests, Personal, Advisory Role: Lilly, Merck, Novartis; Financial Interests, Personal, Other, Honoraria: Roche. M.S. Kuruvilla: Financial Interests, Personal, Research Funding: AstraZeneca Canada; Financial Interests, Personal, Advisory Role, + Honoraria, travel expenses: AstraZeneca Canada, Takeda; Financial Interests, Personal, Advisory Role, + Honoraria: BMS, Merck, Sanofi. All other authors have declared no conflicts of interest.