Abstract 1548P
Background
Currently, the U.S. is experiencing an ongoing shortage of carboplatin and cisplatin chemotherapy (platinum) first reported by the FDA on February 10, 2023, creating uncertainty for patients, oncologists, regulators, and biopharma. The real-world effects of this shortage on platinum prescribing and patient mortality have not been quantified.
Methods
This cohort study used Flatiron Health’s nationwide de-identified EHR-derived database. Included patients started first-line (1L) therapy for advanced lung, head and neck, bladder, ovarian, and uterine cancers before (Feb 1 2022–Feb 9 2023) or during (Feb 10 2023–Jan 31 2024) the platinum shortage. We calculated unadjusted proportions of patients initiating any platinum and each platinum type among all 1L treatment initiators before and during the shortage as well as absolute differences. Adjusted odds ratios for factors associated with platinum use were estimated with multivariable logistic regression. An adjusted hazard ratio (HR) for mortality in patients initiating treatment during compared to before the shortage was estimated using Cox regression.
Results
Among all 1L treatment initiators (n=11430) the unadjusted proportion receiving any platinum was 69.3% before and 65.7% during the shortage, a 3.6% (95% CI: −5.2, −1.8) absolute reduction in platinum use. There was no disproportionate change in platinum use by race, ethnicity, socioeconomic status, insurance, academic vs. community practice, or region. There was no difference in mortality before vs. during the shortage (HR 0.99; 95% CI 0.92–1.07). Table: 1548P
1L therapy | Before shortage, % (n=6521) | During shortage, % (n=4909) | Difference, % (95% CI) |
Any platinum | 69.3 | 65.7 | −3.6 (−5.3, −1.8) |
Cisplatin | 5.9 | 6.4 | +0.5 (−0.4, 1.4) |
Carboplatin | 63.4 | 59.4 | −4.1 (−5.9, −2.3) |
Conclusions
In this large U.S. cohort, during the shortage we observed a modest absolute decrease in platinum prescribing (∼4%) and no difference in mortality. Cisplatin was likely substituted for carboplatin for some patients. Understanding the role of mitigation strategies, such as alternative treatment choices proposed by oncologic societies, will offer important policy insight for future crises.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
National Institutes of Health, Clinical Cancer Epidemiology T32 CA009679.
Disclosure
R. Hubbard: Financial Interests, Personal, Funding: Johnson & Johnson, United States Department of Veterans Affairs. L. Sun: Financial Interests, Personal, Advisory Board: Sanofi Genzyme, Regeneron, GenMab, Seagen; Financial Interests, Personal, Invited Speaker: Bayer; Financial Interests, Institutional, Local PI: Blueprint, Seagen, IO Biotech, Erasca. R.B. Parikh: Financial Interests, Personal, Stocks/Shares: GNS Healthcare, Onc.AI; Financial Interests, Personal, Speaker, Consultant, Advisor: Cancer Study Group; Financial Interests, Personal, Licencing Fees: Medscape; Financial Interests, Personal, Speaker, Consultant, Advisor, travel reimbursement: Flatiron Health, Conquer Cancer Foundation. L.P. Martin: Financial Interests, Personal, Speaker, Consultant, Advisor: Elucida Oncology, Inc, Sutro Biopharma; Financial Interests, Personal, Other: Immunogen, Inc. R. Mamtani: Financial Interests, Personal, Advisory Board: BMS, Astellas/Seagen, Merck, King & Spalding; Financial Interests, Institutional, Research Grant: Astellas; Financial Interests, Institutional, Funding: Merck. All other authors have declared no conflicts of interest.
Resources from the same session
1481P - A case-control study of drug-eluting microspheres and blank microspheres in bronchial artery embolization for hemoptysis in non-small cell lung cancer
Presenter: Tongguo Si
Session: Poster session 10
1482P - Percutaneous transhepatic biliary drainage (PTBD) for palliation of jaundice in patients of unresectable/disseminated carcinoma gall bladder with hilar block: Is it a worthwhile enterprise?
Presenter: Saurabh Galodha
Session: Poster session 10
1484P - Inflammatory patterns of ascites in patients with solid tumors
Presenter: Julia Berger
Session: Poster session 10
1485P - Mitigating symptom clusters of patients with metastatic cancer through a remote physical exercise program (EXIO)
Presenter: Paulo Bergerot
Session: Poster session 10
1486P - A personalized rehabilitation pilot program for improving QOL of unresectable metastatic lung cancer patients
Presenter: Shani Shilo
Session: Poster session 10
1487P - Telemonitoring system effectiveness for alleviating cancer pain in patients with advanced cancer
Presenter: Shiori Yoshida
Session: Poster session 10
1488P - Use of mobile app “SUPPORT+” to enhance community palliative care in advanced cancer patients: A feasibility study
Presenter: Wendy Chan
Session: Poster session 10
1489P - Factors influencing adherence to electronic patient-reported outcomes in palliative cancer care
Presenter: Sarah Gomes
Session: Poster session 10
1490P - Health-related quality of life of cancer patients on chemotherapy and its relationship with caregiver strain: A cross-sectional analytical study
Presenter: Herald Mapa
Session: Poster session 10
Resources:
Abstract