1548P - Real-world impact of the platinum chemotherapy shortage on advanced cancer patients

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

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.