Dr Tarantino on the Effects of Platinum Chemotherapy Shortages in Breast Cancer

Paolo Tarantino, MD, researcher, the European Institute of Oncology, clinical research fellow, Dana-Farber Cancer Institute, discusses how the ongoing shortages of carboplatin and cisplatin in the United States are affecting patients with breast cancer and the importance of overcoming this wave of shortages and preventing this issue from recurring in the future.

On June 7, 2023, the National Comprehensive Cancer Network (NCCN) published results from a survey of 27 NCCN member institutions showing that 93% of participating centers are experiencing a lack of carboplatin, and 70% of the centers are experiencing a shortage of cisplatin.

Although Tarantino says that Dana-Farber Cancer Institute has been able to offer carboplatin to most patients with cancer who need it, he notes that he and his colleagues have experienced difficulties prioritizing the use of this platinum agent across disease settings.

Carboplatin has become increasingly important in both the curative and metastatic triple-negative breast cancer (TNBC) settings, Tarantino explains. In 2021, the FDA approved pembrolizumab (Keytruda) plus carboplatin and paclitaxel followed by doxorubicin or epirubicin and cyclophosphamide in the neoadjuvant setting, as well as surgery and adjuvant pembrolizumab for patients with high-risk stage II or III TNBC. This approval was based on findings from the phase 3 KEYNOTE-522 trial (NCT03036488), in which the pembrolizumab/chemotherapy regimen resulted in a 37% reduction in the risk of disease progression, recurrence, second primary cancer, or death vs neoadjuvant chemotherapy alone (HR, 0.63; 95% CI, 0.48-0.82; P = .00031).

Prior to that approval, in 2020, the FDA granted accelerated approval to pembrolizumab plus investigator’s choice of nab-paclitaxel (Abraxane), paclitaxel, or gemcitabine plus carboplatin in patients with treatment-naïve locally recurrent unresectable or metastatic TNBC. This regulatory decision was supported by findings from the phase 3 KEYNOTE-355 trial (NCT02819518), in which the pembrolizumab/chemotherapy regimen led to a median PFS of 9.7 months (95% CI, 7.6-11.3) vs 5.6 months (95% CI, 5.3-7.5) with placebo plus chemotherapy (HR, 0.65; 95% CI, 0.49-0.86; 1-sided P = .0012).

The carboplatin/cisplatin shortage may affect the availability of other common chemotherapy drugs, Tarantino says. This shortage highlights the importance of these drugs for patient treatments, outcomes, and quality of life, Tarantino emphasizes. The oncology community needs to determine ways to avoid future drug shortages while acknowledging the value of drugs that, though old and cheap, affect the quality of patient care, Tarantino concludes.