Oftentimes, for these patients with muscle-invasive disease, we have 2 modalities that we can treat them with: there’s dose-dense MVAC, and then there’s gemcitabine with cisplatin. Moving away from cisplatin-containing regimens is a significant disservice to these patients, as carboplatin has inferior data. It’s recommended across guidelines, and across most of the literature in the data that we are still trying to cure patients with muscle-invasive disease. Once these patients move into the muscle-invasive space, something like a cisplatin-containing regimen is the gold standard. There are patients who have non-muscle invasive disease where we try to resect the tumors. To understand bladder cancer, there are 3 key stages of the disease. Most critically and recently have been these platinum agents that have been in shortage. When you talk about something like kidney cancer, platinum agents, and some of the drugs we’ve seen shortages haven’t played a significant role in the GU space, but bladder has certainly been our number 1. When you’re talking about bladder cancer, specifically in terms of GU cancers, like cisplatin and carboplatin play a critical role at different stages for these patients. Now, with what we’ve been able to get in, we have further expanded additional indications like head and neck cancers and some cervical cancers where you still have curative intent with cisplatin and limited opportunities outside of that.”Ĭan you discuss the impact of the chemotherapy shortage in the bladder cancer space? During the most intense parts of the shortage around cisplatin, we were conserving utility in 2 patient populations: curative intent for bladder cancer and curative intent for testicular cancer because of the limited opportunity. “They haven’t increased to a comfortable level where we’re just opening prescribing backup. “We have already seen with this importation of supply that our allocations from our wholesale distributor have increased,” Hanna said. 2 Although it is early, Hanna discussed the differences these strategies have made. However, he explained that several strategies may help to lessen the impact of the shortage in the bladder cancer space, including reducing doses where appropriate to preserve cisplatin, as well importing platinum-based chemotherapy agents from China through the help of the FDA. In an interview with CancerNetwork ®, Hanna, director of pharmacy at Minnesota Oncology and assistant professor of pharmacy at the Mayo Clinic College of Medicine and Science, emphasized that there are few alternative treatment options for the population. Although the ongoing cisplatin shortage hasn’t largely impacted the genitourinary cancer space, 1 bladder cancer has proven to be an area of ‘critical need,’ especially for those with muscle-invasive bladder cancer where the agents are used with curative intent, according to Kirollos Hanna, PharmD, BCPS, BCOP, FCCC.
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