Impact of an Etoposide Chemotherapy Shortage on Patients With Extensive-Stage Small-Cell Lung Cancer: Results of a Natural Experiment-Reference-Cited by-同舟云学术

Impact of an Etoposide Chemotherapy Shortage on Patients With Extensive-Stage Small-Cell Lung Cancer: Results of a Natural Experiment

Published:2024-09-03 Issue: Volume: Page:
ISSN:2688-1527
Container-title:JCO Oncology Practice
language:en
Short-container-title:JCO Oncol Pract

Author:

Browne Claire¹,Ayoub Toufic²,Samarasinghe Nadeesha³⁴,Hussaini Syed¹⁵,Warner Andrew⁶,Black Morgan¹^ORCID,Palma David A.⁶^ORCID,Raphael Jacques¹⁷^ORCID,Kuruvilla Sara¹,Blanchette Phillip S.¹⁷^ORCID

Affiliation:

1. Division of Medical Oncology, Department of Oncology, Verspeeten Family Cancer Centre, London Health Sciences Centre, Western University, London, ON, Canada

2. Department of Science, Western University, London, ON, Canada

3. Schulich School of Medicine & Dentistry, Western University, London, ON, Canada

4. Division of General Surgery, Department of Surgery, University of British Columbia, Vancouver, BC, Canada

5. Department of Oncology, Oakville Trafalgar Memorial Hospital, Oakville, ON, Canada

6. Division of Radiation Oncology, Department of Oncology, Verspeeten Family Cancer Centre, London Health Sciences Centre, Western University, London, ON, Canada

7. Department of Epidemiology and Biostatistics, Western University, London, ON, Canada

Abstract

PURPOSE A shortage of essential intravenous (IV) etoposide lasted from 2018 until 2020 in Ontario, Canada, allowing for a natural experiment in which external factors (IV etoposide availability) dictated patients' treatment assignment. The purpose of this study was to evaluate the impact of this IV etoposide shortage (IVES) on patient care outcomes. METHODS Individuals with extensive-stage small-cell lung cancer (ES-SCLC) treated during a pre-IVES (November 2017-October 2018) and IVES (November 2018-October 2019) time intervals were retrospectively reviewed at the Verspeeten Family Cancer Centre. We investigated the association of the shortage on health care utilization and survival using a time-to-event analysis, Cox proportional hazards and logistic regression modeling. RESULTS A total of 119 patients with ES-SCLC were assessed, 49 in the pre-IVES interval and 70 in the IVES interval. The median age was 68 (IQR, 62-74) years, 48% (n = 57) were male, 33% (n = 39) had CNS metastases, and 69% (n = 82) received first-line systemic therapy. Alternate regimens used for IVES cohort included IV platinum-oral (PO) etoposide, IV platinum-IV irinotecan, and PO etoposide monotherapy. An adjusted multivariable model demonstrated a significant increase in hospitalization (odds ratio, 2.30 [95% CI, 1.01 to 5.24]; P = .047) and shorter progression-free survival (PFS; hazard ratio, 1.79 [95% CI, 1.19 to 2.68]; P = .005) during the IVES. CONCLUSION This study demonstrated increased hospitalization, and decreased PFS, among patients with ES-SCLC treated with alternate chemotherapy regimens during an IVES. The impact of cancer drug shortages can be harmful, and optimizing a more secure drug supply with mitigation strategies is warranted.

Publisher

American Society of Clinical Oncology (ASCO)

Link

https://ascopubs.org/doi/pdfdirect/10.1200/OP.24.00394

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