TOPLINE:

During nationwide platinum drug shortages, oncologists followed national guidance by maintaining platinum therapy for nonmetastatic lung cancer while shifting to immunotherapy without platinum for metastatic cases. Analysis of 13,633 infusions revealed strategic adaptations in treatment approaches, with overall platinum use remaining stable for nonmetastatic cases.

METHODOLOGY:

• The FDA announced a nationwide cisplatin shortage on February 10, 2023, followed by a carboplatin shortage on April 28, 2023.
• Researchers conducted a cross-sectional study using the IQVIA PharMetrics Plus for Academics closed health plan claims database from September 2022 to October 2023, spanning 5 months before and after the cisplatin shortage.
• Analysis included 13,633 infusions from 2839 patients with incident nonmetastatic and metastatic lung cancer, with a mean age of 69.0 years (SD, 9.4).
• Investigators performed an interrupted time series analysis using a linear probability model across three periods: pre-platinum shortage, post-cisplatin shortage, and post-carboplatin shortage.
• Statistical analysis adjusted for age, sex, region, and National Cancer Institute Charlson comorbidities, with significance set at P < .05.

TAKEAWAY:

• For nonmetastatic lung cancer, after the cisplatin shortage, researchers observed a 1.7-percentage point monthly decline in cisplatin use (P = .03) and a nonsignificant 1.6-percentage point monthly increase in carboplatin use.
• Following the carboplatin shortage, immediate changes included a 4.5-percentage point decline in carboplatin use (P = .04) and a 5.8-percentage point increase in cisplatin use (P < .001) for nonmetastatic cases.
• In metastatic lung cancer cases, the carboplatin shortage led to an immediate 15.7-percentage point decline in carboplatin use (P = .002) and an 18.4-percentage point increase in immunotherapy without platinum (P < .001).
• According to the authors, oncologists’ response to platinum shortages appeared to follow national guidance, showing encouraging signs given the historically slow integration of guidelines into clinical practice.

IN PRACTICE:

“For nonmetastatic lung cancer, declines during the cisplatin or carboplatin shortages were equally compensated with increases in the other platinum therapy, keeping overall platinum use stable. For metastatic lung cancer, declines in carboplatin were balanced with increases in immunotherapy without platinum,” wrote the authors of the study.

SOURCE:

The study was led by John K. Lin, MD, MSHP, Department of Health Services Research, University of Texas MD Anderson Cancer Center in Houston. It was published online on October 2 in JAMA Oncology.

LIMITATIONS:

The study was limited by potential misclassification bias in the claims-based algorithm for determining metastatic status, unavailability of PD-L1 status, and insufficient follow-up duration to measure outcomes.

DISCLOSURES:

The study received grants from the National Cancer Institute (P30CA016672). Lin reported receiving grants from the National Institutes of Health (R01 AG086300) outside the submitted work. Eric K. Singhi, MD, disclosed advisory board fees from multiple pharmaceutical companies including AstraZeneca, Novocure, Amgen, Janssen, Regeneron, Bristol Myers Squibb, Bayer, Boehringer Ingelheim, Eli Lilly and Company, and Caris. Additional disclosures are noted in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.