Dose Adjusting Hematologic Drugs May Provide Relief During Shortages

In light of chemotherapy agents vinblastine (Velban) and dacarbazine joining the growing list of drugs that are in short supply, Julie M. Vose, MD, MBA, explained how her institution has adjusted treatment regimens to reduce waste and maximize treatment with curative intent.

The use of vinblastine and dacarbazine is most prominent in pediatric patients. Recently, there has been a decrease in the supply of these treatments, forcing clinicians to seek alternative options. Vose, division chief, Neumann M. and Mildred E. Harris Professor in the division of hematology and oncology at the University of Nebraska Medical Center, spoke about how her institution is handling the challenge.

She discussed how these treatments, when used in the curative intent setting, can be combined with newer approved agents to help alleviate the supply shortage. She noted that the focus is still on curative intent for these patients, which is why new combination therapies may be vital.

Transcript:

Each center typically has its own rules and regulations. In general, we try to reserve these agents for patients who are thought to be curable for their malignancy. In addition, we try to conserve the individual doses as much as possible. [This includes] rounding down rather than rounding up, for example, or going to the nearest vial size is something is often done to try to reduce waste. Other things where we’re trying to think ahead and make sure that patients are appropriate for those agents so that we do use them for curable diseases. Patients who are pediatric or young adults who have a very long life expectancy and a curable disease will be the priority for trying to use these agents.

In Hodgkin lymphoma, there are new agents that we’re typically adding to some of these chemotherapy drugs so that we feel more comfortable in using potentially fewer cycles or trying to round down the doses. Some of the PD-1 inhibitors, for example, are used now in Hodgkin disease, or brentuximab vedotin (Adcetris) was used earlier in Hodgkin disease. We’re trying to be able to use those newer agents and decrease perhaps the use of some of the older agents, or decrease the amount that’s given, but still have a curative intent. There are lots of clinical trials that are ongoing to try to see if we can reduce some of these older agents, as well.