Breast Cancer Expert Describes Drug Shortages Impact in TNBC


Paolo Tarantino, MD, discusses how drug prices within the United States are affecting the treatment of breast cancer.

While drug shortages have affected multiple areas of cancer care, Paolo Tarantino, MD, noted that patients in the breast cancer space who need carboplatin for curative intent, such as those with triple-negative breast cancer, are being prioritized for treatment.

In an interview with CancerNetwork®, Tarantino, a medical oncologist at Dana-Farber Cancer Institute, also described the price gouging that has occurred in the wake of these shortages. It has affected the way patients are able to access treatment and resulted in added financial toxicity, Tarantino noted, adding that there are potential solutions to ensure patients are not so heavily impacted by trying to access this standard treatment.


The shortages can be very troublesome, particularly for certain drugs that are utilized to cure breast cancer and other cancers, and probably the most impactful being carboplatin. We know that carboplatin is utilized to treat the majority of solid tumors that we [see] every day, including breast cancer, and in particular, the most aggressive form of breast cancer: triple-negative breast cancer.

We recently implemented carboplatin in the curative treatment of nearly all stage II and III triple-negative breast cancers. We know that it has an important effect on event-free survival. We know that we need carboplatin and having a shortage of this drug and having to select patients to receive it or not receive carboplatin has been very complex. I have to say from an institutional standpoint, Dana-Farber was very proactive and was able to limit the impact of these shortages. We did have to modify the treatment of certain patients from carboplatin to cisplatin which requires much more hydration, and in general, can be associated with more toxicity compared with carboplatin. We often use carboplatin in the metastatic setting, but during the shortage, we were required to prioritize curative treatment for patients.

Drug costs are also a big problem. Especially for me coming from Europe and experiencing a very different health system [after] moving to the U.S. [I’ve seen] that the impact of the cost of the drugs leads to unequal access of the patient to certain drugs is very troublesome. I do feel that we need institutional support to limit the impact of this on the high-cost drugs and the way they are utilized so that we can at least have all the drugs that have important benefits on overall survival, and also the ones that benefit progression-free survival and available to our patients, and that we can limit the barriers related to financial toxicity for our patients.

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