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What do you do when there's a nation-wide shortage of chemotherapy??
Apr 3, 2002

I am half-way through my ABVD chemotherapy for Stage 1A Hodgkins Disease. My Doctor informed me yesterday there is a nation-wide shortage of Vinblastine and he is substituting Vincristine in its place. He assures me this is fine, yet I am concerned about it impacting the effectiveness of my treatement. One, Have you heard of this shortage of Vinblastine? Is this common? and Two, what are your feelings about the substitution? As always, thank you for your help.

Response from Dr. Dezube

It's pretty mind-boggling that a patient can be all psyched up to begin chemotherapy, actually begin chemotherapy, and then find out that the chemotherapy is no longer available. I'm sorry to say that this nation-wide shortage is true. Please realize that these shortages occur in virtually every cancer center throughout the nation. So thousands of oncologists will be dealing with this issue, not just for their Hodgkin's disease patients, but for their other patients receiving vinblastine. Why does this occur? Basically, typically a very limited number of manufacturers will produce a single type of chemotherapy. Unfortunately it is not all that uncommon for specific chemotherapies to suffer from a production/manufacturing issue.

What is one to do? Oncologists will explore alternative options to cope with the shortage. After getting your query, I did contact the suppliers who said that the shortage should be alleviated in the "near future". In terms of Hodgkin's disease, for my patients I am planning to substitute etoposide for the vinblastine. Etoposide is a type of chemotherapy which resembles vinblastine. Moreover, it is VERY effective against Hodgkin's disease. If and when the vinblastine supply issue is resolved, I will then go back to using vinblastine. Although vincristine may also be effective and a reasonable choice, it's not my preference. As mind-boggling as these substitutions are, I do NOT believe they will have a negative impact of the effectiveness of your treatment.


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