Ethical Considerations for the Clinical Oncologist in an Era of Oncology Drug Shortages

[摘要] Consider the following cases:J.W. is an 8-year-old girl diagnosed with acute lymphoblastic leukemia with intermediate risk features and an overall favorable prognosis. She receives induction therapy with vincristine, corticosteroids, and L-asparaginase and attains a complete remission. During consolidation therapy that includes systemic chemotherapy and intensive intrathecal therapy for central nervous system prophylaxis, her physicians are informed that there is a critical shortage of preservative-free methotrexate that is necessary for the administration of both the high-dose systemic methotrexate infusions and the intrathecal doses of methotrexate that are scheduled during her consolidation therapy.A.L. is a 55-year-old woman diagnosed with stage III ovarian cancer. She receives debulking surgery and undergoes chemotherapy with paclitaxel and carboplatin. Within 4 months of her last cycle of paclitaxel and carboplatin, she develops recurrent disease. Her physicians start monthly therapy with pegylated liposomal doxorubicin. After two cycles of therapy, she has shrinkage of her disease. However, her physicians are informed that there is a critical shortage of liposomal doxorubicin and that alternative plans should be considered.

[学科分类] 肿瘤学