Cancer drug shortage may be waning in Michigan. Is it too late for some?

• More than 9 in 10 cancer care providers last month reported a shortage of at least one cancer drug
• There might be some relief for Michigan providers, but supply is tenuous
• A Lansing woman says she is one of an unknown number of Michigan patients affected by cancer drug shortages

Whether the shortage of one of her cancer drugs allowed the return of the tumors that now pepper her pelvis and spinal column, she’ll never know.

Rene Shireman said she tries not to think about a dose of carboplatin she said she was forced to skip in May. The former surgical nurse and grandmother of four is too busy trying to stay alive after first being diagnosed with breast cancer in 2015.

“If I dwell on it, I’d be furious, and anger is not part of a healing process,” said Shireman, 67, of Lansing.

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She is among thousands of American cancer patients facing the possibility of having to skip or curtail drug treatment due to persistent shortages of more than two dozen cancer medications, most notably carboplatin and cisplatin.  Physicians report having to prioritize available drugs for patients with better chances of survival, or dispensing less effective medications or ones with harsher side effects when their first choice is unavailable. 

In May, Shireman, who was on a two-drug cocktail of carboplatin and Gemzar, said she was unable to receive the carboplatin after being told it was unavailable. She said she was able to resume getting both drugs in June and July. 

The drug shortage is not expected to end anytime soon, but officials from five Michigan health systems, two medical groups, as well as the chief scientific officer with the American Cancer Society, told Bridge Michigan there are tentative signs the shortages may be easing. 

“The supply is still tricky, but it’s not as critical,” said Emily Mackler, director of the Pharmacists Optimizing Oncology Excellence in Michigan and the Michigan Oncology Quality Consortium — partnerships of oncologists and of pharmacists specializing in oncology care.

In recent weeks, Eric Warren, the clinical coordinator at the Traverse City-based Munson Healthcare pharmacy, said he too has seen evidence of easing shortages. 

“The market is very, very fluid,” Warren said, adding, “we continue to monitor it.”

Carboplatin and cisplatin belong to a class of infusion drugs containing the element platinum, which binds to the DNA of cancer cells and disrupts the cell’s ability to grow. The U.S. Food and Drug Administration first alerted health providers on Feb. 10 that cisplatin was becoming scarce. On April 28, the administration added carboplatin to its drug shortages list.

Last month, the National Comprehensive Cancer Network announced that 93 percent of U.S. cancer care providers faced shortages of carboplatin, and 70 percent were short on cisplatin. That has forced patients to either skip doses or receive other, older drugs with greater odds of side effects.

This week, spokespeople for Corewell Health, Trinity Health Michigan, and Henry Ford Health told Bridge, via email, their supplies have likewise  improved in recent weeks.

“It’s not as precarious as it was,” said Dr. M. Salim Siddiqui, a Wayne County radiation oncologist and president of the Michigan State Medical Society. “That said, we’re still in a state of vigilance, if not an emergency.”

Dr. William Dahut, chief scientific officer for the American Cancer Society, told Bridge it appears that, “anecdotally” at least, U.S. providers have been able recently to tap into carboplatin and cisplatin production in China and India. What’s unclear, however, is how supplies of other drugs may be impacted by the tornado damage at a Pfizer plant last week in North Carolina, he said.

Shireman, who has been treated at Karmanos Cancer Institute at McLaren of Greater Lansing, had beaten back her first bout of breast cancer after receiving the triple treatment of chemotherapy, surgery and radiation. But in 2020, as COVID bore down across the globe, back pain ultimately signaled its return as metastatic cancer. Tumors were discovered in her skull, liver, lymph nodes, spinal column, ribs and pelvis.

“It seemed everywhere,” she said.

Last summer, she experienced what seemed like a miracle: After taking a series of drugs, Karmanos doctors told her they couldn’t find any signs of cancer anywhere in her body.

She said she sat with her husband in the doctor’s office, “blinking back tears. We were dumbfounded,” she said.

To be safe, doctors and Shireman agreed to continue chemotherapy — a regimen uninterrupted until the skipped carboplatin dose in May, she said.

Whether or not the skipped dose made a difference is unclear. But scans on July 6 “came back showing metastatic activity,” she told Bridge Michigan.

What had appeared as undefined anomalies on previous scans now were  part of a constellation of six tumors on the left side of her pelvis and near her spinal column.

A spokesperson for Karmanos, part of McLaren Health Care, did not return messages from Bridge Michigan about Shireman’s case. McLaren Health spokesperson Dave Jones told Bridge the system will not comment on individual patient’s cases.

Speaking more broadly, however, Jones told Bridge in an email that McLaren has also seen “a relief from shortages in the past weeks.” 

As the drug shortages have dragged on through the summer, federal lawmakers are stepping in, although it’s unclear whether their efforts will make a difference.

U.S. Senator Gary Peters, D-Michigan, chair of the Homeland Security and Governmental Affairs Committee, and two others last week introduced bipartisan legislation to create a database to map the pharmaceutical supply chain and identify possible shortages. It would include information on the manufacture of the drug, including the country of origin and quantity.

U.S. Rep. Elissa Slotkin of Holly met with hospital leaders this month to talk about drug shortages and is considering legislation that would give the U.S. Heath and Human Services secretary power to compel manufacture of drugs in short supply.

Even if successful, such efforts would take time, something Shireman and many other cancer patients may not have.

In a recent visit at her Lansing home, Shireman moved quickly, a tight braid cascading down her neck and back, as she showed 31 family photos on a wall in her family room. A fused glass clock in her kitchen — a timepiece she and husband, Tim, created while on vacation in Saugatuck in 2015 — marked each passing minute.

The photos, she said, aren’t just a collection of memories. They are a nod to a future she still sees as possible — pictures of grandchildren suggest others yet to come; family gatherings offer a hint of future celebrations, trips taken are vacations that still need to be booked.

In a back room, an unfinished blue sundress awaits another sewing lesson she’s giving her 9-year-old granddaughter, Cindel.

“I’m 67, and I think that’s still pretty young,” she said. “I have plans.”