Navigation Links
Shortage of Drug for Children's Cancer May Have Upped Relapse Rates
Date:12/27/2012

By Serena Gordon
HealthDay Reporter

WEDNESDAY, Dec. 26 (HealthDay News) -- When a national shortage of a cancer drug that had helped treat children with Hodgkin's lymphoma for decades forced doctors to find a substitute, they thought they had settled on a drug that would work just as well for these young cancer patients.

But a new analysis suggests they were mistaken.

Mechlorethamine, also known as nitrogen mustard, had been part of a common chemotherapy regimen for Hodgkin's since the 1960s, but experts believed the drug cyclophosphamide would perform equally well. The statistics in the analysis tell another story, however, with two-year remission rates dropping from 88 percent to 75 percent after the switch was made.

"We thought this would be an easy substitution. Cyclophosphamide has been used forever for Hodgkin's lymphoma," said analysis co-author Dr. Monica Metzger, an associate member of the department of oncology at St. Jude Children's Research Hospital in Memphis, Tenn. "We thought the equivalent dose would work just as well, but it doesn't work the same in this chemotherapy regimen. More patients relapsed."

"There are many treatments that work very well. Both mechlorethamine and cyclophosphamide are efficacious, but once you begin a regimen of medications, you have to follow the whole regimen," Metzger said. "It's like a recipe. Like any other recipe, it calls for certain ingredients, and if you make a substitution, you get different results."

The original chemotherapy regimen for Hodgkin's lymphoma, dubbed MOPP, included mechlorethamine, vincristine, procarbazine and prednisone. This combination of drugs was effective, but it also was linked to secondary leukemia and infertility.

Since then, other chemotherapy combinations have been developed to help lessen the side effects. In an effort to further improve outcomes for those with Hodgkin's lymphoma, a newer regimen called Stanford V was developed at Stanford University. This regimen included a shorter course of treatment and lower doses of some of the drugs, including a lower cumulative dose of mechlorethamine.

The Pediatric Hodgkin Lymphoma Consortium, a group of medical centers (including St. Jude's) that conducts clinical trials for pediatric Hodgkin's lymphoma, began using the Stanford V regimen along with low-dose radiation therapy in 2002 for high-risk patients, and in 2006 for patients with an intermediate-risk cancer.

The shortage of mechlorethamine began in 2009. Just one company manufactured the drug, and a manufacturing issue caused the company to abruptly stop making the drug. This caused a worldwide shortage of the drug, Metzger said. Mechlorethamine has only recently become available again, she added.

To see what impact the substitution had on relapses, the researchers turned to the consortium's clinical trial, and compared nearly 200 patients who were treated with the original regimen to 40 patients who were treated with the substituted regimen.

They found that the treatment regimen including cyclophosphamide was significantly less effective.

The analysis is published in the Dec. 27 issue of the New England Journal of Medicine.

Fortunately, there are additional treatment options for people who relapse, although they likely will be exposed to more radiation and have additional side effects that they might have been spared on the original regimen.

Metzger said the U.S. Food and Drug Administration has started to put some programs in place that will help prevent shortages of vital generic medications, such as having the manufacturers let the agency know early if they're planning on exiting the market, or if they're anticipating any manufacturing problems.

Dr. Arlene Redner, associate chief of oncology at Cohen Children's Medical Center in New Hyde Park, N.Y., suggested, "The FDA should ensure that the orphan drugs that are vital in pediatric oncology are manufactured and [that there are] companies known to have excellent manufacturing facilities without production problems to produce them."

"The decision to manufacture these orphan drugs or to stop the manufacture of them should not be a decision of the drug company alone," Redner added. "These drugs should be produced at more than one facility."

Redner also sought to reassure concerned parents, and said it's important to know that "there are other excellent therapies for pediatric Hodgkin's lymphoma that have not required the use of mechlorethamine."

More information

Learn more about how the U.S. Food and Drug Administration handles drug shortages.

SOURCES: Monica Metzger, M.D., associate member, department of oncology, St. Jude Children's Research Hospital, Memphis, Tenn.; Arlene Redner, associate chief, oncology, Cohen Children's Medical Center, New Hyde Park, N.Y.; Dec. 27, 2012, New England Journal of Medicine


'/>"/>
Copyright©2012 ScoutNews,LLC.
All rights reserved  

Related medicine news :

1. Drug shortage linked to greater risk of relapse in young Hodgkin lymphoma patients
2. Fentanyl Injection Shortages Reported: Severe Adverse Events as AttorneyOne Informs
3. Study Foresees Shortage of Primary-Care Doctors
4. Nurse practitioners: The right prescription to ease doctor shortage
5. $3.4 million HHS grant to help UIC address shortage of Latino health providers
6. Canada needs national approach to protect against drug shortages
7. Brain power shortage
8. AFARs MSTAR program addresses shortage of geriatric medicine physicians
9. US Drug Watchdog Now Urges Loved Ones Of A Diabetic Who Died From Bladder Cancer Who Had Used The Diabetes Drug Called Actos To Call The Johnson Law Group Immediately
10. Dr. Gary McClain of JustGotDiagnosed.com Addresses Prostate Cancer Support Group
11. US cancer screening rates decline over the last 10 years, finds new study
Post Your Comments:
*Name:
*Comment:
*Email:
Related Image:
Shortage of Drug for Children's Cancer May Have Upped Relapse Rates 
(Date:1/16/2017)... ... January 16, 2017 , ... ... first-quality education and high-level training standards to an international multidisciplinary group of healthcare ... problems. As a way to further its mission at the grassroots level, iaedp ...
(Date:1/15/2017)... NY (PRWEB) , ... January 15, 2017 , ... In ... accounts in the United States for the asthma & allergy friendly mark. This certification ... to independently test and identify consumer products to be more suitable for the 60+ ...
(Date:1/15/2017)... ... January 15, 2017 , ... San Francisco Magazine recently ... Area counties for 2017. Almost 1,000 nominations were submitted and a little over ... Results were announced the magazine’s January 2017 issue . , Under the ...
(Date:1/14/2017)... ... 2017 , ... According to a December 9 article ... the risk of type 2 diabetes, Alzheimer’s, and cardiovascular disease. Southern California based ... linked to a Mediterranean diet are only some of the many reasons that ...
(Date:1/13/2017)... ... , ... A January 10 article in the Daily Star on ... with an emphasis on some new techniques that the publication says are becoming more ... casually to his patients and colleagues as Dr. J, comments that the best plastic ...
Breaking Medicine News(10 mins):
(Date:1/13/2017)... , Jan. 13, 2017  Alfalfa, cattle, leafy greens and ... environmental sampling film , which emphasizes the food industry,s shift ... highlights how COPAN,s Swab Rinse Kit ... the surface sampling process in the wake of the new ... COPAN is expanding the U.S. production ...
(Date:1/13/2017)... 2017 The 2016 election resulted in ... states voting in favor of legalizing cannabis for recreational use, ... in the U.S. In addition, the state of ... cannabis products sales. The ArcView Group has published an updated ... cannabis sales in the U.S. last year reached $6.7 billion, a ...
(Date:1/13/2017)... 2017 Research and Markets has announced the ... report to their offering. ... Cystic fibrosis (CF) is a progressive genetic condition ... fibroses transmembrane conductance regulator (CFTR) gene from both parents. The defective ... and result in the buildup of a thick and sticky mucus ...
Breaking Medicine Technology: