Drug Shortages — A Critical Challenge for the Generic-Drug Market

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Abstract
While the oncology community has been focusing much of its attention on the remarkable activity and enviable science related to the discovery of targeted drugs, the importance of standard cytotoxic therapeutics has suddenly become apparent, owing to shortages of the common workhorses of cancer treatment — methotrexate, leucovorin, 5-fluorouracil, cytosine arabinoside, vincristine, etoposide, the anthracyclines, paclitaxel, cisplatin, and others. The list of generic drugs in short supply across all medical specialties is astounding and includes antibiotics, anesthetic agents, antihypertensive medications, and common electrolyte solutions and vitamins.1 These shortages, which primarily affect injectable generic drugs, have forced physicians to prioritize patients, improvise standard regimens (substituting capecitabine for 5-fluorouracil, for example, in adjuvant therapy for colorectal cancer), and at times, choose unproven treatment options for patients with curable disease. The National Cancer Institute has watched with increasing concern as common drugs have disappeared from the shelves of cancer-center pharmacies, threatening the completion of research protocols.

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