When cisplatin came on the market in 1978, it revolutionized cancer care. Carboplatin, a related chemotherapy drug with fewer side effects, soon followed in 1986. Together, these two drugs have saved countless lives and are prescribed for up to 20% of cancer patients to treat ovarian, bladder, breast, lung, and other types of cancer. “They’re the backbone for treatments for a lot of different types of cancer,” says Dr. Jacob Reibel, a medical oncologist at Dartmouth Cancer Center.
And yet, in recent years, when some hospital pharmacists have gone to source these chemo drugs for patients, they’ve had difficulty. They’ve had to call around, looking for some other facility that might have extra doses. Doctors, for their part, have had to have tough conversations with patients. If there’s no carboplatin or cisplatin to be had, patients might be given another, less-optimal chemotherapy. Or doctors might try spacing the doses out more than they usually would, trying to stretch the supply. Some fear that these shortages, which have been ongoing since 2023, might make cancer more deadly. In June, the U.S. Pharmacopeia, a nonprofit scientific group, released their latest report on drug shortages, which revealed that the average duration of shortages for drugs of all kinds has more than doubled since 2019.
Why is this happening? The reasons, it turns out, are essentially economic, and have to do with hospitals paying as little as possible for these lifesaving drugs—so little, in the end, that few companies can afford to make them.
Why is there a chemotherapy drug shortage?
This problem has been building for a while, says Matthew Christian, director of supply chain insights at U.S. Pharmacopeia. “Back in 2019, the average drug shortage only lasted about two years. But now when we look at the drugs that remain on the list, the average duration’s over five years,” he says. “In fact, 95% of drug shortages at the end of 2025 were holdovers from 2024. So current shortages—they’re not new. It’s old shortages that have not been resolved and show systemic issues in the supply chain.”
In the case of carboplatin and cisplatin—and several other chemo drugs experiencing shortages—these medicines take a certain investment and expertise to make. They need a specialized sterile facility. But they are now off-patent, or generic, which means that any drug manufacturer is allowed to make them and charge whatever price the market demands.
The market price is the problem. Hospitals in the U.S., or group-purchasing organizations working on their behalf, hunt for the least expensive sources of drugs. A manufacturer that offers the lowest price can win a contract to make a chemo drug. But the purchaser is under no obligation to guarantee that they will buy a given volume, which would ensure that the manufacturer will have enough money to continue making the drug, says Stefan Scholtes, a professor of health management at University of Cambridge in the U.K.
There are plenty of drugs that can be made in the same facilities as chemo drugs. When companies’ capital runs low, “they can repurpose the line for another drug that has a higher margin,” Scholtes says. “Why would they carry on delivering [the chemo]?”
What’s more, the hunt for a minimal cost leads to factories overseas, to relatively few companies willing to take on the task, and to sourcing key ingredients and finished products from just a few places. This leads “to a very fragile supply chain, and when a little thing happens, the whole thing falls over,” says Scholtes. Some global shortages of chemotherapy drugs have been caused by a single plant going offline or failing a quality control check. Currently, the war in Iran has upended supply chains such that some of the few manufacturers of cisplatin and carboplatin are having trouble getting ingredients.
A lot of ingredients for all kinds of drugs come from China and India, says Christian, who has spearheaded the development of a supply-chain monitoring tool for the U.S. Pharmacopeia. He has found that 41% of drugs’ key starting materials are made solely in China, meaning that the health of people around the world relies on Chinese companies continuing to make and provide those ingredients.
What’s the way forward?
At the moment, hospitals “are heavily incentivized to find any drug that is the cheapest upfront cost,” says Christian. “But there’s no real mechanism for hospitals to pay more to ensure greater resilience.” As the shortages prove, these drugs aren’t products where market dynamics lead to a consistent, reliable manufacturing system. “They should be cheap and high-quality,” says Scholtes. “They are essential.”
Generic drugs in general should be like water coming from the tap, he says. It’s a model that inspired a group of U.S. health systems to start a non-profit, U.S.-based drug manufacturer in 2018, which Scholtes, who co-authored a paper about it, calls a “health care utility.” The company, called Civica, is based in Petersburg, Va. and capable of manufacturing a small handful of generic drugs in a U.S. facility and ensuring consistent supply at a sustainable cost. But currently, Civica only produces certain medications—not including chemotherapy drugs. Few companies have similar models and missions, but one, called Phlow Pharmaceuticals, was founded in 2020 to produce active ingredients for drugs in the U.S. in order to mitigate reliance on overseas sources.
Experts say that much more movement in this direction—–from contracts that hold buyers to purchasing a given volume, to factories closer to where drugs are needed, to more diversity and redundancy in supply chains—is needed before patients and doctors can feel secure that cancer care won’t be complicated by shortages. Reibel co-authored a paper looking at whether the 2023 shortage had changed cancer mortality rates, and while they found that doctors seem to have achieved similar short-term survival using alternative treatment plans, he points out that they need to look at the long term to get the full picture of the effects of these shortages.
“In oncology, any shortage in a single medication, a delay in treatment, or substitution could impact cure rates or even survival. So it’s immensely important that we have access to all the therapies at our disposal,” Reibel says. “Unless changes are made in the way that we create and procure these drugs, we will keep having shortages over and over again.”
