Premium ContentMouse over Home then click on Premium Content for information.LINCOLN — Local hospitals are still scrambling in the wake of a nationwide shortage of a drug called methotrexate, which cures almost all cases of the most common childhood cancer.
At St. Elizabeth Regional Medical Center in Lincoln, a patient has already missed one chemotherapy treatment because of the shortage and might have to go without another.
Children's Hospital & Medical Center in Omaha has enough of the chemotherapy drug to last only a few weeks.
Parents and patients at the University of Nebraska Medical Center are looking for answers about whether they will get their future treatments, but doctors can't assure them they will.
"The only answer we have for them is that we're doing the best we can and we're managing the supply we have," said Dr. Jill Beck, a pediatric oncologist at UNMC.
Late last year, one of methotrexate's few U.S. manufacturers suspended production, citing quality concerns. The remaining makers of the drug, which is available only generically, haven't kept pace with demand.
A small profit margin provides little financial incentive, said Dr. Lisa Kwapniowski, Children's pharmacy manager.
Methotrexate is incredibly effective at treating bone cancers and leukemia. It cures 90 percent of cases of acute lymphoblastic leukemia, or ALL, the most common cancer in children.
The shortage involves only the form of the drug administered intravenously.
Drug shortages aren't rare. The U.S. Food and Drug Administration lists about 185 medications that are in short supply. But one of this magnitude, with such serious implications for cancer patients, is worrisome, said Dr. Kurt Clyne, director of the St. Elizabeth pharmacy.
Two weeks ago, the St. Elizabeth pharmacy tried to obtain methotrexate for an adult patient's upcoming chemotherapy session. The pharmacy's buyer contacted a Kansas City wholesaler to place an order, but the drug wasn't available.
The buyer called five manufacturers and only one had the drug in stock — but it wasn't enough for a full dose, so the patient had to go without a treatment.
Clyne wasn't sure the pharmacy will have enough of the drug for the patient's next round, either.
A skipped chemo treatment gives latent cancer cells more time to grow, said Beck, the UNMC oncologist, who also works at Children's and the Nebraska Medical Center.
After working with health care organizations and nearby hospitals and treatment centers, UNMC has enough methotrexate to fulfill scheduled treatments.
"But once we run out, we're kind of stuck," Beck said.
Substituting medications isn't a good option, given the effectiveness of methotrexate.
"To use something that's not the best treatment is not ideal, so we're affecting survival by doing that," Beck said.
The FDA says it has averted a potential crisis by asking the remaining manufacturers to ramp up production, but health care providers could get no assurance that the shortage would quickly subside.
For them, the situation is uncomfortably fluid.
For example, at 12:45 p.m. Thursday, Children's Hospital had enough methotrexate to last a couple of weeks, at best. About 1 p.m., its manufacturer told the hospital it would send 51 grams, which would get the hospital through an additional two weeks.
In the end, the manufacturer could send only 31 grams.
"This drug gives patients a lot of hope, and without enough of it, it's very concerning," Kwapniowski said.
The uncertainty makes an already wrenching situation more stressful for cancer patients and their families, said Beck and Cherie Lytle, a spokeswoman for Children's.
Mindy Lindner said methotrexate, among other treatments, saved her daughter Paige, who was diagnosed with leukemia when she was 3 years old.
After having sore feet for two or three weeks as a toddler, Paige saw a pediatrician. As it turned out, her feet hurt because they were packed with leukemia cells, which would eventually ravage her body and cause her to relapse twice.
Paige is now a healthy 12-year-old worried about boys, seventh grade and sports, her mother said.
"If (methotrexate) wasn't given to her at those high doses," Lindner said, "I'm not really sure where she would be at this time."
Lindner said even though Paige is no longer administered methotrexate, she's worried about the shortage, not only because of the lack of medication but also because of the added mental and emotional drain on families.
"You just want to fix it," Lindner said. "You just wish it was a phone call you could make and say 'Hey, we have kids here that need this.'"
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teresa.lostroh@owh.com
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