The shortages of generic chemotherapy drugs that began this spring have outlasted every resupply estimate drugmakers have given, and one major manufacturer now expects disruptions to last into 2028. Four drugs were in short supply in June. By October, the list had grown, and every cancer center surveyed reported at least one shortage.
Here is how the shortage has unfolded.
June: Rationing concerns surface
Manufacturing problems, shipping delays and discontinuations drove shortages of carboplatin, cisplatin, oxaliplatin and ifosfamide. These drugs anchor treatment for breast, lung, head and neck, ovarian, testicular and bladder cancers. Hospitals working with Premier received only 38% of their ifosfamide orders and about two-thirds of their cisplatin orders. Some providers began spacing out doses, and others prioritized the patients most likely to benefit. The FDA said it was weighing temporary imports from manufacturers that don’t typically supply the U.S., a tool it used during the 2023 cisplatin crisis.
July: Resupply dates slip
Drugmakers pushed back carboplatin resupply estimates, and some formulations are not expected back until 2027. As of July 29, 18 carboplatin presentations lacked enough supply for usual ordering. ASHP advised health systems to check their total supply of each drug before starting patients on combination regimens. It also cautioned that no single agent can replace the drugs in shortage.
September: Every surveyed center is affected
All 31 cancer centers in a National Comprehensive Cancer Network survey reported a shortage of at least one anti-cancer drug. The most common were ifosfamide at 94% of centers, carboplatin at 71% and Bacillus Calmette-Guérin at 52%. Sixty-one percent of centers used mitigation strategies to keep patients on their intended dose and schedule, and 7% said they could not continue treatment. Thirty-nine percent said shortages had affected their clinical trials.
October: The list grows, and the outlook stretches to 2028
Two more injectable chemotherapies joined ASHP’s shortage list. On Oct. 7, ASHP added four Pfizer cytarabine injection products. On Oct. 12, it added 10 irinotecan hydrochloride injection products from Pfizer, Eugia US and Sagent.
Days later, ASHP’s third-quarter report showed chemotherapy shortages rising even as the number of active U.S. drug shortages held steady at 225, down from 227 in the second quarter. ASHP linked part of the increase to flooding at a Pfizer manufacturing facility in India. The plant made generic chemotherapy agents for leukemia, Hodgkin lymphoma and colorectal, pancreatic and testicular cancers, among others, and Pfizer expects the disruption to last into 2028. ASHP warned that shortages may delay treatment for some cancer patients. Children’s hospitals have called chemotherapy their biggest concern because so few alternatives exist.
The broader trend is also moving the wrong way. The 87 new shortages reported through September nearly equal the 89 reported for all of 2025.
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