Shortages of essential medications for children with cancer in Colombia

• Published in: The lancet oncology Vol. 22; no. 10; pp. 1343 - 1345
• Main Authors: Bustamante, Luz Urcuqui, Acosta, Agustín Contreras, Perico, Diego Estupiñan, Grynszpancholc, Edith
• Format: Journal Article
• Language: English
• Published: London Elsevier Ltd 01.10.2021; Elsevier Limited
• Subjects: 6-Mercaptopurine; Acute lymphoblastic leukemia; Arsenic; Arsenic trioxide; Asparaginase; Bleomycin; Calcium; Cancer; Cancer therapies; Carboplatin; Chemoresistance; Children; Children & youth; Cisplatin; Cyclophosphamide; Cytarabine; Dacarbazine; Dactinomycin; Daunorubicin; Decision making; Doxorubicin; Etoposide; Leukemia; Low income groups; Methotrexate; Oxaliplatin; Pediatrics; Public policy; Retinoic acid; Shortages; Survival; Vinblastine; Colombia
• ISSN: 1470-2045; 1474-5488
• DOI: 10.1016/S1470-2045(21)00517-9

For children with acute lymphoblastic leukaemia, overall survival at 5 years is 50–60% in Colombia, whereas overall survival exceeds 90% in high-income countries.1–4 Over the years, the Colombian Association of Pediatric Hematology and Oncology (ACHOP) has developed strategies to increase overall survival in children with cancer. Since 2018, ACHOP has extended the cancer registry at the national level to collect new cases and evaluate clinical results systematically and continuously.1,2 ACHOP gained the support of the Inter-Institutional Observatory of Childhood Cancer as an essential institution for public policy decision making and to help communicate the various national laws that protect the rights of children with cancer.5–7 Despite these strategies, Colombia has historically observed shortages of some medications used in the treatment of childhood cancer, such as mercaptopurine, vincristine, dactinomycin, methotrexate, and asparaginase. Failure to receive the timely application of intrathecal cytarabine increases the risk of relapse in the CNS and the chance of chemoresistance, putting the lives of children and adolescents with these cancers at serious risk.9 Cytarabine is listed by WHO as an essential drug for the management of childhood cancer.10 Other antineoplastic and supportive medications included in the 2019 WHO list of essential medicines for children are arsenic trioxide, bleomycin, asparaginase, calcium folinate, carboplatin, cisplatin, cyclophosphamide, dacarbazine, dactinomycin, daunorubicin, doxorubicin, etoposide, mercaptopurine, methotrexate, oxaliplatin, tioguanine, vinblastine, vincristine, and tretinoin, among others.