A new NCCN survey shows that shortages of generic oncology medicines remain widespread, affecting established treatments such as ifosfamide, carboplatin, and cisplatin—and placing new pressure on cancer care, clinical trials, and the pharmaceutical supply chain.
Key Takeaways
- Cancer drug shortages remain widespread. In the September 2026 NCCN survey, all 31 responding centers reported at least one anticancer drug shortage. Respondents reported shortages of ifosfamide in 94% of centers, carboplatin in 71%, cisplatin in 16%, and BCG in more than half of centers. More than 20% reported shortages involving five or more anticancer medicines. [1][3][25]
- The composition of the shortage changes over time. The severe carboplatin and cisplatin shortage reported in 2023 eased considerably by 2024. Carboplatin shortages have now returned, while ifosfamide has become the most widely reported shortage in the 2026 survey. [1][26][27]
- Most centers have continued treatment. Sixty-one percent of responding centers reported requiring pharmacy- and physician-led mitigation strategies to keep patients on recommended doses and schedules. Thirty-two percent reported that mitigation was not required, while 7% reported that they could not keep all patients on the intended course. [1][3][25]
- Shortages create clinical and administrative consequences even when treatment continues. Ninety percent of centers reported that treatment-plan modifications required repeat prior authorization, and 17% reported that obtaining reauthorization delayed treatment. [1][4][25]
- Clinical trials are also affected. Thirty-nine percent of responding centers reported that shortages had affected clinical trials. [25]
- The underlying problem remains structural. Low prices, manufacturing complexity, limited production capacity, geographic concentration, quality problems, and insufficient redundancy can leave older generic medicines particularly vulnerable to disruption. [6][7][28]
- The direct effect on survival remains incompletely characterized. The available literature documents treatment delays, substitutions, dose changes, and administrative consequences, but the population-level effect of recurrent shortages on cancer outcomes remains difficult to quantify. [10][18][19]
Carboplatin and cisplatin are platinum-based chemotherapies that have been fundamental components of cancer treatment for decades. They are used across multiple malignancies, including lung, ovarian, bladder, testicular, head and neck, and other cancers, and remain important components of both curative and noncurative treatment regimens. Their importance is not simply historical. These established medicines continue to provide the chemotherapy backbone for many evidence-based treatment regimens, including combinations with newer targeted therapies and immunotherapies. Ifosfamide is another established cytotoxic agent used in a range of solid and hematologic malignancies, including sarcomas and selected leukemias and lymphomas.
In September 2026, these older medicines are again drawing attention because of supply constraints. On September 10, the National Comprehensive Cancer Network (NCCN) reported that all 31 responding member institutions were experiencing a shortage of at least one anticancer drug. Ninety-four percent reported an ifosfamide shortage, 71% reported a carboplatin shortage, 16% reported a cisplatin shortage, and more than 20% reported shortages involving five or more anticancer medicines. [1][3][25] For oncology, the significance extends beyond whether a particular vial is available on a particular day. A shortage can require pharmacists and physicians to conserve inventory, modify treatment plans, obtain additional authorization, identify clinically appropriate alternatives, or delay a regimen. The effects can extend to clinical trials and to the administrative systems surrounding cancer treatment.
At the same time, a drug shortage should not be confused with a temporary local inventory problem. The U.S. Food and Drug Administration (FDA) defines a national drug shortage as a period when demand, or projected demand, for a drug in the United States exceeds supply. Hospitals and pharmacies can experience localized distribution problems even when a medicine is not classified nationally as being in shortage. [28][29] This distinction really matters because the current problem is not simply that cancer centers occasionally run out of a drug. Established medicines can become vulnerable to recurring manufacturing and supply disruptions.
Old Drugs, Essential Work
Platinum chemotherapy is not new. Cisplatin was introduced into clinical oncology more than four decades ago, followed by carboplatin, yet both remain clinically important because they are active across multiple tumor types and are included in established treatment regimens. Their continued use also illustrates an important characteristic of modern oncology: newer therapies do not necessarily replace older drugs. Instead, clinicians often combine established cytotoxic agents with targeted therapies, immunotherapies, radiation, surgery, or other systemic treatments. A shortage of a generic chemotherapy can therefore affect a much broader treatment strategy.
The NCCN has emphasized that large randomized phase 3 trials frequently evaluate a new therapy against, or in combination with, an established standard-of-care backbone. That backbone may be a generic medicine such as carboplatin or 5-fluorouracil (5-FU). [11] Renuka Iyer, MD, NCCN’s chief medical officer, has also noted that hundreds of generic medicines are used in oncology, but that a relatively small number are incorporated into treatment regimens across many cancer types. [4] This is one reason substitution is not necessarily straightforward.
Cisplatin and carboplatin belong to the same broad platinum class, but they are not simply interchangeable on a one-for-one basis. Their dosing, pharmacokinetic properties, toxicity profiles, supportive-care requirements, and disease-specific evidence differ. Cisplatin is associated with clinically important nephrotoxicity, ototoxicity, neuropathy, and other toxicities, while carboplatin is generally more strongly associated with myelosuppression, particularly thrombocytopenia. Treatment selection depends on the cancer being treated, the regimen, patient-specific factors, and the evidence supporting the particular combination.
The same principle applies when clinicians consider replacing one chemotherapy with an entirely different agent. An alternative may be guideline-supported in one setting but not another. The existence of another drug does not automatically mean that the clinical evidence, efficacy, toxicity, dosing, and treatment intent are equivalent. That difference matters especially when the affected drug is part of a regimen with curative intent.
Ifosfamide: A Different but Equally Important Problem
Ifosfamide illustrates another dimension of the shortage problem. The NCCN lists ifosfamide among treatments used for bladder, ovarian, testicular, and uterine cancers; soft-tissue sarcoma; osteosarcoma; and selected adult and pediatric leukemias and lymphomas. [1][4] Its FDA-approved indication is narrower, covering previously treated malignant testicular germ-cell tumors, while much of its contemporary use occurs in other settings based on clinical evidence and guideline-supported practice.[12] Unlike carboplatin and cisplatin, ifosfamide is not simply a universal backbone drug across oncology. Its importance is concentrated in particular diseases and treatment settings. That does not make the shortage less consequential for the patients who depend on it. The current shortage also demonstrates how quickly a manufacturing problem can become a clinical supply problem.
The FDA added ifosfamide injection to its shortage database in June 2026. The disruption involved manufacturing and supply constraints affecting multiple manufacturers. [12][14] In August, ASCO warned that some practices had only a few weeks of inventory remaining. A shortage-management document cited by the American Society of Clinical Oncology (ASCO) indicated that the shortage could continue into at least October 2026, although the timing of full production recovery remained uncertain. [12][13]
The FDA has worked with SteriMax USA to temporarily import an unapproved 1-g ifosfamide product manufactured by Qilu Pharmaceutical Co., Ltd., a vertically integrated pharmaceutical company based in Jinan, Shandong, China. In its August 21, 2026 letter to healthcare professionals, the FDA states that the imported product is not FDA-approved and uses non-U.S. labeling. The letter also identifies differences in labeling and handling instructions that healthcare professionals must understand when using the imported product. [15]
This response illustrates one of the mechanisms available to regulators during a critical shortage: temporarily facilitating access to a product that is not ordinarily marketed in the United States. However, the problem is not confined to the United States. The European Medicines Agency (EMA) reports an ongoing shortage of ifosfamide-containing medicines throughout the European Economic Area (EEA).* The EMA attributes the shortage to a technical manufacturing issue and required site improvements following a regulatory inspection in September 2025. Manufacturing has resumed, but the agency expects the shortage to continue until the manufacturing site returns to full capacity in the first quarter of 2027. EMA states that the shortage is not related to a product quality defect or safety issue. [16]
What the September 2026 NCCN Survey Found
The NCCN survey provides the clearest current snapshot of the problem. The results, published September 10, 2026, were based on responses collected in late August from pharmacy directors and other clinical and administrative leaders at NCCN Member Institutions. [1][25] Every responding center reported at least one anticancer drug shortage.
More than 20% of centers reported shortages involving five or more medications at the same time. [1][25]
This operational response was substantial. Sixty-one percent of centers reported requiring pharmacy- and physician-led mitigation strategies to keep patients on recommended doses and schedules. Thirty-two percent reported that they did not require mitigation, while 7% said they could not keep all patients on the intended course. [1][3][25]
Among the 28 centers that provided details about their mitigation strategies:
- 79% used waste-management strategies;
- 43% limited use of available stock;
- 32% used the lower end of the recommended dosing range when appropriate;
- 21% used the maximum interval within a recommended treatment schedule; and
- 29% reported other approaches. [25]
These percentages should not be interpreted as evidence that these strategies are interchangeable. They represent the approaches reported by participating institutions and reflect the need to manage inventory while attempting to maintain guideline-concordant care. Seventy-one percent of the 31 centers reported having a multidisciplinary drug-shortage committee. Among those centers, the most common responsibilities were notifying clinical staff about interim protocols, developing substitution protocols, and tracking and forecasting inventory. [3]
Only 32% reported notifying patients about interim protocols that could affect them. [3] The administrative burden was also significant. Among 29 centers, 90% reported that treatment-plan modifications required repeat prior authorization. Seventeen percent—approximately five centers—reported that obtaining the new authorization delayed treatment. [1][4][25] A treatment change can also trigger additional clinical and administrative steps, including new consent requirements and rescheduling at an infusion center. [4] These consequences illustrate why a shortage can affect patient care even when an alternative treatment is ultimately available.
A Return, Not Simply a Continuation
The historical NCCN data are important because they show that the current situation is not simply the continuation of the exact shortage seen in 2023. In June 2023, 93% of 27 responding centers reported carboplatin shortages and 70% reported cisplatin shortages. By September 2023, those figures were 72% and 59%, respectively. [27] By the spring 2024 survey, only 11% of 28 centers reported carboplatin shortages and 7% reported cisplatin shortages. NCCN described the acute platinum crisis as largely resolved at that time, although shortages involving other generic oncology medicines continued. [26]
The September 2026 survey found carboplatin shortages in 71% of participating centers and cisplatin shortages in 16%. [1] The composition of the shortage has also changed. In 2024, 57% of centers reported vinblastine shortages, 46% reported etoposide shortages, and 43% reported topotecan shortages. [26] In the 2026 survey, no responding center reported a shortage of vinblastine or topotecan, while ifosfamide had become the most widely reported shortage. [1][4]
This distinction is important. The data do not show that the same medicines have remained continuously unavailable since 2023. Instead, they show a recurring pattern in which the specific medicines affected can change as manufacturers, production capacity, demand, inventories, and other supply conditions change. The respondent sets also differ by year—27, 29, 28, and 31 centers in the cited surveys—and the surveys were conducted at different times. Direct comparisons therefore have limitations. [1][26][27] The FDA’s national shortage database is another measure and should not be treated as interchangeable with the NCCN institutional survey. FDA evaluates shortage status nationally, while NCCN reports what participating institutions are experiencing. [28][29]
Why Oncology Drug Shortages Persist
The vulnerability of older generic medicines is not new. The FDA identifies several factors that can contribute to drug shortages, including manufacturing and quality problems, production interruptions, discontinuations, unexpected increases in demand, and limited manufacturing capacity. Older sterile injectable medicines can be particularly vulnerable because relatively few manufacturers may produce them, production lines can be limited, and injectable manufacturing is complex and requires long lead times. [28][29]
The US Pharmacopeia (USP) has identified four interrelated areas of risk particularly relevant to oncology medicines, including low prices, manufacturing complexity, geographic and supplier concentration, and quality and manufacturing concerns [6][7]
Price
Many older generic oncology drugs have been available for years and face intense price competition. The economics can create a difficult balance. Hospitals and health systems need affordable medicines, while manufacturers need sufficient revenue to support production, quality systems, maintenance, redundancy, and investment in additional capacity.
The FDA’s Drug Shortages Task Force, established in July 2018 by then-Commissioner Scott Gottlieb, MD, to identify the underlying root causes of nationwide pharmaceutical shortages and recommend long-term solutions, previously identified a lack of incentives to produce less-profitable medicines and a failure of the market to adequately recognize mature quality systems as important contributors to drug-shortage vulnerability. [12] However, this does not mean that low price alone causes a shortage. Rather, price pressure can become one part of a larger system in which the financial incentive to maintain multiple production sources is limited.
Manufacturing Complexity
Sterile injectable medicines require specialized manufacturing environments and stringent quality controls. Antineoplastic drugs also require additional occupational-safety precautions because many of these agents are hazardous to workers who manufacture, prepare, or administer them. The combination of sterile manufacturing, specialized facilities, limited production lines, quality requirements, and long manufacturing lead times can make rapid supply increases difficult when a manufacturer experiences an interruption. FDA specifically identifies these characteristics as reasons older sterile injectables can be vulnerable to shortage. [28]
Concentration
Supply concentration can create another vulnerability. The USP’s analysis has identified instances in which a relatively small number of facilities account for substantial portions of U.S. supply for particular medicines. A medicine’s geographic source can also change over time, meaning the supply picture in 2026 may not match what was observed in 2022 or 2023. [6][7] Hence, the issue is not simply whether a drug is manufactured in the United States or overseas. A domestic manufacturer can experience quality problems, equipment failures, workforce disruptions, raw-material shortages, or other interruptions. Overseas manufacturers can face those same problems, plus transportation, geopolitical, regulatory, and weather-related disruptions. The relevant question is therefore broader: How much redundancy exists across the entire (global) supply chain?
Quality
Quality problems can directly reduce available supply when a manufacturing facility must correct deficiencies, temporarily stop production, or operate below capacity. The 2023 platinum shortage clearly showed how a manufacturing disruption can ripple across oncology. Published analyses concluded that the shortage reflected multiple factors, including manufacturing and supply-chain vulnerabilities and limited redundancy. [8] Quality and reliability are therefore not separate from supply chain security. They are clearly an important part of it.
Clinical Consequences
The clinical effect of a shortage depends on the medicine, the disease, the treatment setting, and the alternatives available. A patient receiving a curative regimen may face a different clinical situation from a patient receiving later-line treatment for metastatic disease. A pediatric patient may have fewer evidence-supported alternatives than an adult patient with a different malignancy. A clinical trial participant may be subject to protocol requirements that do not apply to routine clinical care. Therefore, no single clinical consequence applies to every drug shortage.
What can be documented is the operational response. Oncology pharmacists may need to identify available inventory, determine which treatment settings require priority, communicate with physicians, evaluate guideline-supported alternatives, conserve available product, modify treatment schedules when clinically appropriate, obtain additional authorization, coordinate with distributors, and communicate changes to patients.
A 2025 review of oncology drug shortages reported that shortages have been associated with treatment delays, dose changes, substitutions, and other disruptions. [6] ASCO has published clinical guidance on alternative treatments during oncology drug shortages and separate ethical guidance addressing the practical management of shortages. [22][23] The existence of alternative therapy does not eliminate the clinical problem. The alternative must be appropriate for the specific disease and treatment setting, supported by available evidence, and suitable for the individual patient.
Pediatric Oncology: Where Substitution Can Be Particularly Difficult
Pediatric oncology deserves specific attention because treatment protocols can be highly structured and the number of evidence-supported alternatives for some cancers can be limited. The pediatric oncology community has previously addressed chemotherapy shortages through consensus recommendations emphasizing two principles: maximizing the benefit of effective medicines and maintaining equitable access to treatment. [21]
Those recommendations included optimizing use of available supply, maintaining access to evidence-based treatment inside and outside clinical trials, and improving information sharing about shortages. The current NCCN survey also illustrates the breadth of ifosfamide’s use in pediatric oncology, including selected leukemias and lymphomas. [1] The clinical significance of a shortage therefore cannot be determined simply by counting available alternatives. The relevant question is whether an alternative has sufficient evidence for the particular disease, patient population, treatment intent, and line of therapy.
Clinical Trials Are Part of the Supply Chain Problem
Drug shortages can also interfere with clinical research. Thirty-nine percent of respondents in the 2026 NCCN survey reported that shortages had affected clinical trials at their institution. [25] This is important because a shortage can involve a standard-of-care component of a trial rather than the investigational drug itself.
A protocol may specify a particular chemotherapy backbone. If that medicine becomes unavailable, a site may need to limit enrollment, delay trial activation, or work through additional procedures to obtain sufficient supply. NCCN previously reported that shortages affected clinical trials through reduced enrollment in open studies, delays in opening studies that included medicines in shortage, and additional administrative work required to secure drug supply. [11]
For oncology drug development, this adds another layer of complexity. Clinical trials depend on predictable access to both investigational products and established standard-of-care medicines. A shortage of an established generic drug can therefore affect the infrastructure required to evaluate newer therapies.
Coping at the Bedside
Clinicians increasingly must manage supply-chain problems alongside clinical care. The USP has reported that oncology pharmacists have faced treatment delays, dose reductions, and regimen changes linked to drug shortages. [6] The practical response varies by institution. Some hospitals maintain shortage committees that monitor inventory and establish interim protocols. Others create drug-conservation strategies or identify guideline-supported alternatives. Moffitt Cancer Center in Tampa, for example, has described an approach that identifies historically vulnerable medicines and builds inventory planning around them. [4] Such institutional strategies can reduce the immediate effect of a shortage, but they also consume staff time.
And while most cancer centers can continue treating patients, that doesn’t mean the shortage has no consequence. It means that pharmacists, oncologists, nurses, administrators, and other healthcare professionals are absorbing part of the disruption. The 2026 NCCN survey makes that clear.
Equity and Community Oncology
The NCCN survey also raises an important question about what is happening outside major academic cancer centers. Seventy-seven percent of responding institutions reported being aware of shortage problems in community practices in their areas. [25] This is self-reported awareness, however, rather than a systematic measurement of community oncology shortages. A 2025 analysis argued that community and safety-net hospitals may be particularly vulnerable because they often operate with fewer financial and operational resources. [9]
The distinction between academic and community oncology matters because institutions may differ in their ability to maintain larger inventories, employ dedicated pharmacy teams, participate in shortage committees, and negotiate with multiple suppliers. However, more data are needed to determine how much the burden differs across healthcare settings.
What Pharmacy Directors Want
The NCCN survey also asked pharmacy directors about policy. Among the 23 pharmacy directors who responded to those questions, 4% said national or state policies had improved the shortage situation since 2023, while 96% said the situation had remained about the same. [1][3] Ninety-one percent favored economic incentives to encourage high-quality generic manufacturing. Fifty-seven percent supported better systems for accrediting or rating generic suppliers, and 48% favored exempting generics from tariffs. [1][3][25] Respondents also requested greater transparency regarding generic suppliers and earlier notification to FDA when manufacturers anticipate problems. [1][3]
These are policy preferences reported by survey respondents; they are not evidence that any particular policy would resolve shortages. The NCCN has joined other cancer organizations in the End Cancer Drug Shortages Coalition.** Its May 2026 consensus statement identified three broad priorities. including greater transparency across the drug supply chain; stronger incentives for high-quality and redundant manufacturing; and the stabilization of the generic drug market. [24]
The USP and American Cancer Society Cancer Action Network (ACS CAN) have also supported measures involving early-warning systems, identification of vulnerable medicines, and payment models intended to recognize supply reliability and quality. [6] The FDA has separately emphasized the importance of early notification from manufacturers and risk-management strategies intended to identify and mitigate potential shortages before they become severe. [28][29]
A Domestic Manufacturing Test Case
One development in Arizona offers a useful case study in efforts to strengthen domestic manufacturing capacity. On August 11, 2026, the FDA granted Bright Path of Mesa, AZ, an Advanced Manufacturing Technology (AMT) designation, the agency’s pathway for encouraging the adoption of novel technologies for critical medicines, covering production of carboplatin and lidocaine, both of which have appeared on the FDA shortage list. The designation was reported as the first AMT designation for a small-molecule manufacturing technology. [20]
The company’s manufacturing platform uses a spinning tube-in-tube reactor and a robotic sterile-filling system. According to the company, the process can convert base chemicals into finished medicine in hours and has produced average yields 178% higher than conventional batch manufacturing. [20] Those are company-reported figures and should be interpreted accordingly. The company has also reported that its initial production capacity is committed under contract, with first shipments planned for early 2027. [20]
The significance of the development is not that one manufacturer can solve the national shortage problem. Rather, it illustrates one possible approach to increasing manufacturing flexibility and domestic production capacity. However, important questions still remain unanswered, including how much product the facility will ultimately manufacture, what price it will command, how much national demand it could represent, and whether additional manufacturers will adopt similar technologies.
While domestic manufacturing can reduce some forms of supply-chain dependence, it does not eliminate the possibility of manufacturing interruptions. A resilient supply system requires redundancy, quality, sufficient capacity, and reliable access to raw materials and components.
Not a New Problem
The current shortage is the latest chapter in a much longer history. In 2011, a hematology/oncology pharmacy specialist reported that approximately 20 chemotherapy agents, most of them widely used generic medicines, were in short supply. [10]
An Institute for Safe Medication Practices (ISMP) survey cited in that report found that oncology professionals had experienced or witnessed medication errors associated with shortages. The same report described treatment substitutions, including changes involving FOLFOX chemotherapy, a combination regimen made of oxaliplatin, fluorouracil (5-FU), and leucovorin primarily used as a standard treatment for colorectal cancer, where alternative regimens did not necessarily have the same evidence base in the same clinical setting. [10]
The 2023 platinum shortage brought the issue back into national focus. In September 2023, the FDA listed multiple cancer medicines in shortage, including carboplatin and cisplatin. USP identified several essential cancer medicines that had experienced shortages, including platinum agents and other commonly used oncology medicines. [6][7] ASCO and other oncology organizations subsequently called for greater attention to the underlying supply problem. [18]
Patient surveys also demonstrated that shortages can be experienced directly by people receiving cancer treatment. ACS CAN reported that some patients had been affected by cancer drug shortages and that many of those affected had difficulty identifying substitutes. [19] The platinum shortage subsequently eased. But the broader pattern continued.The identity of the scarce medicine changes, while many of the underlying vulnerabilities remain.
What We Know—and What We Still Do Not Know
The current evidence supports several conclusions. We know that oncology drug shortages remain widespread. The September 2026 NCCN survey found that every responding institution reported at least one anticancer drug shortage. [1] We also know that the drugs affected change over time. Carboplatin and cisplatin dominated the 2023 crisis. By 2024, their reported shortage rates had fallen substantially, while other medicines were affected. In 2026, ifosfamide is the most widely reported shortage, while carboplatin shortages have returned. [1][26][27] And, we know that treatment frequently continues despite shortages.
Most responding NCCN centers reported strategies designed to maintain recommended doses and schedules. [1][3] We know that shortages create additional clinical and administrative work, including repeat prior authorization, regimen evaluation, inventory management, alternative-treatment decisions, clinical-trial coordination, and patient communication, all of which require additional resources. [1][3][25] We know that clinical trials can be affected. Thirty-nine percent of responding centers reported an effect on trials in the 2026 survey. [25].
But important questions remain.
Patient Outcomes
The literature documents treatment delays, dose changes, substitutions, and other disruptions. The direct population-level effect of recurring shortages on survival and other cancer outcomes remains incompletely characterized. [10][18][19] This is an important distinction. It is reasonable to document that shortages can disrupt treatment without assuming that every disruption results in an adverse cancer outcome.
Community Oncology
The NCCN survey provides information from participating NCCN Member Institutions. It does not constitute a national survey of all community oncology practices. The 77% figure regarding awareness of community shortages reflects the responding institutions’ observations rather than a systematic assessment of community practices. [25]
Duration
Manufacturer estimates and regulatory information indicate when supply may recover, but those estimates can change as manufacturing resumes and distribution improves. The current ifosfamide shortage illustrates this uncertainty. U.S. supply has required regulatory mitigation, while EMA expects the European shortage to continue until the first quarter of 2027. [15][16]
Policy Effectiveness
The NCCN survey shows that pharmacy leaders still see little improvement since 2023. It does not, however, establish that any individual policy intervention will or will not solve the shortage problem. This remains an area for evidence and evaluation.
Where This Leaves Oncology
The September 2026 data do not describe a single cancer-drug shortage. They describe a shifting supply chain environment. Platinum shortages that NCCN centers reported as largely resolved in 2024 have returned. Ifosfamide has become the most widely reported shortage in the latest survey. Other medicines that were scarce in previous years are no longer being reported by participating centers at the same frequency. What has remained remarkably consistent is the supply system’s underlying vulnerability.
Older generic oncology medicines can be clinically indispensable while facing intense price competition. Their manufacture can be technically complex. Production may be concentrated among a limited number of facilities. Quality problems can remove capacity from the market. Raw materials and other components may come from a limited number of suppliers. And when production is interrupted, remaining manufacturers may not be able to increase supply quickly. For patients, the immediate question is often very simple: Will the medicine I need be available when I need it?
However, for clinicians and health systems, the question is more complicated. Can evidence-based cancer treatment remain reliable when the medicines that support it depend on a supply chain with limited redundancy? Most patients in the current NCCN survey are still receiving treatment, often because pharmacists, oncologists, nurses, administrators, and other healthcare professionals have developed increasingly sophisticated strategies to manage shortages. That effort should not be mistaken for evidence that the underlying problem has been solved.
Recurring shortages of carboplatin, cisplatin, ifosfamide, and other established oncology medicines point to a broader issue in cancer care: access to proven medicines is part of the infrastructure of evidence-based treatment. The clinical value of these medicines was established years ago. Their importance has not disappeared simply because they have become generic.
The challenge now is ensuring the supply system remains reliable enough for those medicines to reach the patients for whom they are clinically appropriate.
Related Onco’Zine Coverage
- Additional links to previous Onco’Zine coverage on oncology drug shortages, pharmaceutical supply chains, generic drug manufacturing, and cancer-drug access:
Notes
* Baxter International is the dominant supplier of ifosfamide-containing medicines in the European Union, with an estimated near-100% market share. The company supplies major products including Holoxan, Tronoxal, and Mitoxana. European regulators have highlighted the region’s heavy dependence on this single supplier, with no readily available alternative manufacturers able to provide sufficient volumes to offset shortages. This concentration has contributed to ongoing supply concerns expected to persist into 2027.
** The End Cancer Drug Shortages Coalition is a collaborative initiative led by the National Comprehensive Cancer Network (NCCN) alongside 16 other hematology and oncology organizations—including the Hematology/Oncology Pharmacy Association (HOPA)—formed to address chronic and dangerous shortages of essential generic cancer medications.
References
[1] National Comprehensive Cancer Network. New NCCN survey highlights persistent cancer medication shortages across the United States. News release. September 10, 2026. Online. Last accessed on September 17, 2026.
[2] National Comprehensive Cancer Network. NCCN 2026 Drug Shortage Survey Results. September 2026. Online. Last accessed on September 17, 2026.
[3] Schneider ME. Shortages of cancer medicines persist across the United States. Cancer Therapy Advisor. September 17, 2026. Online. Last accessed on September 17, 2026
[4] Bankhead C. Cancer drug shortages continue with no immediate path toward relief. MedPage Today. September 2026. Online. Last accessed on September 17, 2026
[5] Biese A. NCCN survey: US cancer centers face generic oncology drug shortages. Oncology Nursing News. September 14, 2026. Online. Last accessed on September 17, 2026
[6] Malta M, Christian M, Cadwallader AB. Oncology Drug Shortages: Impacts, Policy Reforms, and Advocacy Imperatives. Cancer J. 2025 Sep-Oct 01;31(5):e0784. doi: 10.1097/PPO.0000000000000784. Epub 2025 Sep 25. PMID: 41002877; PMCID: PMC12459138.
[7] Raghavendran V. Why cancer medicines remain vulnerable to drug shortages. US Pharmacopeia. May 30, 2026. Online. Last accessed on September 17, 2026
[8] Izen ML, McKoy JM, Martin L, Nabhan C, Watson GL, Magagnoli J, Carson KR, Knopf K, Smith E, Zyszkowski E, Lynch M, Uslu D, Georgantopoulos P, Aboulafia D, Bennett CL. Mitigating the Impact of Drug Shortages in Oncology: Lessons Learned From the 2023 Shortages of Carboplatin and Cisplatin. Cancer J. 2025 Sep-Oct 01;31(5):e0786. doi: 10.1097/PPO.0000000000000786. Epub 2025 Sep 25. PMID: 41002874; PMCID: PMC12724352.
[9] Reich L, Knopf KB. The Oncology Drug Shortages and Its Impact on Community Hospitals. Cancer J. 2025 Sep-Oct 01;31(5):e0794. doi: 10.1097/PPO.0000000000000794. Epub 2025 Sep 25. PMID: 41002879.
[10] Tobin J. Understanding and managing drug shortages in oncology. Oncology Nurse Advisor. May/June 2011. Online. Last accessed on September 17, 2026
[11] Steinzor P. Cancer drug shortage: causes, trends, and implications for clinical trials. AJMC. July 3, 2024. Online. Last accessed on September 17, 2026
[12] Critical Drug Supply Warning: U.S. Ifosfamide Shortage. ASCO Press release. August 25, 2026. Online. Last accessed on September 17, 2026
[13] Cortese T, Fabbricatore R. ASCO warns of critical ifosfamide shortage threatening cancer treatment. CancerNetwork, August 28, 2026. Online. Last accessed on September 17, 2026
[14] Gerlach A, Mackay K. What pharmacists should know about the ifosfamide shortage. Pharmacy Times. September 4, 2026. Online. Last accessed on September 17, 2026.
[15] US FDA / SteriMax USA Inc. Dear Healthcare Provider Letter: Temporary Importation of Ifosfamide for Injection. U.S. Food and Drug Administration. August 21, 2026. Online. Last accessed on September 17, 2026.
[16] European Medicines Agency (EMA). Ifosfamide: supply shortage. Updated March 3, 2026. Online. Last accessed on September 17, 2026.
[17] USFDA taps Indian pharma to ease ifosfamide shortage. Medical Dialogues. June 26, 2026. Online. Last accessed on September 17, 2026
[18] America’s cancer doctors demand action from Congress: address drug shortages. ASCO Post. May 10, 2024. Online. Last accessed on September 17, 2026.
[19] American Cancer Society Cancer Action Network (AM CAN).Position letter on drug shortages. Press release. December 4, 2023. Online. Last accessed on September 17, 2026.
[20] Mesa drugmaker secures historic FDA designation in push to onshore critical medicines. inBusinessPHX. September 16, 2026. Online. Last accessed on September 17, 2026.
[21] Decamp M, Joffe S, Fernandez CV, Faden RR, Unguru Y; Working Group on Chemotherapy Drug Shortages in Pediatric Oncology. Chemotherapy drug shortages in pediatric oncology: a consensus statement. Pediatrics. 2014 Mar;133(3):e716-24. doi: 10.1542/peds.2013-2946. Epub 2014 Feb 2. PMID: 24488741; PMCID: PMC3934344.
[22] Santos ES, Oliver TK, Lacchetti C, Geisel R, Wilfong LS, Fader AN, Eng C. Drug Shortages in Oncology: ASCO Clinical Guidance for Alternative Treatments. JCO Oncol Pract. 2024 Jan;20(1):19-32. doi: 10.1200/OP.23.00545. Epub 2023 Nov 14. PMID: 37963306.
[23] Hantel A, Spence R, Camacho P, Bradbury AR, Denburg AE, Jagsi R, Moy B, Rathmell WK, Rosenberg AR, Symington B, Marron JM, Peppercorn J. ASCO Ethical Guidance for the Practical Management of Oncology Drug Shortages. J Clin Oncol. 2024 Jan 20;42(3):358-365. doi: 10.1200/JCO.23.01941. Epub 2023 Dec 7. PMID: 38061010.
[24] End Cancer Drug Shortages Coalition. Consensus Statement. NCCN Press Release May 13, 2026. Online. Last accessed on September 17, 2026.
[25] Gregerson E. 100% of cancer centers surveyed have 1 drug in shortage: 6 notes. Becker’s Hospital Review. September 10, 2026. Online. Last accessed on September 17, 2026.
[26] Brooks M. Cancer drug shortages continue in the US, survey finds. 2024. MDedge. Online. Last accessed on September 17, 2026.
[27] Worcester S. MA., NCCN survey shows ongoing chemotherapy drug shortages. Medscape/The Hospitalist, October 5, 2023. Online. Last accessed on September 17, 2026
[28] U.S. Food and Drug Administration. Frequently Asked Questions About Drug Shortages. FDA Drug Shortages. Online. Last accessed on September 17, 2026.
[29] U.S. Food and Drug Administration. Drug Shortages. FDA. July 15, 2026. Online. Last accessed on September 17, 2026.
[30] U.S. Food and Drug Administration. CY 2025 Drug Shortages Report to Congress. 2025. Online. Last accessed on September 17, 2026.
The NCCN’s September 2026 survey is based on responses from participating NCCN Member Institutions and should not be interpreted as a national survey of all U.S. oncology practices. Historical NCCN survey comparisons involve different respondent groups and survey periods. The FDA shortage status is a national determination and is distinct from local supply or distribution problems. The direct effect of the current shortage environment on cancer survival and other patient outcomes remains incompletely characterized. This article is intended for informational purposes for healthcare professionals and does not constitute medical advice.
Featured image: © 2016 ON JOC. Used with permission.
DOI
