'Groundbreaking' Cancer Drug Recycling at Major US Center

Nick Mulcahy

February 05, 2020

A new program allows cancer patients in Ohio to pass along their unused and unneeded oral cancer drugs to fellow patients with cancer who cannot afford the pricey pills — even if the pills are not in the original packaging.

The free exchange is debuting at Ohio State University Comprehensive Cancer Center, but other institutions and pharmacies can apply to participate under new state rules that took effect in October, according to officials speaking at a press conference in Columbus and broadcast online.

Ohio State and its James Cancer Hospital has formed a new cancer drug repository program to facilitate the donations from individual patients, pharmacies, hospitals, and nonprofit clinics. The drugs will be re-dispensed to patients who cannot afford their cost.

"This does not solve all of the inequities that exist in cancer treatment" but is "an important step in the right direction," said Mark Hurst, MD, medical director, Ohio Department of Health.

Phillip Baker, PharmD, founder of two drug recycling organizations in Memphis, Tennessee, called the new program "super encouraging," in part because of Ohio State University's "prestigious status."

Baker, who was not involved in the press conference, described the new statewide regulation as "groundbreaking."

"It's the first program in the country to allow for the reclamation oral chemotherapies that are not in their original packaging. All other programs specify the meds have to be unopened and in the original manufacturer packaging (stock bottle)," he said in an email to Medscape Medical News.

"This means vastly more medication can be reclaimed," he pointed out.

Baker also noted that Ohio now has the first program in the country to allow for the reclamation of controlled substances, specifically those used to treat opioid dependence or addiction.

All donated drugs at Ohio State will undergo a multipoint inspection to ensure safety, emphasized Julie Kennerly-Shah, PharmD, MHA, a pharmacist at the OSU Cancer Center and James Hospital, during the press conference.

Two Drugs Will Test the Concept

Initially, the Ohio State cancer drug program will be limited to two generic oral therapies — capecitabine (Xeloda, Genentech) and temozolomide (Temodar, Merck).

Such generic pills, while less costly than patent-protected oral cancer therapies, are "still out of reach" for low-income and uninsured patients, said Kennerly-Shah. 

For example, Xeloda, which is used in the treatment of breast and colorectal cancers, has an average retail price of $4499.73 for 84 tablets of 500 mg according to GoodRx. Generic capecitabine costs $3036.47 for 84 tablets of 500 mg.

For financially needy patients, on-patent oral cancer drugs, which are much more expensive, are typically covered by pharmaceutical patient assistance programs, said Kennerly-Shah. Thus patented drugs have a less urgent status in the initial recycling effort, she suggested.

The Ohio State cancer drug repository program hopes to expand to more drugs "in the near future," added Kennerly-Shah.

Cancer treatment generates medication waste in multiple ways, including when patients switch to a new drug or have a dose reduction. "We end up with a lot of wasted medication that must be disposed of," she commented in a press statement.

It's better to have leftover cancer drugs in the hands of patients than in landfills, according to physician advocates of cancer drug recycling efforts in a 2019 essay who called the concept "medically sound" and environmentally sensible.

The effort to legitimize cancer drug recycling got a shot in the arm last year when the US Food and Drug Administration chose two organizations devoted to recycling expensive oral cancer drugs for a drug supply-chain pilot project.

Since 2018, Good Shepherd Pharmacy and RemediChain, two start-ups located in Memphis, Tennessee and founded by Baker, have been taking unused chemotherapy capsules and pills donated by individuals and cancer clinics and giving them to patients who cannot afford them.

The organizations have processed over $3 million worth of oral cancer drug donations, said Baker.

Kennerly-Shah and have disclosed no relevant financial relationships.

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