Many may have received only partial doses of drugs

As many as 234 late-stage cancer patients from Eastern Ontario may have received lower than intended doses of immunotherapy treatment, according to a review by The Ottawa Hospital.

The patients were among about 1,000 across the province treated for melanoma, lung cancer, colorectal and other cancers, who were identified as potentially receiving only partial doses of their prescribed cancer drugs. (All Eastern Ontario patients who may have received partial doses have been notified.)

At issue is that some of the highly concentrated drugs remained in IV tubing, resulting in a discrepancy in how much treatment patients were receiving.

The issue came to light after officials at a Toronto-area hospital raised concerns with Cancer Care Ontario, the provincial agency in charge of improving cancer care in the province, earlier this summer.

Dr. Robin McLeod, vice-president of clinical programs and quality initiatives at Cancer Care Ontario, said officials at Trillium Health Partners in Mississauga contacted the agency in June with concerns that some cancer patients were not receiving all their intended drugs. The agency sent memos to 74 institutions across the province. Of those, 28 hospitals identified it as an issue.

Among those hospitals were The Ottawa Hospital, the Hawkesbury and District General Hospital and the Cornwall Community Hospital in Eastern Ontario. A medical team from The Ottawa Hospital, which is the cancer hub for Eastern Ontario, reviewed the chart for each of the Eastern Ontario patients, some of whom have since died, and determined “no harm could be attributed to the reduced doses, and no patient’s regime has changed.”

McLeod said 10 patients across the province have been given additional treatment as a result of the review.

She said the way IV tubes were being flushed was part of the issue. The hospitals have changed procedures and processes to ensure patients are getting all of the cancer drugs prescribed, McLeod said.

Cancer Care Ontario will investigate the issue further, including whether other drugs might be involved, she said.

“Our first objective was to understand what was going on and make changes. All of the hospitals have made changes. We wanted to notify the patients that might have been impacted.”

She did not elaborate on which other drugs are being looked at as potential sources of similar issues.

The cancer drugs in question — pembolizumab, nivolumab and panitumumab — are part of a revolution in treatment for some patients. The drugs work by boosting the body’s natural defences to fight cancer.

Immunotherapy has been a game-changer for melanoma, said melanoma survivor Annette Cyr of the Melanoma Network of Canada. One of the drugs in question — pembrolizumab, or Keytruda — is widely known as the Jimmy Carter drug because it is what the former U.S. president was given when he had metastasized melanoma in his 90s. He is now clear of melanoma.

She called the revelation that some Ontario patients had only received partial doses “very concerning.”

Cyr noted that coming up with proper dosages is “not an exact science.” Still, as a patient, she says, the news would be worrying.

“For those people who had a loved that has passed away, of course that is going to cause some significant concern.”

All of the hospitals have made changes. We wanted to notify the patients that might have been impacted.