By the time 55-year-old testicular cancer patient Ravi* walked into the out-patient clinic of Sir Ganga Ram Hospital on Thursday afternoon, Dr Shyam Agarwal already knew that a crisis was brewing. For the last couple of days, his patients had been running from store to store in search of two very commonly used and affordable chemotherapy drugs — cisplatin and carboplatin.“These are life-saving drugs, especially for a patient like him. Testicular cancer, even in the fourth stage like his, is extremely curable. Nearly 80% of the patients get cured with appropriate treatment. But now no pharmacy has it,” says Dr Agarwal, chairman of the Department of Medical Oncology at Sir Ganga Ram Hospital in New Delhi. Almost 70 per cent of his patients need one or both of the drugs as part of their treatment protocol. This shortage has the potential to disrupt the treatment of cancer patients across the country, affecting their outcomes.Ravi has been hopping stores and even looking for distributors and wholesalers, who are selling direct to some patients. “I have spent an entire day checking out at least 15 stores, contacting wholesalers and distributors, asking them if there is any other source I can get the drugs from, even agreeing to pay a bit extra. It’s not about missing a cycle, it’s about ensuring that I can keep to the whole course. I want to get better,” he says.Also Read | New Hepatitis B drug may prevent cirrhosis, liver cancer with functional cure in 20% patients: Liver Doc explains breakthroughChemotherapy regimens for testicular cancer are carefully designed with specific doses and timing to maximize cancer cell kill while preventing the tumour from regrowing between cycles. If a dose is missed or a cycle is delayed, chemotherapy becomes less effective and cancer cells may have more time to recover and multiply between treatments. Multiple or prolonged delays are generally more concerning than a single short delay. “In patients with advanced disease, maintaining the planned schedule is especially important because cure rates depend on delivering the full treatment regimen whenever possible,” says Dr Agarwal.Even one of the biggest drug retailers in Delhi — who almost never sends patients back without medicines — had to turn them away. “We usually never say no. Even when we run low, we order it for our patients on priority basis. But what can I do when suppliers across India either do not have the medicine or refuse to sell it to retailers? Two of my staff and I were on the phone for the better part of the day trying to source the medicine without luck,” the retailer said. The two key drugs had been in short supply over the last two months but the situation became dire over the last few days.What are these medicines?Both cisplatin and carboplatin are platinum-based chemotherapy drugs that can be used in the treatment of several solid tumour cancers such as testicular, ovarian, cervical, bladder, head and neck, lung among others.Once inside a cancer cell, the drugs become activated and bind to DNA strands. They form cross-links between DNA bases, effectively tying parts of the DNA together. This prevents the cancer cell from replicating, thereby triggering programmed cell death — the immune mechanism to destroy and remove any infected or damaged cells. Both are IV drugs that can be used alone or in combination with other chemotherapy and immunotherapy drugs.Story continues below this adAlso Read | A new pill can double survival time for deadliest cancer: An expert explains why this is a gamechangerWhy is there a shortage of medicines?There are several reasons that have led to the current shortage. First is the increasing price of platinum, which is one of the key ingredients required for manufacturing the two drugs. Platinum is in short supply globally owing to a production deficit in South Africa that continues to be the world’s largest supplier. The demand for platinum has also gone up, with it increasingly being used in the automotive sector and production of green hydrogen.The second reason is supply disruption due to the West Asia crisis. For India, the United Arab Emirates (UAE) was the largest supplier of platinum, accounting for nearly half of the country’s imports. The supply from the Gulf country has been disrupted and the prices of the raw material have increased.Third, price control by the government. Both the drugs come under the Drug Pricing Control Order (DPCO), which regulates the prices of essential medicines in India. Companies manufacturing any drugs under DPCO cannot raise prices to react to changes in the cost of the raw materials — the order allows companies to increase the cost of essential medicines only once a year in tandem with the average wholesale price increase.Why is this a cause for concern for patients?Both drugs are widely used for the treatment of cancer patients. With a severe shortage, patients have been running from one retailer or distributor to the other. “Now, they are buying the drugs at much higher prices, sometimes several fold of what it costs,” said the owner of the retail store mentioned above. “With people desperate to get their hands on the medicine, there are retailers who are selling ones that may not be of good quality or vials for which the cold chain might not have been maintained. So, people may end up paying more for poor quality drugs.”Story continues below this adFor Ravi, consistency in drug supply is critical because chemotherapy effectiveness depends on maintaining planned doses and treatment intervals. Equally important is the consistency of the drug product itself: improperly stored or substandard cisplatin may not deliver the intended therapeutic effect and could expose patients to unnecessary toxicity. With reports of disrupted supply chains and concerns about compromised cold-chain maintenance, Ravi’s challenge is not only obtaining the medicine but ensuring that each vial meets the quality standards required for his treatment.