Medknow Publications on behalf of the Association of Radiation Oncologists of India (AROI)
Abstract
Background: Administering drugs outside the terms of their official
labeling is called off-label use. In the West, oncologists often use
drugs off-label, which offers several advantages especially while
treating patients with multiple comorbidities or advanced cancer. The
practice of off-label prescribing of anticancer agents in India is not
well documented. Materials and Methods: A survey on prescribing
practices of 10 important drugs used in cancer was conducted in March
2010. Ten centers representing all parts of India were identified. One
oncologist from each center was contacted by phone or email and
explained about the survey. The list of drugs was sent to them by email
if they agreed to participate and they were requested to fill all the
indications for which these drugs were used in their center. Labeling
for each drug was obtained from the Food and Drug Administration (FDA)
website. Off-label practice was categorized as those recommended by the
National Comprehensive Cancer Network (NCCN) and those without.
Results: Nine out of 10 centers agreed to participate in the survey.
Four centers responded to the questionnaire. Six out of 10 drugs were
used for off-label indications, cisplatin being the most commonly used.
All drugs were either used as per FDA labeling or according to the
recommendations of NCCN, except for gemcitabine which was used in one
center for some indications based on phase II data. Conclusion: Very
limited off-label prescribing was found in oncology practice in India.
Since off-label use offers several advantages, judicious use of this
practice should be encouraged among the oncologists