Cancer patients in India are gradually gaining better access to immunotherapy as more affordable versions of nivolumab become available. Over the past six months, oncologists have reported a rise in prescriptions for this advanced cancer treatment, which has remained financially out of reach for many patients.
Nivolumab, a checkpoint inhibitor used to treat several types of cancer, has become more accessible following the introduction of lower-cost biosimilars. In addition, Indian research, including studies conducted by Tata Memorial Centre (TMC), suggests that lower-dose regimens may be effective in certain clinical settings, potentially reducing treatment expenses.
Dr Imran Shaikh of Kokilaben Dhirubhai Ambani Hospital in Andheri, Mumbai, reported that his nivolumab prescriptions increased by more than 50% over the past six months following the arrival of a cheaper version of the drug. “My patients are responding well to the drug. People who were earlier unsure whether they could afford a cycle costing over a lakh of rupees are comfortable with the new price tag of Rs 30,000,” Dr Shaikh said.
Immunotherapy Improves Outcomes in Selected Cancers
Although the overall increase in immunotherapy prescriptions remains difficult to quantify, the treatment access gap has historically been significant. A TMC study found that only 2.8% of patients eligible for immunotherapy received it in 2022. Dr Jyoti Bajpai, director of precision oncology at Apollo Hospitals in Navi Mumbai and a co-author of the study, has observed a substantial increase in prescriptions.
According to Dr Kumar Prabhash, head of medical oncology at Tata Memorial Hospital in Parel, immunotherapy has significantly improved outcomes in certain cancers, particularly melanoma, a type of skin cancer. He noted that long-term survival in some melanoma cases has increased from around 5% to 50% with immunotherapy. Furthermore, some patients with advanced lung cancer are now living for five years or longer.
Immunotherapy may also offer an alternative to conventional treatment for selected patients with microsatellite instability-high (MSI-high) colorectal cancer. According to Dr Prabhash, eligible patients diagnosed at an early stage may benefit from immunotherapy alone, potentially avoiding chemotherapy, radiotherapy and surgery while preserving the affected organ. However, treatment decisions depend on the cancer type, stage and individual patient characteristics.
High Costs Continue to Limit Access to Immunotherapy
Despite these advances, India still has limited access to immune checkpoint inhibitors compared with some other countries. Dr Shaikh said India offers seven such drugs, compared with 35 in China. He added that, apart from nivolumab, the other six available drugs are imported and can cost several lakh rupees for a course of treatment.
Meanwhile, the National Pharmaceutical Pricing Authority (NPPA) has introduced a measure to cap trade margins on 137 anti-cancer medicines, effective November 8. The move is projected to generate annual savings of ₹2,500 crore and could reduce costs across a range of cancer treatments. Nevertheless, lower medicine prices do not automatically guarantee savings for patients. The availability of affordable alternatives also depends on hospital purchasing and dispensing practices.
Hospital Pharmacy Practices Could Affect Savings
K M Gopakumar of Third World Network cautioned that hospitals requiring patients to purchase medicines through their in-house pharmacies may have limited incentives to stock cheaper alternatives. He warned that hospitals could favour more expensive original medicines if they generate higher margins, potentially restricting patients’ access to lower-cost options. Additionally, four more versions of nivolumab are expected to enter the Indian market soon. Increased competition could bring the price down further, potentially from ₹30,000 to ₹10,000 per treatment cycle. However, Gopakumar questioned whether hospitals would stock medicines offering lower margins. Dr Prabhash said the actual benefits of these price reductions remain to be seen. He added that Tata Memorial Centre makes arrangements to minimise patients’ medicine expenses.
Affordable Biosimilars and Evidence-Based Dosing Offer Hope
For Dr Bajpai, the key challenge is ensuring that advances in medical and precision oncology reach patients regardless of their financial circumstances. Cheaper biosimilars and evidence-based dosing strategies could help more eligible patients access treatment. However, their impact will depend on whether healthcare providers make affordable medicines available and ensure that patients receive appropriate treatment. Dr Bajpai emphasised that innovation should not be measured only by improvements in survival, but also by how many patients can access the treatment they need without facing financial hardship. She added that research into shorter treatment courses and lower doses reflects the difficult choices patients face when costs become a barrier. More affordable biosimilars could help expand access to evidence-based, full-dose and full-course treatment for eligible patients.
Immunotherapy Is Not Effective for Every Patient
Despite its promise, immunotherapy is not a universal solution for cancer. Its effectiveness varies depending on the cancer type, disease stage and individual patient response. Dr Prabhash stressed that every medicine has specific indications and limitations, and checkpoint inhibitors are no exception. Therefore, oncologists must select treatments based on clinical evidence and individual patient needs.
As reported by The Times of India, lower-cost nivolumab, increased competition and pricing interventions could improve access to cancer immunotherapy in India. However, the long-term success of these measures will depend on whether affordability translates into wider availability and equitable access to effective treatment.