A 57-year-old smoker, Jai Singh (name changed), visited the cancer clinic at Medanta in December after doctors diagnosed him with advanced lung cancer that had already spread to his brain, liver, and bones.
Although he had started radiotherapy to shrink tumours and destroy cancer cells, he remained hesitant to undergo chemotherapy because of concerns about its side effects. Consequently, his doctors explored an alternative treatment approach using immunotherapy, which has now become easier to administer through injectable formulations.
High PD-L1 Levels Made the Patient Eligible for Immunotherapy
Explaining the case, Dr. Sajjan Rajpurohit, Head of Medical Oncology at Medanta, said the patient’s tests revealed PD-L1 expression levels of 75%.
This indicated that a large proportion of the cancer cells were actively using the PD-L1 protein to evade the immune system.
Dr. Rajpurohit explained, “The patient had heard about chemotherapy-related side effects from other patients and was reluctant to proceed with it. Fortunately, his PD-L1 levels were significantly high, making him an ideal candidate for immunotherapy. Therefore, we recommended the newly launched subcutaneous atezolizumab injection.”
Roche Launches Subcutaneous Version of Tecentriq in India
Roche has recently launched the subcutaneous version of its cancer immunotherapy drug atezolizumab under the brand name Tecentriq in the Indian market.
Previously, doctors administered the drug through intravenous (IV) infusion. However, the newly introduced under-the-skin injection offers greater convenience and significantly reduces hospital time for patients.
According to Dr. Rajpurohit, the injectable version has also improved treatment compliance because patients experience fewer infusion-related side effects and shorter treatment sessions.
Therapy Specifically Targets Certain Lung Cancer Patients
As reported by The Indian Express, the treatment is designed for patients with non-small cell lung cancer (NSCLC), which accounts for the majority of the more than 81,000 lung cancer cases diagnosed annually in India.
However, not all NSCLC patients qualify for this therapy. Since the drug specifically targets PD-L1 receptors, only patients whose cancer cells express high levels of this protein can benefit from the treatment.
Doctors estimate that nearly half of all non-small cell lung cancer patients may be eligible for this immunotherapy approach.
Injectable Version Reduces Treatment Time
The subcutaneous version of Tecentriq can be administered by trained nursing staff in outpatient departments through an injection in the thigh within just seven minutes.
In contrast, the intravenous version requires a significantly longer infusion process.
Moreover, hospitals can treat nearly five patients with the injectable version in the same amount of time needed for one IV infusion. Global studies also show that four out of five patients preferred the subcutaneous formulation over the IV option.
High Treatment Cost Remains a Challenge
Despite its advantages, the treatment remains expensive. Each dose costs approximately ₹3.7 lakh, and most patients require nearly six doses during treatment.
To improve accessibility, Roche has introduced a patient assistance programme called Blue Tree, which aims to reduce treatment costs for eligible patients.
Additionally, the drug has now been included under the Central Government Health Scheme (CGHS).
Dr. Rajpurohit further explained that although the subcutaneous version requires a higher bio-equivalent dose — 1,800 mg compared to 1,200 mg for the IV formulation — the overall treatment cost remains nearly similar once hospitalisation and infusion-related expenses are considered.
How Atezolizumab Helps the Immune System Fight Cancer
Atezolizumab works by blocking the PD-L1 protein that cancer cells use to escape detection by the immune system.
Normally, immune cells known as T cells identify and destroy abnormal cells in the body. However, many cancer cells protect themselves by displaying PD-L1 proteins on their surface. These proteins bind to receptors on T cells and send signals that prevent the immune system from attacking the cancer.
Atezolizumab interrupts this interaction by attaching to the PD-L1 protein and blocking the “off signal.” As a result, the immune system can once again recognise cancer cells as harmful and activate T cells to attack and destroy them.
Immunotherapy Expands Treatment Possibilities
Doctors believe that the availability of easier-to-administer immunotherapy options marks an important step forward in lung cancer treatment.
Furthermore, injectable immunotherapy has the potential to improve patient comfort, reduce hospital burden, and enhance long-term treatment adherence, especially for patients who cannot tolerate conventional chemotherapy.