A drug that once cost more than Rs 1 lakh a cycle is now available for around Rs 30,000, giving more cancer patients in India a chance to access immunotherapy, a treatment that has transformed outcomes in several cancers but remained prohibitively expensive for many. Oncologists have reported a sharp rise in prescriptions for nivolumab over the past six months following the launch of a cheaper biosimilar, according to a report by Times of India's Malathy Iyer.
The shift comes as Indian research into lower-dose regimens offers another potential route to reducing treatment costs. Together, cheaper drug alternatives and evidence-based dosing strategies could widen access to advanced cancer treatment, although affordability at the manufacturer's end does not guarantee that patients will benefit at the hospital counter.
Dr Imran Shaikh of Kokilaben Dhirubhai Ambani Hospital in Mumbai told TOI that his nivolumab prescriptions had risen by more than 50% over the past six months.
“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,” he said.
From a costly option to a broader treatment window
The change matters in a country where access to immunotherapy has historically been limited by price. A Tata Memorial Centre (TMC) study found that only 2.8% of patients eligible for immunotherapy were receiving it in 2022. Dr Jyoti Bajpai, director of precision oncology at Apollo Hospitals in Navi Mumbai and a co-author of the study, said prescriptions have since risen substantially, though the overall increase is yet to be quantified.
Nivolumab belongs to a class of drugs called immune checkpoint inhibitors, which help the body's immune system recognise and attack cancer cells. Its use across multiple tumour types makes the availability of a less expensive version particularly significant. TMC doctors say the drug is effective across 25 tumour types and has about 100 indications.
The benefits can be substantial for eligible patients. Dr Kumar Prabhash, head of medical oncology at Tata Memorial Hospital in Mumbai's Parel, cited melanoma, or skin cancer, as an example of the difference immunotherapy has made.
“Earlier barely five out of 100 patients had long-term survival, but survival has now increased to 50% with immunotherapy,” he said, adding that some patients with advanced lung cancer are surviving for five years or longer.
In certain cases, the treatment may also spare patients more invasive interventions. Patients with early-stage colorectal cancer carrying high microsatellite instability (MSI-high), a biomarker that can help predict response to immunotherapy, may be able to avoid the conventional combination of chemotherapy, radiotherapy and surgery.
“A patient of MSI-high type of colon cancer would earlier need chemotherapy, radiotherapy and surgery. But if he comes in early stages, then only immunotherapy works. The patient will have his native organ intact,” Prabhash said.
Cheaper at the factory, but will patients pay less?
The price of nivolumab could fall further, with four additional versions expected to enter the market. Yet competition alone may not be enough to ensure that patients receive the least expensive option.
Shaikh said India has only seven checkpoint inhibitor drugs available, compared with 35 in China. The other six available in India, apart from nivolumab, are imported and can cost lakhs of rupees over a course of treatment.
A separate policy intervention could help ease the wider cost burden. The National Pharmaceutical Pricing Authority's decision to cap trade margins on 137 anti-cancer medicines, effective November 8, is projected to generate annual savings of Rs 2,500 crore. The measure could reduce costs across several cancer treatments, though the actual savings for patients will depend on how the price controls translate into retail prices and hospital purchasing practices.
K M Gopakumar of Third World Network warned that hospitals requiring patients to buy medicines from their in-house pharmacies could have little incentive to stock lower-priced alternatives if the margins are less attractive.
“Hospitals may favour more expensive original medicines because of higher margins. The cheaper versions may thus not be available to the patients as a result,” he said.
The same concern applies to nivolumab as more biosimilars enter the market. Gopakumar said the price could drop from Rs 30,000 to Rs 10,000, but questioned whether hospitals would stock products that offer them lower margins.
Prabhash said TMC tries to keep medicine costs as low as possible for patients. Whether similar savings reach patients across the healthcare system remains an open question.
For Bajpai, the larger opportunity lies in combining affordable biosimilars with treatment strategies backed by clinical evidence. Research into shorter courses and lower doses has explored ways to reduce expenses for patients who might otherwise struggle to complete treatment. More affordable alternatives could make it possible for a greater number of eligible patients to receive full-dose, full-course treatment where clinically appropriate.
“The real success of innovation is not just how long patients live, but how many patients can access the treatment they need — without financial hardship,” she said.
