Less than 3% of cancer patients in India can access  immunotherapy treatment: Study 

Under immunotherapy, patients are administered checkpoint inhibitor drugs that modify specific types of cells in their bodies to fight cancerous cells. It is indicated for certain categories of late-stage or relapsed cases of cancers.

“The accessibility of immunotherapy is below 3 percent in India,” researchers, based on the findings, said in the study report that was published on November 8 in the journal ecancermedicalscience.

The authors of the first-ever empirical evidence on immunotherapy also noted that among the patients with head and neck cancers, those registered as private category — patients who could pay for the treatment or had medical insurance — and male patients had marginally higher access to this therapy.

The findings have prompted the researchers to demand addressing the issue of immunotherapy accessibility urgently.

The cost of these drugs is enormous and, unfortunately, there is a lack of guidelines suggesting fair pricing, noted the authors, adding that the costs are kept similar across the globe and there is limited support for patients from low and middle income countries (LMIC).

“These costs which might be affordable for high-income countries are not necessarily affordable by LMIC,” they said. “Hence, we are of the opinion that having differential pricing across the globe might help in improving accessibility”.

The study has also underlined that multiple insurances available in India do not support palliative treatment or treatment with immunotherapy, thus limiting the usefulness of such insurance in treating cancer patients.

The analysis

As part of the audit, medical oncologists Dr Vijay Patil, Dr Kumar Prabhash and Dr George Abraham, along with others in their team identified all patients who were registered in the head and neck and thoracic medical oncology units between 2015 and 2019.

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Patients who received immunotherapy were then identified from the prospective database of immunotherapy maintained by the departments and then lists of patients who were eligible for immunotherapy per year and those who received recommended treatment were prepared.

The drugs used for immunotherapy include Nivolumab, Pembrolizumab, Atezolizumab, Durvalumab, Avelumab or Ipilimumab.

The analysis showed that among head and neck cancer patients, 4.5 percent received immunotherapy versus 2.35 percent among thoracic cancer patients. Among the general category or patients from low socioeconomic background, only 0.29 percent versus 6.6 percent among the private category or those from relatively higher socioeconomic status received the treatment.

Also, while 3.7 percent of male patients managed to get the treatment, just 1.39 percent of women did.

The suggestions

Based on the results from the audit, the authors said there is a need for positive steps by LMICs for addressing this disparity in the accessibility of high-cost anti-cancer drugs.

The development of generic or bio-similar molecules and innovative studies on low-dose regimens or longer-duration treatment schedules, for example, would help bring down the cost of treatment and improve accessibility in these regions.

There are multiple retrospective analyses that suggest that such schedules might be helpful, researchers said, adding that there is a need for performing dose-response and minimum effective dose-finding studies backed by large-scale randomised trials.

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The same researchers have now also completed one such randomised phase 3 study evaluating 20 mg Nivolumab — or one-tenth of the company recommended dose — in head and neck squamous cell carcinoma, which showed that low-dose drug, in comparison with chemotherapy alone, does improve outcomes.

This innovation makes it possible for patients to access immunotherapy at about 5 percent of the full-dose treatment regimen and promises to make it accessible to over 75 percent of cancer patients who may need it.

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