Immunotherapy for Cancer in India: Navigating the Access–Efficacy Chasm

Abstract The advent of immune checkpoint inhibitors (ICIs) has transformed oncology practice, yet their penetration in India remains under 5%, mainly due to prohibitive financial toxicity. This commentary explores the “access–efficacy chasm” in the Indian health care landscape. While incorporating ICIs into the National List of Essential Medicines is a necessary step for price rationalization, regulators must balance price ceilings against the risk of compromising manufacturing quality and disrupting the supply chain. To democratize access, Indian oncologists have pioneered scientifically adaptive low-dose protocols. However, the recent introduction of affordable indigenous biosimilars and the potential influx of novel Asian molecules are fundamentally altering the financial justification for these ultra-low doses. Pragmatic price policies, academic validation of affordable regimens, and robust legal safeguards for off-label dosing are advocated.