Government slashes prices for targeted cancer drugs: All you need to know

Here is how the three medicines work, the impact of the government’s decision, and the cancer profile of India.

First, what are targeted cancer drugs?

Targeted cancer drugs are designed to attack only the cancer cells, leaving the normal cells unaffected. They target specific genetic changes in cancer cells that help them grow, divide, and spread.

These drugs have better outcomes and fewer side effects compared to traditional chemotherapy drugs that indiscriminately target all cells.

Newer targeted cancer therapies such as immunotherapy do not target the cancer itself by using any drug. Instead, they train the patient’s immune system to find and attack the cancer cells.

How do these three drugs work?

📌 Trastuzumab deruxtecan is an antibody-drug conjugate — a substance made up of a monoclonal antibody (a laboratory-made protein that acts like human antibodies) chemically linked to a drug. It is used to treat any cancer with HER-2 receptor (a protein that appears on the surface of some breast cancer cells) that has metastasised or cannot be operated on.

Developed by Daiichi Sankyo and marketed by Astrazeneca as Enhertu, trastuzumab deruxtecan is a second-line treatment, which is used when traditional therapies have failed.

In 2019, the drug was approved for the treatment of breast cancers, and, in 2021, for targeting certain types of gastrointestinal cancers.

Earlier this year, it became the first drug in its class to receive “tissue-agnostic approval” from the US Food and Drug Administration (FDA) — meaning it can be used to treat any cancer with HER-2 receptor regardless of where it originates.

Cost: The drug costs around Rs 1.6 lakh per vial.

📌 Osimertinib is the most commonly used of the three cancer drugs in India. Marketed as Tagrisso by AstraZeneca, the drug is used to treat lung cancers that have epidermal growth factor receptors (EGFR) — they are thought to be involved in the development of cancer. Osimertinib blocks these receptors on cancer cells, and stops the cancer from growing.

The drug can be prescribed after the tumour has been removed surgically, or even as a first-line treatment when the cancer has metastasised. The drug can be consumed till it fails and the cancer starts to progress again, or till there is a case of severe toxicity.

Dr Ankur Bahl, Senior Director of medical oncology at Fortis Gurugram, told The Indian Express: “Osimertinib has survival benefits over other available treatments as it can extend the life of cancer patients by four to five years”.

He also said osimertinib targets the mutation, which occurs in 25% to 30% of lung cancers in women who are non-smokers.

Cost: The drug, however, is quite expensive — it costs 1.5 lakh per strip of ten pills, and has to be taken every day.

📌 Durvalumab  —  an immunotherapy treatment — is used for the treatment of certain lung cancers, biliary tract cancers, bladder cancer, and liver cancer. It attaches itself to PD-L1 proteins — they are present on the surface of cancer cells, and help them escape immune detection — and allows the body’s immune system to recognise cancer cells and kill them.

Studies have shown that patients on the drug remained in remission and live longer.

Cost: Sold as Imfinzi, durvalumab costs around Rs 1.5 lakh for every 10ml vial.

What will be the impact of the customs duty exemptions?

The customs duty exemptions on these drugs is widely expected to help reduce the financial burden on cancer patients and their families.

Speaking to The Indian Express, one cancer patient said even a Rs 12,000 drop in price would help them purchase more nutrition and protein supplements, and use the amount for other expenses such as tests and scans.

Dr Abhishek Shankar, oncologist at the All India Institute of Medical Sciences (AIIMS) in New Delhi, said, “This is a positive move from the government. These drugs cost up to lakhs, and even a small percentage decrease will make a significant difference to patients and their families. They are targeted therapies that offer much better results than traditional therapies.”

He also said that in India, around one lakh patients need rastuzumab deruxtecan, osimertinib, and durvalumab.

What is the cancer profile in India?

The number of cancer cases is rising in India. An estimated 14.6 lakh new cancer cases were detected in 2022, up from 14.2 lakh in 2021, and 13.9 lakh in 2020, according to the National Cancer Registry data. The number of deaths due to cancer increased to an estimated 8.08 lakh in 2022, up from 7.9 lakh in 2021, and 7.7 lakh in 2020.

The incidence of cancer is higher among women — 103.6 per 100,000 population in 2020 — compared to 94.1 among men. Among men, the most common cancers were of the lung, mouth, prostate, tongue, and stomach; for women, they were breast, cervix, ovary, uterus, and lung.

The therapies that will become cheaper are useful for the treatment of lung and breast cancers, which are among the most common cancers in men and women, respectively.

One in nine Indians will develop cancer during their lifetime, according to an Indian Council of Medical Research (ICMR) study, which used data from population-based cancer registries. One in 68 men will develop lung cancer, and one in 29 women will develop breast cancer, the study said.