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Journalism of Courage
One cancer drug transformed the lives of three women suffering from an advanced stage of lung cancer. For 53-year-old Manjula*, who was being treated at AIIMS for gastrointestinal complaints, the diagnosis was quite by accident.
But as the cancer had started to metastasize, she was put on the life-saving targeted therapy drug Osimertinib. When a 60-year-old woman in Delhi’s Saket area was diagnosed with Stage IV lung cancer, doctors told her she just had between two and nine months to live. But two years on, with this drug, she lives. Similarly, a 77-year-old woman from CR Park with the same cancer has made it beyond the timeline predicted by doctors.
Targeted therapy drugs, which cost around Rs 5 lakh a month, are holding out hope for patients as they prolong life by precisely identifying and inhibiting the growth of cancer cells. They are better than other cancer therapies.
But these patented drugs, which have to be imported, are prohibitively expensive. This is why the 10 per cent custom duty cut on three of these drugs as announced by Finance Minister Nirmala Sitharaman in the Union Budget 2024, will help bring their costs to under a lakh for a vial. “To provide relief to cancer patients, I propose to fully exempt three more medicines from customs duties,” she said. The three medicines are trastuzumab deruxtecan, osimertinib and durvalumab.
Osimertinib — sold as Tagrisso — is a medication that helps in treating certain types of lung cancer by blocking the action of a protein that multiplies cancerous cells. It costs around Rs 1.5 lakh per strip of ten pills.
Trastuzumab deruxtecan — sold as Enhertu — is a monoclonal antibody that is used for the treatment of breast and stomach cancers. The drug was first approved by the US Food and Drug Administration for gastric and gastrointestinal cancers in 2021.
Earlier this year, the US regulator approved the drug for all cancers with HER-2 receptor, including breast cancers. The cancerous tissues grow quicker when there are HER-2 receptors. Patients have to shell out around Rs 1.6 lakh per vial of the medicine. Durvalumab — sold as Imfinzi — is used for the treatment of certain lung and bladder cancers. It trains the body’s immune system to look for a PD-L1 protein that is found on cancer cells and attack it. This drug costs around Rs 1.5 lakh for every 10 ml vial.
Exemption of even 10 per cent duty on these expensive drugs are likely to reduce the financial burden on patients as they need long-term therapies. Explains Dr Abhishek Shankar, oncologist from the All India Institute of Medical Sciences (AIIMS), “The drugs are still under patent, which means we do not make them here, and hence cost a lot as they have to be imported. These cost typically over a lakh. But these are all targeted immunotherapy drugs which give much better results than other available therapies for certain types of cancers. This is the reason we prescribe these therapies to even patients at AIIMS and they shell out huge amounts. Any reduction in the prices will help patients.”
There was a time when the family of the 77-year-old lung cancer patient had to make a hard decision before the treatment protocol. “We first chose a second-generation drug called Afatinib but then she had severe side effects like diarrhoea, itching and toe infection. We were told that Osimertinib, the third-generation drug, could give her up to three years, improve her quality of life and have fewer side effects. But we signed up for Osimertinib only when its manufacturer, Astrazeneca, put us on a patient programme. It allowed us to get three strips of ten pills each for Rs 1.5 lakh. Independently, each strip costs Rs 1.5 lakh. Still, we ran out of money and then accessed the grey market for lower prices,” says her daughter.
Manjula’s husband Sunil had also signed up for the patient assistance programme of Astrazeneca. “The medicine is still expensive and she has to keep taking it just like treatments for diseases such as diabetes,” he adds. “It is not the only thing that we have to think of. She needs to maintain a very healthy diet and take a lot of protein supplements. All of it adds to the expenses,” Sunil says.
Dr Ankur Bahl, senior director of medical oncology at Fortis Gurugram, who is treating the 60-year-old patient, prescribes Osimertinib to two or three patients every week. “I have prescribed it for a particular type of lung cancer which accounts for 25 to 30 per cent of incidence in non-smoking women. The drug has a survival benefit. I know patients who have survived with this medicine for four years. But many have to either sell properties and assets to get the therapy or opt for two other drugs — knowing that it is not as good — because they cannot afford this. Any reduction in the costs will be helpful,” he said.
Lung cancer is the second leading cause of cancer deaths among men and it is affecting younger age groups now. “This is an additional challenge because the paying capacity of a young person is also low,” adds Dr Bahl.
Dr CS Pramesh, director of Tata Memorial Hospital, highlights that the pharma industry should ensure that the tax benefit is passed on to patients requiring these drugs. “These three drugs have all been shown to improve outcomes in breast, lung and some other common cancers and this will make these drugs more affordable. The pharmaceutical industry should ensure that this benefit is passed on to patients requiring these drugs,” he says.
(Inputs from Rupsa Chakraborty)
