🇮🇳 India: what India is up to in cancer

GLOBOCAN 2022 estimates about 1.41 million new cancers and 917,000 deaths in India, an age-standardised incidence of 98.5 per 100,000 (roughly a third of the US rate) but with a high case-fatality because so many cancers are found late. Lip and oral cavity cancer alone accounts for about 144,000 cases, and the head and neck sites together exceed breast cancer. Cervical cancer (about 127,500 cases, 79,900 deaths) is the second cancer of women. India's registries record most breast (57%), cervical (60%) and head and neck (66.6%) cancers at a locally advanced stage. Gallbladder cancer is concentrated in the northern and north-eastern Gangetic states, where incidence in women is among the highest in the world.

The Global Adult Tobacco Survey (2016-17) found 28.6% of people aged 15 and over, about 267 million, using tobacco in some form, with smokeless products (khaini, gutka, betel quid with tobacco) more common than cigarettes or bidis. The National Tobacco Control Programme attributes about 3,500 deaths a day to tobacco and half of cancers in men and a fifth in women. The Cigarettes and Other Tobacco Products Act (COTPA, 2003) bans smoking in public places, sales to and by minors and sales within 100 yards of schools, and requires pictorial warnings; state gutka bans followed from 2012; a national quitline (1800 11 2356) and mCessation service operate.

The ICMR National Cancer Registry Programme (since 1982, coordinated from Bengaluru) drew on 28 population-based and 58 hospital-based registries for its 2020 report, projecting 1,392,179 cases for 2020 and, in a 2022 update, 1,461,427 cases with a 12.8% rise by 2025 and a lifetime risk of about one in nine. Registries cover roughly a tenth of the population and are urban-weighted; GLOBOCAN uses different methods and gives slightly different totals. The north-east (Aizawl, Papumpare) has the highest recorded rates.

PM-JAY was launched on 23 September 2018 and is run by the National Health Authority with state agencies. It covers about the poorest 40% of the population (the original target was 10 crore households, around 50 crore people) for secondary and tertiary hospital care at empanelled public and private hospitals, with oncology among the largest tertiary package groups. In September 2024 cover was extended to all people aged 70 and over. A 2025 study of 6,695 cancer patients at seven centres in six states found PM-JAY enrolment strongly associated with starting treatment within 30 days, and 36% higher odds of timely treatment for patients diagnosed after 2018. Outpatient visits, most oral cancer drugs and diagnostics remain outside the cover, and package rates for newer drugs are low.

Tata Memorial Centre, run by the Department of Atomic Energy, registers well over 100,000 new patients a year across its Mumbai hospitals and its units in Varanasi, Sangrur and Mullanpur, Visakhapatnam, Muzaffarpur and Guwahati, treating the majority in the general (subsidised) category. Regional Cancer Centres such as Kidwai (Bengaluru), the Cancer Institute (WIA) in Chennai (about 60% of its 100,000 annual patients treated free or subsidised) and the state cancer institutes funded under the national NCD programme do the same. Twenty AIIMS were operating by January 2023, each with oncology services. The gap is capacity: radiotherapy machines, specialists and beds are concentrated in a few cities.

Section 3(d) of the Patents Act, upheld by the Supreme Court in Novartis v Union of India (1 April 2013), refuses patents on new forms of known drugs without improved efficacy, which kept generic imatinib on sale at a small fraction of the Glivec price. India's first compulsory licence (Natco, sorafenib, March 2012) cut that drug's price by about 97%. Indian biosimilars of rituximab (Dr Reddy's, 2007), trastuzumab (Biocon, 2014) and bevacizumab (Hetero, 2016) were among the first anywhere. The National Cancer Grid's pooled procurement of 40 drugs for 23 centres cut costs by a median of 82% against list price. Newer patented drugs (immunotherapies, ADCs) are still priced beyond most patients, which is why Tata Memorial's low-dose and metronomic trials matter.

CDSCO sits under the Ministry of Health and Family Welfare and approves new drugs and clinical trials, licenses vaccine and biologic manufacturing and sets standards, while state authorities license most manufacturing and retail. The New Drugs and Clinical Trials Rules 2019 shortened approval timelines and allowed waivers of local trials for drugs approved by reference regulators. India's biosimilar guidelines date from 2012 (revised 2016). CDSCO approved the first Indian CAR-T (NexCAR19, talicabtagene autoleucel) in 2023 and the second (Qartemi, varnimcabtagene autoleucel) in 2024, and India's first domestic HPV vaccine (CERVAVAC) in 2022. Prices of essential medicines are controlled separately by the National Pharmaceutical Pricing Authority.

The IARC India study showed one dose of HPV vaccine protects as well as three at 10 years (efficacy 95.4% against persistent HPV 16/18), which halved the cost of vaccinating a girl worldwide; the Serum Institute's CERVAVAC, approved in 2022, gives India its own supply for a national programme. The Osmanabad trial showed one round of HPV testing halves cervical cancer deaths, the Mumbai trial that VIA by health workers cuts them by 31%, and the Kerala trial that oral visual screening cuts oral cancer deaths in tobacco users by a third. The national NCD programme now includes population screening for oral, breast and cervical cancer at Health and Wellness Centres.

Low-dose nivolumab (20 mg every 3 weeks, roughly 6% of the standard dose) added to oral metronomic chemotherapy raised one-year survival in advanced head and neck cancer from 16.3% to 43.4% (JCO 2023). Oral methotrexate plus celecoxib was non-inferior to, and beat, intravenous cisplatin (Lancet Global Health 2020). METRO PLUS in Varanasi doubled median survival by adding metronomic tablets to paclitaxel-carboplatin (2026). Peritumoral lidocaine before breast surgery improved 5-year survival from 86.4% to 90.1% (JCO 2023). Gefitinib plus chemotherapy doubled progression-free survival in EGFR-mutant lung cancer (JCO 2020). These results travel through the National Cancer Grid's guidelines to hundreds of centres.

NexCAR19 (ImmunoACT, from IIT Bombay and Tata Memorial) was approved in 2023 with a 73% response rate in its phase 1/2 trial and has treated more than 600 patients at over 130 centres; Qartemi (Immuneel, from Barcelona's ARI-0001) followed in 2024. Biocon Biologics' trastuzumab (Ogivri) and bevacizumab (Abevmy) biosimilars are approved in the US and EU; Dr Reddy's rituximab reached the EU in 2024. Glenmark's ISB 2001 trispecific antibody was licensed to AbbVie in July 2025. Indian CDMOs (Syngene, Aragen, Sai Life Sciences, Jubilant) do a large share of the world's early cancer drug chemistry and biology.

The National Cancer Grid, run from Tata Memorial, publishes resource-stratified guidelines, runs virtual tumour boards and quality programmes, trains researchers (CReDO) and launched a cancer EMR initiative in 2025. Tata Memorial's units in Varanasi, Sangrur and Mullanpur, Visakhapatnam, Muzaffarpur and Guwahati bring comprehensive care to regions with the highest burden of oral, cervical and gallbladder cancer. Twenty AIIMS were operating by January 2023. The remaining constraints are workforce and radiotherapy capacity, outpatient and oral-drug costs outside PM-JAY, and the price of new patented drugs.