Global access and affordability roadmap: essential medicines and generics → biosimilars and frugal trials → reliance, pooling and homegrown innovation

The World Health Organization's list of medicines every health system should provide, which now includes about 60 cancer drugs from cyclophosphamide and cisplatin to trastuzumab, imatinib and PD-1 inhibitors, guiding procurement and pricing in lower-income countries.

The UN health agency that sets global cancer policy: the cervical cancer elimination strategy, the essential medicines list, the childhood cancer initiative and the classification of tumours.

The Mumbai generics maker famous for a one-dollar-a-day HIV regimen, which sells oncology generics across India and Africa and in 2026 partnered with ImmunoACT to take Indian CAR-T therapy to Africa.

The oncology generics company at the centre of India's two landmark patent fights: the first compulsory licence, for sorafenib in 2012, and the Supreme Court's 2013 refusal of Novartis's imatinib patent.

The Hyderabad generics maker that launched the world's first rituximab biosimilar in 2007 and now sells oncology generics and biosimilars in India, the US and Europe.

India's largest drug company, which owns the branded cancer drugs Odomzo and Yonsa in the US and bought the PD-L1 antibody maker Checkpoint Therapeutics in 2025.

Seventy percent of cancer deaths occur in low- and middle-income countries, where radiotherapy machines, pathologists, essential medicines and palliative care are scarce. Global oncology works on affordable, adapted care and the systems to deliver it.

Seven in ten cancer deaths happen in low- and middle-income countries, where radiotherapy, pathology, surgery and drugs are scarce.

Near-identical copies of Herceptin, approved since 2017, that cut the price of HER2 treatment and widened access worldwide.

A biosimilar is a copy of a biologic drug such as trastuzumab, shown to be as safe and effective as the original once its patent expires, usually at a lower price.

India's largest biopharmaceutical company, founded by Kiran Mazumdar-Shaw in 1978, and the parent of Biocon Biologics, which makes low-cost copies of the antibodies trastuzumab and bevacizumab.

Biocon's biosimilars arm, one of the few companies outside the US and Europe with FDA- and EMA-approved cancer antibody biosimilars, and since 2022 the owner of Viatris's biosimilars business.

A privately held Ahmedabad company whose European arm, Accord Healthcare, is one of the largest suppliers of generic chemotherapy and supportive-care biosimilars to European hospitals.

A large Ahmedabad drug maker with oncology generics and biosimilars for India and US approvals for cancer generics such as enzalutamide.

A network of more than 360 Indian cancer centres, run from Tata Memorial, that agrees common treatment guidelines, buys cancer drugs together at a fraction of list price and runs shared tumour boards and trials.

India's largest cancer centre, a leader in low-cost, high-impact trials such as low-dose immunotherapy and oral metronomic chemotherapy.

India's oldest philanthropic trusts, which built the Tata Memorial Hospital in 1941 and since 2017 have been building a network of 20 cancer hospitals across seven states so that treatment is closer to home.

When 23 Indian cancer centres bought 40 cancer drugs together instead of separately, prices fell by a median of 82%, saving about 13 billion rupees against list prices.

Cheaper copies of biological cancer drugs exist but are used far less in some countries than others. Making them the default choice saves billions with no loss of benefit.

A Mumbai trial that added about one-twentieth of the usual dose of the immunotherapy nivolumab to cheap oral chemotherapy and nearly tripled the share of patients alive at one year.

Giving about one-twentieth of the standard dose of nivolumab alongside cheap oral chemotherapy nearly tripled one-year survival in advanced head and neck cancer, showing that immunotherapy can be made affordable without losing its effect.

Two cheap tablets taken at home matched, and in fact beat, intravenous cisplatin for advanced head and neck cancer in a 422-patient Indian trial, with fewer side effects.

Adding low-cost oral metronomic tablets to standard paclitaxel-carboplatin doubled median survival from 5 to 10 months in a randomised trial run in Varanasi.

A single cheap hormone injection before breast surgery did not help every woman, but in those whose cancer had reached the lymph nodes it improved survival at five years, a finding still being tested.

A Tata Memorial trial ended a 50-year debate by showing that removing the neck lymph nodes at the first operation for early mouth cancer raises three-year survival from about two-thirds to four-fifths.

Six months of trastuzumab was almost as good as twelve, with half the heart toxicity, though twelve remains the global standard.

Giving radiotherapy in fewer, bigger daily doses (fractions) so a course takes one to three weeks instead of five to seven, with equal cure and side effects for many cancers. Convenience, cost and machine capacity all improve.

Six weeks of cheap, generic chemotherapy before standard chemoradiation cut deaths by 40%, an advance usable anywhere in the world.

A trial in India found that adding a very small dose of an immunotherapy drug, about a twentieth of the usual amount, to chemotherapy improved survival in head and neck cancer. If confirmed, this could make immunotherapy affordable for millions.

Indian trials have shown that tiny daily doses of old oral chemotherapy drugs can help patients with head and neck cancer at a cost of a few dollars a month. These regimens should be proven and adopted worldwide.

Frequent tiny doses of cheap old chemotherapy pills have shown surprising benefit in some cancers. A single large trial network in India and Africa could find out where this works and where it does not.

The PERSEPHONE trial showed six months of trastuzumab after surgery is as good as twelve, halving the drug cost; no company will run such trials, so public funders and charities must.

Many cancer drugs work as well at lower doses or given less often, but companies have no reason to prove it. Public funders should run those trials.

India's first home-grown CAR-T cell therapy, approved in 2023 for relapsed leukaemia and lymphoma, made in Mumbai for roughly a tenth of what the same kind of treatment costs in the US.

The trial behind India's first CAR-T approval: about three in four heavily pretreated patients with lymphoma or leukaemia responded to a therapy made in Mumbai.

The IIT Bombay spin-off that won India's first CAR-T approval in 2023 with NexCAR19 and has treated more than 600 patients at a tenth of Western prices.

India's second approved CAR-T therapy, a Bengaluru-made version of a Spanish hospital's academic CD19 cell therapy, for lymphoma that has come back after other treatments.

The first industry-run CAR-T trial in India, testing a Bengaluru-made version of a Barcelona hospital's cell therapy in relapsed lymphoma and leukaemia; it led to the approval of Qartemi.

A Bengaluru cell therapy company that brought Barcelona's academic CD19 CAR-T to India as Qartemi, the country's second approved CAR-T, after the IMAGINE trial.

India's first home-made HPV vaccine, protecting against the two virus types that cause most cervical cancers and the two that cause genital warts, at a price meant for a national programme.

The world's largest vaccine maker by doses, which developed CERVAVAC, India's first home-made HPV vaccine, so that cervical cancer prevention no longer depends on imported shots.

Sintilimab is Innovent's PD-1 antibody, one of the most widely used cancer immunotherapies in China, with approvals across lung, liver, oesophageal and stomach cancer that rest on the ORIENT trials.

Innovent makes sintilimab, China's best-selling PD-1 antibody, and has become a source of next-generation assets for Roche and Takeda.

The trial that made sintilimab a first-line lung cancer treatment in China, and the one the FDA later refused to accept as evidence for US patients.

One of China's most widely used PD-1 blockers, approved there for oesophageal, liver, lung, and other cancers; not approved in the US.

Jiangsu Hengrui is China's largest oncology pharma, maker of pyrotinib and the HER2 ADC trastuzumab rezetecan, and one of the biggest out-licensers of Chinese assets.

Junshi developed toripalimab, the first Chinese PD-1 antibody approved in China (2018) and the first approved by the FDA (2023, nasopharyngeal cancer).

Relma-cel was the first CAR-T therapy developed and made in China to be approved, for large B-cell lymphoma that has come back after two treatments.

The trial that made relma-cel the first CAR-T developed and manufactured in China to be approved, with three quarters of patients responding.

Hengrui's HER2 ADC, approved in China for lung cancer and showing Enhertu-scale results in breast cancer, part of a wave of Chinese ADCs heading for global trials.

The first head-to-head trial in which a new drug beat Keytruda, in China; a survival benefit followed in 2026.

The NHSA runs China's public health insurance and negotiates once a year which new cancer drugs are reimbursed, and at what price, through the National Reimbursement Drug List.

CSCO guidelines are China's national oncology guidelines, notable for grading recommendations by both evidence and affordability, and for covering Chinese-developed drugs (PD-1 inhibitors, ADCs) and cancers common in China (nasopharyngeal, oesophageal, liver, gastric) earlier than Western guidelines.

One round of HPV testing in rural Indian villages halved deaths from cervical cancer within eight years, while a Pap smear or a visual check did not, which is why HPV tests are now the world's preferred screen.

Trained health workers looking inside the mouths of tobacco and alcohol users in Kerala cut oral cancer deaths by a third, and by four-fifths in those who came to every screening round.

A trained health worker looking inside the mouth with a light can find mouth cancer early; in India this cut deaths by a third among people who use tobacco or alcohol.

Health workers with a torch and vinegar, screening women in Mumbai's slums every two years, cut cervical cancer deaths by 31% in a trial of more than 150,000 women.

When an Indian vaccine trial was halted midway, thousands of girls had had only one shot; following them for ten years showed one dose protected as well as three, changing the world's vaccination policy.

One shot of HPV vaccine was 97.5% effective against the two most dangerous HPV types, making it realistic to vaccinate the whole world.

A swab tested for the virus that causes cervical cancer, more accurate than the Pap smear and doable at home.

Destroying precancerous cervical cells with a heated or frozen probe in under a minute, the tool that makes screen-and-treat possible where there are no surgeons.

Women can collect their own sample for the virus that causes cervical cancer; those who test positive can be treated the same day with a simple heat device. Done nationally, this could eliminate a disease that still kills hundreds of thousands of women a year.

IARC is the WHO's cancer agency, responsible for global cancer statistics (GLOBOCAN), carcinogen classification, and prevention research.

About four in ten cancers could be prevented with tools that already exist: vaccines against the viruses that cause them, tobacco and alcohol control, weight, aspirin for the right people, and finding the families who carry a high-risk gene. The roadmap is mostly about deployment, with interception vaccines as the long-range bet.

Project Orbis is a scheme where the FDA and partner regulators (Australia, Canada, UK, Switzerland, Singapore, Brazil, Israel) review a cancer drug at the same time.

Regulators in several countries already look at the same cancer drug dossier at the same time. Let them split the work and write one report instead of six.

If the FDA and EMA have both approved a cancer drug, a smaller country should be able to approve it in three months using their reports rather than starting over.

Cheap copies of key antibody drugs exist but many countries cannot check their quality. A WHO quality stamp plus large pooled orders would make them safe to buy and very cheap.

Immunotherapy patents start expiring around 2028. Guaranteeing in advance to buy cheap copies for poorer countries would make sure manufacturers build the capacity.

Copies of biological cancer drugs are still required to run large trials that rarely change the answer. Dropping them would cut years and tens of millions from each biosimilar.

Companies can license their patents to generic makers for poorer countries through a UN-backed pool, as happened for HIV. Only one cancer drug has been licensed so far; the whole essential list should be.

When a cancer drug is added to the WHO essential medicines list, the maker should publicly commit to a low price and reliable supply for poorer countries, or the listing is withheld.

Companies get longer monopolies for rare and paediatric cancer drugs. That reward should come with a commitment to sell at cost in low-income countries.

India has shown CAR-T can be made for a tenth of the US price. Public production in large middle-income countries could make it available to millions who are currently excluded.

Academic hospitals can already make CAR-T cells for a fraction of the commercial price. A public network would scale that so more patients can be treated for less.

Countries buying radiotherapy machines one at a time pay high prices and get poor service. A single global buyer negotiating for dozens of machines a year could cut prices and demand long-term support.

Governments and donors should buy guaranteed working hours from radiotherapy vendors, with remote monitoring and regional spare-parts depots, instead of buying machines that then sit broken.

Cervical cancer cannot be cured by external radiotherapy alone; it needs internal radiation, which many hospitals lack. A cheaper internal-radiation unit using a long-lived source could be placed in every regional centre.

Giving radiotherapy in five larger doses over one week instead of 15-25 smaller doses is proven safe for breast and prostate cancer and could treat three times as many patients on the same machines.

Copy the model that transformed HIV, TB and malaria care: a pooled international fund that pays for radiotherapy machines, pathology labs and essential cancer medicines where there are none.

Small European countries have started negotiating cancer drug prices together. A bloc of large middle-income countries would have far more bargaining power.

New cancer drugs routinely cost over $150,000 a year, often for months of benefit. Systems cannot afford them and patients go bankrupt.

Approval says a drug works; reimbursement says who will pay. Health technology assessment bodies (NICE, G-BA, PBAC) judge whether the benefit is worth the price, often per quality-adjusted life year, and can delay access for years after approval.

The UK body that decides which cancer treatments the NHS pays for, publishing detailed appraisals of cost per quality-adjusted life year for each drug, plus clinical guidelines. Its decisions are widely read as an independent view of value.

NICE technology appraisals say whether the NHS will pay, and why. They are the most transparent HTA record in the world.

The ESMO guidelines are Europe's treatment algorithms, and the ESMO-MCBS scores how much each new drug actually helps.

Oncology societies already grade how much benefit each new drug gives. Payers should tie the maximum price they pay to that grade.

One immunotherapy may add years of life in one cancer and weeks in another, yet costs the same. Prices should track the benefit in each use.

Keeping cheap, essential chemotherapy drugs like cisplatin available; shortages in 2023 forced rationing in US hospitals.

Cheap, essential chemotherapy drugs like cisplatin run out because making them is not profitable enough. A non-profit maker could guarantee supply at a fair price.

Cancer costs push patients into debt and make them skip treatment. Asking about money at every visit, and having someone to help, catches this before it does harm.

Chemotherapy went from a poison that sometimes worked to the backbone of most cures, and is now being given more precisely: to fewer people, at better doses, and increasingly delivered inside an antibody so that it reaches the tumour and not the whole body.

The number of people with cancer is rising faster than the workforce trained to treat them.

Most people who die of cancer worldwide do so without adequate pain relief.

Millions of community health workers already visit homes for vaccines and maternal care. Training them to recognise cancer warning signs, guide patients through the system and support home pain care would reach people no hospital does.

Project ECHO is a weekly video class where district doctors and nurses present real cases to a specialist team, learn by doing, and build a network. It worked for hepatitis C and could work for cancer.

Hospitals without enough physicists could upload scans to a shared planning centre, where AI drafts the treatment plan and remote experts finish and check it within a day.

Video visits, remote second opinions, and slides reviewed from afar, which let rural and low-resource patients reach specialists.

Most of the world's people who die in cancer pain have no access to morphine, a drug that costs pennies, because of restrictive national rules. Fixing the rules, not inventing new drugs, is the answer.

You cannot fix what you cannot count. Every donor-funded cancer programme should fund and require a population-based cancer registry so results can be measured over time.

Seven in ten cancer deaths are in poorer countries, yet almost all trials happen in rich ones. Funders would commit a share of money for trials designed and led where the burden is.

Most of the world's cancer patients live in countries that host almost no registrational trials. Including sites there, and paying to build them up, would make results apply globally and speed local access.

Most cancer deaths are in low and middle income countries, where scans and endoscopies are scarce. A cheap methylation blood test tuned to liver, stomach, oesophageal, cervical and breast cancer could fill the gap.

The Geneva-based membership body of more than 1,100 cancer organisations that runs World Cancer Day, the World Cancer Congress and the TNM staging system.

Radiotherapy cures more people than any drug and has reinvented itself every decade: from crude X-ray fields to beams shaped by computer, delivered in days instead of weeks, and now in fractions of a second. Its future is precision, fewer visits, and combination with drugs that make radiation work better.

Seven in ten cancer deaths happen in low- and middle-income countries, where radiotherapy, pathology, surgery and drugs are scarce.

New cancer drugs routinely cost over $150,000 a year, often for months of benefit. Systems cannot afford them and patients go bankrupt.

Regulatory divergence means a drug approved in one country can take years to reach another, or never arrive.

Old, cheap drugs with anti-cancer signals never get the trials they need because no one profits from the result.

Older, Black, Hispanic, Asian, rural, poor and multimorbid patients are under-represented, so results may not apply to them.

Most people who die of cancer worldwide do so without adequate pain relief.

The number of people with cancer is rising faster than the workforce trained to treat them.