Daijiworld Media Network - Mumbai
Mumbai, Mar 10: Doctors in India are increasingly exploring “dose optimisation” to make expensive treatments more affordable while also reducing side-effects, and new findings from Tata Memorial Hospital highlight how significant the impact could be.
The Mumbai-based cancer institute found that administering one-tenth of the standard dose of the immunotherapy drug Nivolumab worked just as effectively in patients while causing fewer side-effects. The study indicates that the monthly cost of this modern anti-cancer treatment could drop from around Rs 4.4 lakh to about Rs 18,700.
“This is an ultra-low dosage of an immunotherapy drug called nivolumab that is increasingly being used for multiple cancers, including head and neck and lung cancers,” said senior author Dr Kumar Prabhash.
The research, published in the Journal of Clinical Oncology, is considered the world’s largest randomised study on nivolumab, involving 500 patients with previously treated or advanced disease. According to the findings, the one-year overall survival rate was 27.3 per cent in the nivolumab group compared to 16.9 per cent among patients receiving standard chemotherapy. In addition, infections, diarrhoea and hospitalisations were significantly lower among patients treated with the immunotherapy drug.
Experts say nearly 80 per cent of cancer patients worldwide are unable to access such medicines due to their high price. “We are trying to identify the least possible dose that remains effective,” Dr Prabhash explained. Traditionally, drug development focuses on identifying the maximum tolerable dose to ensure effectiveness against disease.
The nivolumab trial is part of a broader effort in India to adapt expensive treatments and medicines in ways that reduce costs and toxicity. Similar strategies have been used in vaccination and tuberculosis treatment programmes.
For instance, India’s recent human papillomavirus (HPV) vaccination drive recommends a single dose for girls aged 14–15, unlike the two-dose schedule used in countries such as the US and UK. According to International Agency for Research on Cancer (IARC) and the World Health Organization (WHO), data from long-term studies suggest that even one shot can generate sufficient antibodies.
Likewise, tuberculosis treatment has also seen optimised dosing. India introduced the BPaL-M regimen in 2025 after a three-year trial aimed at reducing the toxicity of the antibiotic linezolid. Instead of administering 600 mg daily for six months, the revised protocol uses 600 mg for 13 weeks followed by 300 mg for the remaining treatment period.
Despite these promising findings, experts say such innovations often remain confined to public hospitals. According to Dr Rajendra Badwe, former director of Tata Memorial Centre, many private hospitals continue to follow the original dosage protocols approved during early clinical trials.
He noted that cost-effective treatment strategies are essential, particularly for middle-class patients struggling with the high cost of cancer care.
Another example cited by researchers is a study led by Dr Sudeep Gupta on the antibody drug Trastuzumab for HER2-positive breast cancer. The research found that three months of therapy delivered outcomes similar to the standard one-year treatment course. While Tata Memorial Hospital adopted the shorter protocol, many private hospitals have yet to follow suit.