Finance Minister Nirmala Sitharaman, in her 2024-25 budget speech on Tuesday, announced customs duty exemptions for three targeted cancer drugs, trastuzumab terextecone, osimertinib and durvalumab. Before the budget announcement, customs duty on these drugs was around 10%.
This decision will make these drugs more accessible to Indian patients and reduce the overall cost of cancer treatment.
Here’s how the three drugs work, the impact of the government’s decision and India’s cancer profile.
First, what are targeted cancer drugs?
Targeted cancer drugs are designed to attack only cancer cells, leaving normal cells unaffected. They target specific genetic changes in cancer cells, helping them to 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 by using any drugs. Instead, it trains the patient’s immune system to find and attack cancer cells.
How do these three drugs work?
Trastuzumab deruxtecan is an antibody-drug combination drug. It is combined with a monoclonal antibody (a lab-made protein that acts like human antibodies) medicine. It is used to treat any cancer where the HER-2 receptor (a protein that appears on the surface of some breast cancer cells) has changed or is unresectable.
Developed by Daiichi Sankyo and marketed by AstraZeneca as EnHerd, trastuzumab terextegan is a next-line treatment used when traditional treatments have failed.
In 2019, the drug was approved for the treatment of breast cancers, and in 2021, for the treatment of certain types of gastrointestinal cancers.
Earlier this year, the drug became the first drug to receive “tissue-agnostic approval” from the US Food and Drug Administration (FDA), meaning it can be used regardless of which cancer develops with the HER-2 receptor.
Price: A vial costs around Rs.1.6 lakh.
Osimertinib is the most commonly used of the three anticancer drugs in India. Marketed by AstraZeneca as Tagrisso, this drug is used to treat lung cancers. Epidermal growth factor receptors (EGFR) are thought to be involved in the development of cancer. Osimertinib blocks these receptors on cancer cells, preventing the cancer from growing.
Osimertinib may be prescribed as a first-line treatment after surgical removal of a tumor or if cancer has metastasized. It can be taken until the drug fails and the cancer starts to progress again or severe toxicity occurs.
Dr Ankur Bahl, senior director of clinical oncology at Fortis Gurugram, told The Indian Express: “Osimertinib has survival advantages over other treatments as it can extend the life of cancer patients by four to five years”.
Dr. Ankur Bahl also said that osimertinib targets the mutation, which occurs in 25% to 30% of lung cancers in non-smoking women.
Price: However, the drug is quite expensive, i.e. 1.5 lakhs for a pack of ten tablets and has to be taken every day.
Durvalumab, an immunotherapy drug, is used to treat certain lung cancers, bile duct cancers, bladder cancer, and liver cancer. It attaches itself to PD-L1 proteins on the surface of cancer cells, helping these proteins escape immune detection. Durvalumab allows the body’s immune system to recognize and kill cancer cells.
Studies have shown that patients who take the drug go into remission and live longer.
Price: Marketed as Imfinzi, durvalumab costs around Rs 1.5 lakh for each 10ml vial.
What is the impact of customs duty exemptions?
Customs duty exemptions for these drugs are widely expected to help reduce the financial burden on cancer patients and their families.
A cancer patient who spoke to The Indian Express said even a Rs 12,000 drop in prices would help him buy more nutritional and protein supplements and use the money for other expenses like tests and scans.
Dr Abhishek Shankar, an oncologist at the All India Institute of Medical Sciences (AIIMS) in New Delhi, said, “This is a positive step by the government. These drugs can cost millions, and even a small percentage drop can make a significant difference to patients and their families. They are targeted therapies that provide better results than traditional treatments,” he said.
Dr. Abhishek Shankar also said that in India, about one lakh patients require rastuzumab terextecon, osimertinib and durvalumab.
What is the cancer situation in India?
The number of people suffering from cancer in India is increasing. According to data from the National Cancer Registry, 14.6 lakh new cancers were diagnosed in 2022, increasing to 14.2 lakh in 2021 and 13.9 lakh in 2020. The number of cancer deaths increased to 8.08 lakh in 2022, 7.9 lakh in 2021 and 7.7 lakh in 2020.
Cancer incidence is high among women, with 103.6 women diagnosed with cancer per 100,000 population in 2020. 94.1% of males are affected. In men, the most common cancers are lung, mouth, prostate, tongue and stomach; In women, breast, cervical, ovarian, uterine and lung cancers occur.
Treatment is cheap and effective for lung and breast cancers, which are among the most common cancers in men and women, respectively.
Using data from population-based cancer registries, an Indian Council of Medical Research (ICMR) study said one in nine Indians will be affected by cancer in their lifetime. According to the study, 1 in 68 men will develop lung cancer and 1 in 29 women will develop breast cancer.
