India's missed shot, world is winning race for cancer cures

Cancer has become one of the greatest threats to global healthcare. Despite the rapid advancement in anticancer therapeutics development, approximately 12 million cancer-related deaths occur globally, according to the World Health Organization (WHO). 

Anticancer treatments have changed from conventional to groundbreaking treatments, such as stem cell therapies, immunotherapies, and robotic surgeries. 

However, India's contribution to once-therapeutics development is insignificant compared to that of the US, China, and other countries like Germany. We aimed to explore the causes of this gap and actionable steps that can be beneficial to enhance India’s contribution. The cancer product market is expected to reach approximately $580 billion by 2030, with CAGR of 12.4%. The expenditures of nations like the USA ($6.56 billion invested in 2024) on anticancer research, development, and manufacturing are very high compared to India. Indian pharma majors are known for generic product development, but their contribution to finding new anticancer products is limited. 

In India, approximately 1.40 billion people are suffering from the deadliest diseases, and an estimated 1.5 million new cancer cases are coming every year. This warrants an equal contribution from India in anticancer R&D and product development growth. By 2025, India's cancer incidence is expected to increase from 1.39 million to 1.57 million, according to the National Cancer Registry Programme (NCRP). Nearly 50% of all cancers are breast cancer, lung cancer, cervical cancer, and oral cancer. Although these numbers are scary, access to effective treatment remains challenging. 

Identifying the gap 
Although India's pharmaceutical sector accounts for approximately $50 billion, only 8% of total revenue is utilized for anticancer R&D. This indicates the need for more investment to get the new products claiming Indian origin. In contrast, global companies like Pfizer and Roche invest 20% of their profit in R&D. Higher investment in R&D has always contributed significantly to discoveries and groundbreaking anticancer medications such as CAR-T therapy. Innovating in India is hampered by low profit and investment ratios. At this point, the involvement of the Indian drug regulator, Central Drugs Standard Control Organisation (CDSCO), New Delhi, cannot be completely ruled out, and some policies should be warranted to encourage the Indian manufacturer to dive deep to get some meaningful therapies. However, CDSCO has made significant changes with appreciable affords to bring the medications early to the market. Another factor is collaboration, as advanced cancer research requires multidisciplinary collaboration between academia, industry, and government. Unlike countries like the US, where public-private partnerships thrive, India’s ecosystem is fragmented. This realizes the need for more cohesive efforts to overcome the limitations in the futuristic development of onco-products from India. However, specialized expertise is another requirement to develop breakthrough cancer products, and it’s high time to realize the adequate availability and involvement of Indian researchers compared to the US, China, and other developed countries.    

However, developing a new anticancer product was never easy, as it cost around $2.6 billion, but it has no alternative. In contrast, Indian companies often focus on cost-effective generics rather than high-risk, high-reward, innovative drugs due to limited financial incentives and support. High-end research facilities and clinical trial infrastructure are essential for drug development. India’s infrastructure is under development, with only a fraction of global clinical trials conducted there. As a result, filling out a New Drug Application, usually considered the first on earth is rare for Indian companies, limiting India’s participation in high-value pharmaceutical innovation. 

Success stories and missed opportunities
A subsidiary of Dr. Reddy's Laboratories, Aurigene Oncology Limited, located in Bengaluru, is one of the few players in India that is involved in advanced anticancer therapies known as CAR-T therapy. Despite the remarkable progress, their efforts are dwarfed by the innovation pipelines of global giants such as Roche, Novartis, and Merck. The investment of these companies is the key differentiation factor. These companies are investing significantly in developing novel anticancer therapies such as monoclonal antibody-based systems, CAR-T treatments, and gene therapies. Global giants control 18-21% of the cancer products in the global market with breakthrough products like Herceptin (monoclonal antibody-based product for breast cancer) and Tecentriq (immunotherapy-based product). More to add to the list are Novartis' Kymriah and Merck's Keytruda, well surviving in the market and known for new age-targeted anticancer therapies. 

In India, government initiatives in the healthcare sector, like Ayushman Bharat and the National Health Mission, have gained success and popularity but are largely unfocused on cancer. This realizes an urgent need for the development and promotion of cancer-centric research. One of the missing parts in India (compared to the USA) is Public-Private Partnerships (PPPs), which can play a significant role in developing emerging technologies to fight cancer. The blend of government funding and private sector efficiency can ensure long-term innovation growth. 

What next
Prioritization of pharmaceutical R&D in India can promote anticancer research and bring significant investment. Obviously, support in tax benefits, academia-industry collaborations, cancer-specific government grants, and subsidies can serve as nutrients. Moreover, developing cancer-centric hubs (like development of IT hubs in India) can bring together the major stakeholders, like pharma industries, academia, and government agencies like ICMR, DBT and DST, to get important breakthroughs against cancer. As an example from the USA, the National Cancer Institute has had a significant impact on cancer research in the country. Similar platforms in India, can also foster India's research ecosystem for anticancer therapeutics discovery and development. Besides, partnerships with leading global universities for specialized education and training programs can enhance India's expertise in this segment. With these strategies, India can become a global leader in cancer medicine development, offering cutting-edge yet affordable treatments for millions.

Conclusion
India can become a global leader in cancer medication with its strong pharmaceutical base and talent pool. Nevertheless, achieving this will require collaboration, innovation, and investment. In the fight against cancer, India can address systemic gaps and adopt a forward-looking approach to ensure it keeps pace with the global pace. A major advantage of Indian pharmaceuticals is their affordability and ability to manufacture drugs in bulk, which makes them a lifeline for low- and middle-income nations. Companies like Roche and Merck focus heavily on innovation and advanced technologies such as biologics and CAR-T therapies. Cancer has become the leading killer in the world, raising the stakes to unprecedented levels. India must join the race as a leader, not just as a participant, as cancer medications become more readily available.