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India has gained access to two new drugs: one aimed at a brain disease that is increasing with the country's aging population; the other reinvents how cancer patients are treated
Both come with high prices. Eli Lilly's Lormalzi is priced at Rs 91,688 per vial, administered as a monthly intravenous infusion. Similarly, Tecentriq SC (atezolizumab subcutaneous), Roche's subcutaneous version of its PD-L1 immunotherapy, is priced at Rs 3.70 lakh per vial. (Representative photo/Reuters)
In the space of two days, India has crossed two pharmaceutical thresholds: one in the brain and another in the lungs.
Eli Lilly's Lormalzi (donanemab), launched on Wednesday, is the first drug available in India that attacks Alzheimer's disease itself and not just its symptoms. Roche's Tecentriq SC, launched Thursday, is the country's first “subcutaneous lung cancer immunotherapy”: the same molecule as the established intravenous drug Tecentriq, but delivered via a seven-minute injection into the thigh or arm instead of an hour-long intravenous infusion.
The two drugs do fundamentally different jobs. Donanemab attempts to change the trajectory of Alzheimer's by clearing amyloid plaques from the brain, but only in patients diagnosed at the earliest stage, a window currently missed by most Indian families.
Tecentriq SC changes the logistics of receiving immunotherapy, saving patients hours and chair space in overloaded oncology day care units.
Both come with high prices. Eli Lilly's Lormalzi is priced at Rs 91,688 per vial, administered as a monthly intravenous infusion. The Central Drug Standard Control Organization (CDSCO) and the US FDA have approved it for patients with mild cognitive impairment (MCI) or mild dementia due to Alzheimer's, not for moderate or advanced stages. Lilly has marked an “Alternative Access Program” for eligible patients.
Similarly, Tecentriq SC (atezolizumab subcutaneous), Roche's subcutaneous version of its PD-L1 immunotherapy, is priced at Rs 3.70 lakh per vial. The key change is the mechanism of drug delivery in approximately seven minutes. The drug itself hasn't changed; The formulation combines atezolizumab with recombinant human hyaluronidase (Halozyme's Enhanze platform) to enable absorption under the skin.
Donanemab: brain cleansing
Lilly's Donanemab is a humanized monoclonal antibody that binds to a specific form of beta-amyloid found in established plaques in the brain of a person with Alzheimer's. Label these plaques for microglia to remove. In the pivotal phase 3 TRAILBLAZER-ALZ 2 trial, donanemab slowed cognitive and functional decline by approximately 35% over 18 months in early symptomatic patients, with the strongest effect in those with low to medium tau burden.
But there are caveats. The most clinically significant adverse events, such as amyloid-related imaging abnormalities (brain edema/swelling) and microbleeds, can be seen on MRI.
According to Dr Manjari Tripathi, head of the department of neurology at AIIMS Delhi, “Donanemab has been approved for very early Alzheimer's disease or mild cognitive impairment of the Alzheimer type. Patients have to present very, very early, but in India, most come in the middle stage of dementia. This requires a paradigm shift; relatives have to bring patients much earlier.”
He stressed that the drug is approved only for the early stages and is not free of side effects. “These side effects include edema or swelling in the brain and bleeding in the brain. The percentages are small, but informed consent and counseling are required. Recent meta-analyses have not shown a very dramatic effect. Therefore, only patients with very early Alzheimer's or mild cognitive impairment of the Alzheimer's type should receive this medication.”
Similarly, Dr Sanjay Pandey, HOD, neurology and stroke medicine at Amrita Hospital, Faridabad, explained that for decades, Alzheimer's care around the world has been largely symptomatic, with doctors frequently witnessing ongoing cognitive decline despite the best supportive therapies. “The arrival of donanemab signals an important shift in the scientific and therapeutic conversation around neurodegenerative diseases, moving the conversation away from symptom management and toward specific disease modification in carefully selected patients with early symptomatic Alzheimer's disease.”
He believes that for a country like India, with a rising prevalence of dementia and increasing life expectancy, this also highlights the need for timely diagnosis, biomarker-based assessment, advanced neuroimaging and specialized memory care pathways. At the same time, he added that the application of this type of therapies should be considered with scientific caution and clinical responsibility. “Patient eligibility, risk stratification, longitudinal monitoring, and multidisciplinary neurological supervision remain the cornerstone for meaningful outcomes.”
Tecentriq SC: same drug, easier administration
Tecentriq (atezolizumab) is a PD-L1 inhibitor, a drug that reignites the immune system's attack against cancer. Cancer cells deploy a protein called PD-L1 that signals the immune system's T cells to stand down. Atezolizumab blocks this conversation. It prevents PD-L1 from turning off T cells, allowing the immune system to defend itself.
The subcutaneous version is pharmacologically identical to the intravenous version. It is the same medication, but the only difference is how it is administered.
Clinical trials demonstrated this equivalence. The phase 1b/3 IMscin001 trial demonstrated that the subcutaneous formulation achieves non-inferior blood levels of the drug, with safety and efficacy comparable to that of the intravenous form. In other words, patients get the same cancer outcomes either way.
What differed was the patients' preference. In the phase 3 IMscin002 trial, 71% of patients preferred the subcutaneous formulation after trying both, and 79% chose to continue with it.
The value proposition is not better outcomes in cancer. It's the same results, but with less time in the hospital chair, less burden on healthcare infrastructure, and a less invasive experience for patients.
According to Dr. Pragya Shukla, head of the department of clinical oncology at Delhi State Cancer Institute, “The launch of Tecentriq subcutaneous represents an important step forward in the evolution of immunotherapy delivery. Traditionally, immunotherapy and targeted therapy infusions require prolonged office time and repeated hospital visits. A subcutaneous formulation can significantly reduce administration time, making the treatment more convenient and less disruptive to patients' daily lives, while also saves a lot of associated costs.”
Beyond efficiency, Shukla said, this approach also offers patients a more discreet and comfortable treatment experience, which can positively impact overall quality of life. “In busy oncology environments like ours, shorter administration times can help us optimize healthcare resources and improve patient throughput. This change reflects how cancer care is increasingly moving toward improving outcomes while improving the overall treatment experience for patients.”
Dr Manish Kumar, senior consultant, medical oncology, SPARSH Hospital, Bengaluru, said the availability of subcutaneous immunotherapy for lung cancer is an “important step in making cancer treatment more patient-friendly”. However, he noted that access and affordability remain critical concerns, especially when the cost hovers around Rs 3.70 lakh per vial. “For Indian patients, the real impact of such innovation will depend not only on clinical benefit and appropriateness, but also on broader insurance coverage, patient assistance programs and equitable access.”
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