Ultra-low doses could bring costly cancer treatments to more patients in poorer countries

Pharma Ultra-low doses could bring costly cancer treatments to more patients in poorer countries Researchers found a tiny dose of nivolumab helped patients in India live longer Manage alerts for this article Email this article Share this article By Katherine MacPhailMay 31, 2026 Reporter, Live Journalism Katherine MacPhail[email protected]Katherine MacPhail is a reporter and editorial events programmer for STAT. CHICAGO — What if the trick to getting cancer immunotherapy to parts of the world that can’t access it is simply lowering the dose? A lower-cost immunotherapy approach could extend survival for patients with advanced head and neck squamous cell carcinoma in resource-limited countries, according to results presented Sunday at the annual meeting of the American Society of Clinical Oncology.Advertisement Immune checkpoint inhibitors have transformed cancer treatment in wealthier countries, but in many parts of the world, their cost — potentially tens of thousands of dollars a year in India — keeps them out of reach. In India, where the phase 3 trial took place, head and neck squamous cell carcinoma is the second most commonly diagnosed cancer. Despite its prevalence, less than 3% of eligible patients receive a checkpoint inhibitor. Researchers led by Minit Jalan Shah of Tata Memorial Centre in Mumbai tested whether an ultra-low dose of the PD1 inhibitor nivolumab in combination with chemotherapy could offer a more affordable alternative. The study enrolled 422 adults with advanced platinum-sensitive disease. Participants were randomly assigned to receive either paclitaxel-carboplatin, a standard platinum-based chemotherapy, or triple-oral metronomic chemotherapy combined with ultra-low-dose nivolumab, known as TMC-I, which costs about $230 a month. Advertisement Patients receiving TMC-I lived significantly longer, with a median overall survival of 10.3 months compared with 6.2 months for those receiving standard chemotherapy. About 46% of patients who got TMC-I were alive after a year, compared with 23% in the control arm. TMC-I was also associated with fewer severe side effects. Rates of grade 3 or higher adverse events were roughly 10 percentage points lower than in the standard chemotherapy group. Based on these results and prior studies, TMC-I has become the preferred first-line regimen in India, Shah said. Still, the overall survival outcomes remain lower than those reported with the U.S.’s first-line agents. These new TMC-I data have spurred “growing momentum” for a trial directly comparing standard-dose and low-dose immunotherapy approaches, said Julie Gralow, ASCO’s chief medical officer and executive vice president, during a press briefing. Although such a head-to-head trial would need to be conducted abroad, Gralow said the results could have broad implications if it included a U.S. standard-of-care comparator arm. “We could, thanks to a low-resource setting, potentially do the study needed for us to maybe more appropriately dose these drugs in high-resource settings,” she said. In the U.S., the question of optimal dosing could be one piece of reducing health care costs while preserving efficacy, Gralow continued. “Health care costs in the United States and for the treatment of cancer are exceedingly high, and anything we could do to better understand the comparability across these 12 U.S. FDA-approved PD1/PDL1 inhibitors, the biomarkers that better select a smaller population who benefit, and the appropriate dosing, are incredibly appropriate and are in the best interest of our patients as well as our healthcare system,” she said. ASCO, Cancer, global health, Pharmaceuticals, Policy, research Submit a correction requestReprints Katherine MacPhail Reporter, Live Journalism Katherine MacPhail is a reporter and editorial events programmer for STAT. Newsletter Your morning rundown of the science, politics, and money driving biotech today Recommended Biotech May 31, 2026 STAT Plus: Akeso and Summit’s ivonescimab extends survival in squamous cell lung cancer Biotech May 31, 2026 STAT Plus: For prostate cancer patients set on surgery, new hormone regimen may improve outcomes, study finds Advertisement Biotech May 31, 2026 STAT Plus: Practice-changing results reported for Revolution Medicines pancreatic cancer drug Biotech May 30, 2026 STAT Plus: BioNTech and Pfizer tout bispecifics data at ASCO, and Pazdur sees silver lining at FDA Biotech May 30, 2026 STAT Plus: China competition, ‘destruction’ at FDA give agency chance to restructure, Rick Pazdur says Subscriber Picks