A recent debate triggered by comedian Rahul Dua’s remarks comparing immunotherapy with chemotherapy has brought renewed attention to a critical issue in cancer care: there is no single treatment that can be considered universally “better” for every patient.
Cancer specialists have stressed that the choice between chemotherapy, immunotherapy or a combination of both depends on several factors, including the type of cancer, its stage, molecular profile and the patient’s overall condition.
Immunotherapy has emerged as one of the most significant advances in modern cancer treatment, delivering remarkable results in selected cancers. However, experts say its growing success does not mean chemotherapy has become outdated.
“Cancer treatment is not binary. It depends on tumour stage and biomarkers,” said Dr Kumar Prabhash, medical oncologist and researcher at Tata Memorial Centre, Mumbai. He noted that while some cancers respond exceptionally well to immunotherapy, many patients benefit more from a combination of chemotherapy and immunotherapy.
Chemotherapy continues to play a central role in cancer care. It can be used to shrink tumours before surgery, destroy remaining cancer cells after surgery, support radiation therapy or control advanced-stage disease.
Immunotherapy works differently by helping the body’s immune system identify and attack cancer cells. Drugs known as immune checkpoint inhibitors, including pembrolizumab, nivolumab, durvalumab and atezolizumab, have expanded treatment options for several cancers.
However, specialists emphasise that immunotherapy is effective only in selected patients and situations.
According to senior oncologist Dr Shyam Agarwal, treatment decisions are guided by cancer type, disease stage and biomarkers. Tests for markers such as PD-L1 expression and other molecular or genetic features can help determine whether a patient is likely to benefit from immunotherapy.
This means that even patients with cancer affecting the same organ may receive completely different treatment plans.
In several cancers, including selected cases of breast, lung, rectal, stomach and bladder cancers, immunotherapy may be used along with chemotherapy, sometimes before surgery or radiation. Experts say this highlights an important point: in many cases, immunotherapy complements chemotherapy rather than replacing it.
While immunotherapy has produced long-lasting responses in certain cancers, including melanoma and some advanced malignancies, its benefits are not universal. Some cancers, including certain brain tumours, gliomas and soft tissue cancers, have so far seen limited breakthroughs with available immunotherapies.
Immunotherapy can also lead to serious side effects. Since it activates the immune system, treatment may sometimes cause immune cells to attack healthy organs, resulting in inflammation affecting the lungs, liver, intestines, thyroid and other organs.
The debate also highlights a major challenge for India affordability and access.
Newer immunotherapy medicines can cost patients tens of lakhs of rupees over a prolonged treatment period, placing them beyond the reach of many eligible patients. Limited insurance coverage and gaps in public funding can further restrict access to these advanced therapies.
With India facing a rising cancer burden, experts say the focus should not be on presenting immunotherapy and chemotherapy as competing treatments. Instead, greater emphasis is needed on accurate diagnosis, biomarker testing, personalised treatment decisions and improving access to effective cancer medicines.
The message from oncologists remains clear: immunotherapy is a major breakthrough in cancer treatment, but the right therapy depends on the individual patient and for many, chemotherapy continues to remain an essential part of the treatment journey.
