Immunotherapy vs chemotherapy: Why cancer treatment is not a simple choice

Rahul Dua's remark comparing immunotherapy favourably with chemotherapy drew criticism from oncologists online. Doctors said cancer care depends on tumour type, biomarkers, side effects and access.Comedian Rahul Dua’s claim that immunotherapy is “better” than chemotherapy has triggered outrage online, with doctors and cancer specialists pointing out that the comparison is far too simplistic for a disease as complex as cancer.The controversy has also opened up a larger conversation. Immunotherapy is undoubtedly one of the biggest breakthroughs in modern cancer care and has transformed outcomes for some patients. But that does not make chemotherapy obsolete or immunotherapy universally superior.Globally, cancer is becoming an even bigger public health challenge. An estimated 20 million new cancer cases and 9.7 million cancer deaths were recorded in 2022, according to the World Health Organisation- International Agency for Research on Cancer (WHO-IARC).The number of new cases annually is projected to rise to 35 million by 2050. India, too, faces a growing cancer burden, reporting more than 15.6 lakh new cases every year and over 9 lakh deaths, according to recent estimates by the same agency.Against this backdrop, the search for more effective and less toxic cancer treatments has put immunotherapy firmly in the spotlight. But experts stress that cancer treatment cannot be reduced to a contest between two therapies.NOT A BINARY CHOICE “Cancer treatment is not binary – it depends on tumour stage and biomarkers,” Dr Kumar Prabhash, medical oncologist and researcher at Tata Memorial Centre (TMC), Mumbai told India Today. “There are cancers where only immunotherapy can give excellent results, while there are many where chemo plus immunotherapy is offered.”Chemotherapy, commonly called chemo, uses powerful drugs to kill or slow down rapidly dividing cancer cells. It has been a cornerstone of cancer treatment for decades and remains essential for curing or controlling many cancers.It can be used before surgery to shrink tumours, after surgery to eliminate microscopic cancer cells, alongside radiation, or to control advanced disease.Immunotherapy works differently. Instead of directly attacking cancer cells, it helps the body's immune system recognise and fight them.The best-known drugs used in India include immune checkpoint inhibitors such as pembrolizumab, nivolumab, durvalumab and atezolizumab, among others.These drugs have changed treatment for several cancers. Pembrolizumab (marketed as Keytruda) and nivolumab (available under the brand names Opdyta and Tishtha), for instance, are used across multiple indications, while durvalumab and other checkpoint inhibitors have expanded treatment options in cancers including lung and bladder cancer.But whether a patient will benefit depends on much more than simply the name of the treatment.BIOMARKERS MATTER MOST“What is being said is too simplistic,” said Dr Shyam Agarwal, senior oncologist with Gangaram Hospital in the capital. “Cancer treatment (is) decided by specific cancer types, stage and other factors. Biomarkers decide whether the available immunotherapy will help a patient or not.”Biomarkers are measurable biological features of a tumour that can help doctors predict whether a particular drug is likely to work. In some cancers, tests for markers such as PD-L1 expression or other genetic and molecular characteristics help guide the use of immunotherapy.This is why two patients with the same organ affected by cancer may receive entirely different treatments.“In many cancers today, immunotherapies have revolutionised the treatment path,” Dr Agarwal said. In selected early cancers of the breast, lung, rectum, stomach and urinary bladder, immunotherapy may now be offered alongside chemotherapy, sometimes before surgery or radiation.The key point, however, is that this is often immunotherapy plus chemotherapy, not immunotherapy replacing chemotherapy.For some patients, chemotherapy remains the most effective treatment. For others, immunotherapy alone may produce remarkable and long-lasting responses. And in many cases, doctors combine the two because they work through different mechanisms.BREAKTHROUGH, NOT REPLACEMENTThe excitement around immunotherapy is justified. In certain cancers such as melanoma – a very aggressive form of skin cancer, apart from several others, it has produced responses that were once difficult to imagine, including prolonged disease control in some advanced cancers.But its success is not universal.“There are also cancers where immunotherapy so far has not been able to make much breakthrough – for instance, brain cancers, cancers of soft tissue and gliomas,” Dr Agarwal pointed out.Immunotherapy can also cause serious side effects. By activating the immune system, it can sometimes make immune cells attack healthy organs, causing inflammation in the lungs, liver, intestines, thyroid or other parts of the body. These complications require specialised monitoring and treatment.That makes the idea that one treatment is simply “better” than another misleading.INDIA’S ACCESS CHALLENGEThere is another complication in India: access.Even when immunotherapy is medically appropriate, it may remain financially out of reach.Pembrolizumab, one of the world's most widely used cancer immunotherapies, is a striking example. Its patent protection and high cost have limited access in India, with estimates suggesting that only a small fraction of eligible patients can afford newer immunotherapy drugs.A TMC and Advanced Centre for Treatment, Research and Education in Cancer (ACTREC) study released in 2026 also highlighted the affordability crisis around modern cancer medicines, including pembrolizumab and nivolumab.The cost of a prolonged course can run into tens of lakhs of rupees, while insurance coverage and public funding may not always bridge the gap. Pembrolizumab's patent in India is currently expected to remain a key barrier to wider competition until 2028.As immunotherapy becomes increasingly important in cancer care, India therefore faces two parallel challenges: identifying the patients most likely to benefit through better biomarker testing, and making effective treatments affordable to those who need them.- EndsPublished On: Sep 7, 2026 18:59 IST