New Delhi: Swiss pharmaceutical company Roche Wednesday launched Tecentriq SC, the world’s first subcutaneous immunotherapy for lung cancer, in India.
The drug delivers atezolizumab—the same molecule as in its existing intravenous (IV) immunotherapy, Tecentriq—but through an entirely different delivery system. Compared to the IV version, which takes an hour, a single injection is administered under the skin, taking nearly seven minutes.
India’s drug regulator, the Central Drugs Standard Control Organisation (CDSCO), has approved Tecentriq SC for a select category of patients, with non-small cell lung cancer (NSCLC)—the most common type of lung cancer in the country. The cancer typically develops in the epithelial cells of the lungs. It grows more slowly than small-cell lung cancer.
India diagnoses close to 80,000 new lung cancer patients every year. Nearly half of them come to hospitals at an advanced stage, frail and symptomatic, and most seek care in government hospitals, which are stretched thin. For these patients, a single treatment visit can take up an entire day.
Studies have shown that nearly a fifth of the remaining days in the lives of advanced lung cancer patients are spent in contact with healthcare systems.
“Patients spend at least five hours in a hospital on average. And along with them is a dedicated, also burdened, family member and caregiver,” said Dr Sivabalan Sivanesan, Chief Medical Officer at Roche Pharma India.
“We believe we have brought a huge leap forward in how cancer can actually be reimagined,” he added.
What is Tecentriq SC, and how is it different
Atezolizumab is an immunotherapy that works by blocking a protein that cancer cells use to hide from the immune system, allowing the body’s own defences to identify and attack the tumour.
The intravenous version, Tecentriq, has been used in India for several years.
Tecentriq SC is a distinct product—not a reformulation but a combination of atezolizumab with a drug delivery technology developed by Halozyme Therapeutics, an American biotechnology company. The technology temporarily makes the tissue under the skin more permeable. It, therefore, allows the drug to disperse and be rapidly absorbed into the bloodstream.
“The first infusion for the IV takes about an hour, subsequent three-weekly infusions take about 30 minutes,” said Dr Sivanesan. “This version reduces it (the treatment time) to seven minutes.”
“More important than this reduction is that if you take a step back and look at the holistic journey, there is a lot more preparation required for something given intravenously. Subcutaneous injection is given at the patient’s bedside within four to eight minutes. It is the same established treatment which patients know and clinicians know—it is just delivered very differently, with a significantly better experience,” he added.
In India, Tecentriq SC is approved for patients with NSCLC—both at an early post-surgery stage and for advanced disease that has spread to other parts of the body. Crucially, eligible patients can receive it without chemotherapy.
“The determining factor is a biomarker called PD-L1—patients with high expression of this marker are the strongest candidates,” explained Dr Sajjan Rajpurohit, Director and Head of Medical Oncology at Medanta Hospital in New Delhi.
Programmed Death-Ligand 1 (PD-L1), a cellular protein, acts as an immune system checkpoint. It is a predictive medical biomarker that determines if a patient will benefit from cancer immunotherapy.
He added that about 50 percent of India’s 80,000 annual lung cancer patients are likely to carry the marker at meaningful levels. The drug is already approved in over 85 countries and has been used in more than 10,000 patients globally since its first approval by the UK medicines regulator in 2023, followed by the US FDA in 2024.
Notably, Roche was granted a Phase 3 clinical trial waiver by CDSCO last year for the Indian launch of Tecentriq SC. So, the company was not required to conduct a separate local clinical trial before receiving approval.
Addressing the media in Delhi Thursday, Dr Sivanesan said that while global studies for the subcutaneous formulation did not include Indian patients, the IV version of atezolizumab had been used in India for eight to nine years with a well-established efficacy and safety record.
“It is the same molecule,” he said. “You would not expect a different level of efficacy or safety between these two formulations.”
He added that alongside the approval, Roche was committed to conducting a Phase 4 study—a post-market study—on the subcutaneous formulation specifically in India.
What doctors are seeing
Dr Rajpurohit said he currently has seven patients on Tecentriq SC at Medanta. The first is an 80-year-old woman from Defence Colony in Delhi—not Indian by origin, but married to an Indian man. Her husband is 84, and their children are all living abroad.
She came to him three months ago, having lost seven kg, coughing up blood, and in significant pain from cancer that had spread to her bones. She had never smoked.
When he told her the diagnosis, her first response was that she did not want to live, not because she was suicidal, but because the life she had known—of an active, independent person—already felt out of reach.
She refused chemotherapy outright.
She was given Tecentriq SC, along with a bone-strengthening injection, both administered separately, every three weeks. “Within a week, she was about 30 percent better. By her third dose, I would say she’s almost 80 to 90 percent the way she probably would have been before she got this disease.”
The second patient was a 57-year-old male smoker whose cancer had spread to his brain, liver, and bones, leaving him with weakness on one side of his body. He was so frightened of chemotherapy that he started getting opinions from multiple doctors and was on the verge of turning to faith healers.
His PD-L1 expression was 75 percent—high enough to make him a strong candidate for immunotherapy alone. After completing radiation for the brain disease, he was started on Tecentriq SC.
“He couldn’t believe that it is so simple to start the treatment,” said Dr Rajpurohit. “If a therapy does not cause pain to a person, then they are more willing to accept it.”
The patient has since agreed to add a few cycles of chemotherapy, alongside the immunotherapy—something that Dr Rajpurohit said would not have been possible had the treatment not first earned the patient’s trust.
Dr Amit Rauthan, the head of Medical Oncology at Manipal Hospital Bangalore, said the pattern mirrors what happened when subcutaneous antibodies arrived in breast cancer treatment. Once patients experienced the difference, the shift was swift. “Less pain, less time, they are more compliant, and they are ready to go home fast,” he said.
Dr Sivanesan pointed to a less obvious benefit of the seven-minute injection, one that the IV drip, paradoxically, cannot offer. With an intravenous infusion, once the drip is set up and running, the nurse or pharmacist typically walks away, leaving the patient alone for the duration. The subcutaneous injection requires the nurse to stay for the full seven minutes.
“There is that good but forced time with the patient one to one, and a lot of questions and answers go on that actually enriches the patient’s experience,” he said. “Information like side effects, what should I do next, all these questions get answered.”
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Rs 3.7L a dose, 6 doses—who can afford it
Each dose of Tecentriq SC carries an MRP of approximately Rs 3.7 lakh. A typical course requires nearly six doses—though the number can vary depending on the patient’s stage and response—putting the total sticker price at roughly Rs 22 lakh. That is well beyond the reach of most Indian patients.
Tecentriq SC is priced slightly higher than the IV version because it contains a larger dose of the molecule—1,800 mg versus 1,200 mg—though the two are considered clinically equivalent.
Doctors pointed out, however, that the cost of daycare admission for an IV infusion—typically Rs 25,000 to Rs 30,000 per visit—is eliminated with the subcutaneous route, narrowing the effective gap.
“The patient actually ends up getting the same kind of cost,” said Dr Rajpurohit.
Roche offers subsidised access through a programme called Blue Tree, though the company declined to detail the terms publicly. It said the details were being shared with patients individually.
The drug has, reportedly, been enrolled under the Central Government Health Scheme (CGHS). Government employees, therefore, could access it through the route.
On private insurance, Dr Rajpurohit said, “Whenever a person takes personal health insurance, make sure that modern therapies are included. There is some premium, which has to be given additionally, otherwise these are exclusions.”
Dr Rauthan offered historical context—when immunotherapy first arrived in India a decade ago, perhaps two to five percent of eligible patients could afford it. Five years later, it was 15 to 20 percent.
Today, at Dr Rauthan’s private hospital, 60 to 70 percecsdcnt of eligible patients remain on immunotherapy. “Get the drug to India, work on the cost,” he said. “The cost will come down. We have seen this change with immunotherapy in the last decade.”
The bigger picture
Beyond individual patients, there’s a logistical convenience in using Tecentriq SC, doctors said.
The same oncology daycare chair which holds one IV patient for hours could serve up to five patients who are on subcutaneous injections in the same window.
At cancer centres where the average wait time is already three to four hours and staff are stretched, that arithmetic matters.
The longer-term possibility is decentralisation. In the UK, Tecentriq SC is already being used to shift cancer care from specialist hospitals to community centres closer to patients’ homes. France is running hospital-level pilots.
The doctors said that India, where patients routinely travel from smaller towns to metros for treatment, could see a similar shift, with trained nurses at district-level clinics administering a seven-minute injection, without the infrastructure demands of an IV infusion suite.
“Cancer care is evolving beyond survival outcomes alone, towards approaches that also prioritise patient experience, convenience and quality of life,” Dr Sivabalan said.
(Edited by Madhurita Goswami)
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