Two Game-Changing Drugs For Alzheimer’s & Lung Cancer Launched: What India Needs To Know
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India has gained access to two new medicines: one targets a brain disease that’s surging with the nation’s ageing population; the other reimagines how cancer patients get treatment
Both come with steep price tags. 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. (Representational pic/Reuters)
In the space of two days, India has crossed two pharmaceutical thresholds—one in the brain, one in the lung.
Eli Lilly’s Lormalzi (donanemab), launched Wednesday, is the first drug available in India that goes after Alzheimer’s disease itself rather than 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 as a 7-minute injection into the thigh or arm instead of an hour-long intravenous infusion.
The two drugs do fundamentally different jobs. Donanemab attempts to bend the trajectory of Alzheimer’s by clearing amyloid plaques from the brain—but only in patients diagnosed at the earliest stage, a window most Indian families currently miss.
Tecentriq SC changes the logistics of getting an immunotherapy, saving hours for patients and chair space in overloaded oncology day-care units.
Both come with steep price tags. Eli Lilly’s Lormalzi is priced at Rs 91,688 per vial, administered as a monthly intravenous infusion. The Central Drugs Standard Control Organisation (CDSCO) and the US FDA have cleared it for patients with mild cognitive impairment (MCI) or mild dementia due to Alzheimer’s, not for moderate or advanced stages. Lilly has flagged an “Alternate Access Programme” 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 shift is the delivery mechanism of the drug within approximately seven minutes. The drug itself is unchanged; the formulation pairs atezolizumab with recombinant human hyaluronidase (Halozyme’s Enhanze platform) to enable under-the-skin absorption.
Donanemab: Cleaning the Brain
Lilly’s Donanemab is a humanised monoclonal antibody that binds to a specific form of amyloid-beta found in established plaques in the Alzheimer’s brain. It tags these plaques for clearance by microglia. In the pivotal Phase 3 TRAILBLAZER-ALZ 2 trial, donanemab slowed cognitive and functional decline by roughly 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 (oedema/brain swelling) and microhaemorrhages, can be seen on MRI.
According to Dr Manjari Tripathi, head of department, neurology at AIIMS Delhi, “Donanemab has been approved for very early Alzheimer’s disease or mild cognitive impairment of the Alzheimer’s type. Patients need to present very, very early, but in India, most come in the middle stage of dementia. This requires a paradigm shift; relatives need to bring patients in much earlier.”
She emphasised that the drug is approved only for early stages, and it is not devoid of side effects. “These side effects include oedema or swelling in the brain, and bleeding in the brain. The percentages are small, but both informed consent and counselling are required. Recent meta-analyses have not shown a very dramatic effect. Hence, only patients with very early Alzheimer’s or mild cognitive impairment of the Alzheimer’s kind should receive this medication.”
Similarly, Dr Sanjay Pandey, HOD, neurology and stroke medicine at Amrita Hospital, Faridabad, explained that, for decades, Alzheimer’s care worldwide has been largely symptomatic, with clinicians frequently witnessing ongoing cognitive decline despite the best supportive therapies. “The arrival of donanemab signals a major shift in the scientific and therapeutic conversation around neurodegenerative disease, moving the conversation away from symptom management and toward targeted disease modification in carefully selected patients with early symptomatic Alzheimer’s disease.”
He believes that for a country like India, with rising dementia prevalence and increasing life expectancy, this also brings to the forefront the need for timely diagnosis, biomarker-led evaluation, advanced neuroimaging and specialised memory care pathways. At the same time, he added that the application of such therapies must be considered with scientific caution and clinical responsibility. “Patient eligibility, risk stratification, longitudinal monitoring and multidisciplinary neurological oversight remain the cornerstone to meaningful outcomes.”
Tecentriq SC: Same Drug, Easier Delivery
Tecentriq (atezolizumab) is a PD-L1 inhibitor—a drug that revives the immune system’s attack on cancer. Cancer cells deploy a protein called PD-L1 that tells the immune system’s T-cells to stand down. Atezolizumab blocks this conversation. It prevents PD-L1 from switching off T-cells, allowing the immune system to fight back.
The subcutaneous version is pharmacologically identical to the intravenous version. It is the same drug, but the only difference is how it’s delivered.
Clinical trials proved this equivalence. The Phase 1b/3 IMscin001 trial showed that the subcutaneous formulation achieves non-inferior blood levels of the drug, with comparable safety and efficacy to the intravenous form. In other words, patients get the same cancer outcomes either way.
What differed was patient preference. In the Phase 3 IMscin002 trial, 71% of patients preferred the subcutaneous formulation after trying both, and 79% chose to continue on it.
The value proposition is not better cancer outcomes. It’s the same outcomes—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 department, clinical oncology at Delhi State Cancer Institute, “The launch of subcutaneous Tecentriq represents an important step forward in the evolution of immunotherapy delivery. Traditionally, immunotherapy and targeted therapy infusions require prolonged chair time and repeated hospital visits. A subcutaneous formulation can significantly reduce administration time, making treatment more convenient and less disruptive to patients’ daily lives, while saving on a lot of associated costs.”
Beyond efficiency, Shukla said, this approach also offers patients a more discreet and comfortable treatment experience, which can positively influence overall quality of life. “In busy oncology settings like ours, shorter administration times may help us optimise healthcare resources and improve patient throughput. This shift reflects how cancer care is increasingly moving towards improving outcomes while also enhancing the overall treatment experience for patients.”
Dr Manish Kumar, senior consultant, medical oncology at SPARSH Hospital, Bengaluru, said that the availability of subcutaneous immunotherapy for lung cancer is an “important step towards making cancer treatment more patient-friendly.” However, he pointed out that access and affordability remain critical concerns, especially when the cost is around Rs 3.70 lakh per vial. “For Indian patients, the real impact of such innovation will depend not only on clinical benefit and suitability, but also on wider insurance coverage, patient assistance programmes and equitable access.”
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