Background: Advances in cancer therapeutics have transformed patient outcomes, yet escalating costs, treatment complexity and inequitable access threaten the sustainability of oncology worldwide. In India, where significant out-of-pocket expenditure limits access to modern therapies, resource constraints have stimulated innovative approaches to delivering effective, affordable cancer care. These experiences offer valuable lessons for the global Common Sense Oncology movement.
Aim: To examine how Indian-led clinical research is challenging conventional treatment paradigms through pragmatic trials, dose optimisation and value-based treatment strategies, while maintaining scientific rigour and patient-centred outcomes.
Content: Landmark Indian innovations will be highlighted, including a randomised phase III trial demonstrating improved overall survival with ultra-low-dose nivolumab (20 mg every three weeks) combined with metronomic chemotherapy in recurrent or metastatic head and neck cancer [1]. A subsequent multicentre phase III trial evaluating low-dose abiraterone (250 mg with food) against conventional dosing in metastatic castration-resistant prostate cancer demonstrated broadly comparable observed outcomes, although premature closure prevented confirmation of non-inferiority [2]. Emerging evidence from a systematic review of reduced-dose PD-(L)1 inhibitors further supports the potential for substantial cost savings while highlighting important methodological limitations [3].
The presentation will critically examine trial design, appropriate comparators, pharmacokinetic considerations, survival endpoints and the distinction between promising results and established therapeutic equivalence. Broader implications for pragmatic clinical trials, financial toxicity, treatment de-escalation and equitable access will be discussed.
Conclusion: Resource-constrained oncology need not mean compromised oncology. Indian-led innovations demonstrate how necessity can generate clinically relevant research that challenges assumptions about treatment intensity and value. International collaboration, particularly between India and Australia, offers opportunities to develop rigorous, affordable and patient-centred cancer treatment strategies.