Why India Continues to Face a Critical Shortage of Key Chemotherapy Drugs
India is grappling with a persistent nationwide shortage of two of its most essential chemotherapy drugs, cisplatin and carboplatin. These platinum-based medicines form the backbone of treatment for a wide range of solid tumours, including cancers of the lung, ovary, cervix, head and neck, bladder, gallbladder, and certain testicular and breast cancers. Despite a government intervention in June 2026 to raise their price ceilings, supplies remain uneven, with private hospitals in many regions still struggling to maintain adequate stocks while some government facilities have stabilised their inventories.
The shortage has stretched for nearly seven months in several centres and has forced oncologists to ration doses, delay treatment cycles, or switch patients to alternative regimens that are often less effective, more expensive, or carry different toxicity profiles. With India recording more than 1.5 million new cancer cases every year, any disruption in access to these foundational drugs carries serious implications for patient outcomes.
The Central Role of Platinum-Based Drugs
Cisplatin, a first-generation platinum compound, and carboplatin, its second-generation counterpart, work by binding to the DNA of cancer cells and preventing them from dividing. For many cancers, particularly those treated with concurrent chemoradiation such as cervical and head-and-neck malignancies, weekly cisplatin significantly enhances the effectiveness of radiotherapy. In paediatric oncology, these agents remain critical for treating neuroblastoma, hepatoblastoma, germ-cell tumours and retinoblastoma, where validated substitutes are limited.
Their relative affordability compared with newer targeted therapies or immunotherapies has made them indispensable in both public and private cancer centres across the country. When supplies tighten, the impact is immediate and widespread.
Why Production Became Unviable
Three interconnected factors triggered the crisis. The primary driver has been a sharp rise in the global price of platinum, the core raw material from which the active pharmaceutical ingredients of both drugs are derived. Platinum prices in India more than doubled over recent months, climbing from roughly ₹2,000–3,900 per gram in mid-to-late 2025 to levels approaching ₹5,000–8,000 per gram. The surge stemmed from constrained mine output in major producing countries such as South Africa, rising industrial demand from the automotive, green hydrogen and semiconductor sectors, and broader market deficits.
Compounding the problem were geopolitical tensions and shipping disruptions through West Asia. These constraints restricted the flow of raw materials and active pharmaceutical ingredients from key global suppliers. India remains heavily dependent on imported platinum, and the logistical bottlenecks made procurement both costlier and less reliable.
The third factor was India’s domestic price-control regime. Both drugs fall under the Drug Price Control Order, which means the National Pharmaceutical Pricing Authority sets maximum ceiling prices. Manufacturers could not pass on the steeply higher input costs to the market. With production margins collapsing or turning negative, several generic manufacturers slowed or temporarily halted output. Industry representatives noted that for sterile injectable oncology products, which already operate on thin margins and require stringent quality controls, the combination of soaring raw-material costs and frozen price caps left them with little commercial incentive to continue production at previous volumes.
Impact Across Hospitals and Patients
The consequences have been felt unevenly but significantly. At the Cancer Institute (WIA) in Adyar, Chennai, the shortage has lasted nearly seven months. Officials reported that the cheapest option, cisplatin, was simply unavailable for extended periods, while carboplatin and the more expensive third-generation drug oxaliplatin remained in limited supply. Apollo Proton Cancer Centre in the same city similarly struggled to obtain stocks from its regular suppliers and had to rely on alternative Indian generic manufacturers.
In Hyderabad, the Mehdi Nawaz Jung Institute of Oncology and Regional Cancer Centre, which requires thousands of vials every month, has been able to procure only a few hundred in recent periods. Oncologists in Bengaluru reported that some hospitals held stocks sufficient for only six to eight weeks. Experts there emphasised the particular vulnerability of paediatric cancer patients and those undergoing concurrent chemoradiation, where treatment delays can compromise curative intent.
Patients and families have described scrambling across pharmacies and wholesale distributors, sometimes travelling between cities in search of vials. In private facilities the crunch has often been sharper, while several major government institutions—including centres in Kerala, Bengaluru and Delhi—reported improved availability after the price revision and through diversified procurement channels, annual tenders and support from non-governmental organisations.
Beyond physical shortages, the crisis has imposed psychological and financial stress. Switching to non-standard regimens can increase both the cost of treatment and the risk of different side-effect profiles. For many families already stretched by cancer care expenses, the uncertainty has added another layer of hardship.
Government Response and Partial Relief
On 12 June 2026, the National Pharmaceutical Pricing Authority invoked special public-interest provisions under the Drug Price Control Order. It raised the ceiling price of cisplatin from ₹7.26 to ₹10.89 per ml and that of carboplatin from ₹60.49 to ₹90.74 per ml—an approximate 50 per cent increase. The one-time revision was to be reviewed after six months. Authorities cited the reported shortages, the rise in active pharmaceutical ingredient costs, and the critical nature of uninterrupted supply for public health.
Following the price adjustment, some manufacturers resumed or scaled up production. A Union Health Ministry official indicated that the central government had taken steps to stabilise supply chains and advised states or institutions facing difficulties to approach the relevant departments. Yet as of mid-August 2026, the shortage had not fully resolved. Government hospitals in several states reported better stock positions, but private hospitals in many parts of the country continued to experience constraints.
Looking Ahead: The Need for Structural Solutions
Oncologists and industry observers have stressed that temporary price revisions, while necessary, are not a permanent fix. Longer-term measures suggested include the development of a national oncology drug security framework featuring strategic reserves, greater diversification of manufacturing and active pharmaceutical ingredient sources, streamlined import clearances for critical raw materials, stronger early-warning systems for potential shortages, and more flexible pricing mechanisms that can respond more quickly to sharp commodity price movements.
The episode also highlights a broader vulnerability in India’s pharmaceutical ecosystem. While the country is a major global supplier of generic medicines, certain essential injectable oncology products remain dependent on imported precious-metal inputs and operate under rigid price controls that can become misaligned with global market realities. When those two pressures coincide with geopolitical disruptions, the result is precisely the kind of supply shock now affecting cancer care.
For patients and clinicians, the priority remains restoring reliable access to cisplatin and carboplatin. Every delayed cycle or forced regimen change carries potential consequences for survival and quality of life. As cancer incidence continues to rise, ensuring the uninterrupted availability of these foundational drugs has become not merely a pharmaceutical supply issue but a matter of national health security. Coordinated action among regulators, manufacturers, procurement agencies and clinical centres will be essential to prevent similar crises from recurring.
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