Cervical and Uterine Cancer Medicines in India: Imported Options

Cervical cancer and uterine cancer are not the same disease

Both begin in the womb, so the names are often mixed up. They grow from different tissue, have different causes and are matched to different medicines:

Three further medicines on this page, Vitrakvi, Rozlytrek and Augtyro, are approved for any solid tumour that carries an NTRK gene fusion. This change is rare, and it is found only through a sequencing panel on the tumour sample.

Why so many Indian women learn of cervical cancer late

The World Health Organization advises screening with a high-performance test every 5 to 10 years from the age of 30, as one part of its 90–70–90 targets for eliminating cervical cancer [6]. In India, uptake is still very low. In the fifth National Family Health Survey, only 1.9% of women said they had ever been screened. Tamil Nadu reported the highest share, at 9.8% [2]. Indian hospital studies show what follows from this:

• Most patients arrive at stage II or III. Of 587 women treated at Sir Sunderlal Hospital, BHU, Varanasi, 36.3% were at stage II and 45.8% at stage III. Three in four (76.0%) had a tumour of 4 cm or larger, and 91.8% had squamous cell carcinoma [3].
• HPV 16 dominates. At the State Cancer Institute, IGIMS Patna, HPV was detected in 236 of 248 confirmed cervical cancers (95.2%). HPV 16 alone was found in 194 of them (78.2%), and HPV 18 in 22 (8.9%) [7].
• Radiation with chemotherapy is the usual first treatment. In a North Indian series of 435 women with stage I to IVA disease, only 14 (3.2%) had surgery. Most were treated with external radiotherapy followed by a brachytherapy boost, and 71% received more than four cycles of chemotherapy alongside it. Five years later, 64.5% were alive. Where the cancer returned, local relapse came at a median of 35 months and spread to distant organs at 37.6 months [8].

When the disease returns after platinum chemotherapy, or has spread beyond the pelvis, the options become limited. The cervical cancer medicines on this page were approved for exactly that situation.

The MMR result matters in endometrial cancer

A pathologist can check the four mismatch repair proteins (MLH1, PMS2, MSH2 and MSH6) on the same tissue used for diagnosis. If one or more is missing, the tumour is called MMR-deficient (dMMR). In Indian laboratories, a sizeable share of the endometrial cancers tested have shown this:

• Gurugram referral laboratory: 27 of 82 endometrial cancers tested over five years (33%) were dMMR. Loss was more frequent when the lower part of the womb was involved or when there was a family history of cancer [9].
• Tata Memorial Hospital, Mumbai: 50 of 104 tumours tested (48%) were dMMR. All 50 were endometrioid adenocarcinomas, the median age was 53, and the MLH1 and PMS2 pair was lost in 33 of them (66%) [10].

Both figures come from tumours sent for testing at one centre each, so they may not reflect every woman with endometrial cancer in India. A dMMR result can also point to Lynch syndrome in the family, which is worth discussing with a genetic counsellor.

Reports your oncologist will usually ask for

Approvals here are tied to narrow situations, so the treating doctor will want the following on file before writing the prescription:

Paperwork, hospital supply and support with cost

These medicines are imported for one patient at a time. The application, Form 12A, is drafted by our pharmacist in the patient's name and filed by the patient; once CDSCO approves it, the regulator grants a Form 12B permit for that import. The documents to keep ready are listed in our guide to the 12A application and 12B import permit.

Jemperli, Tivdak, Socazolimab and Enlonstobart are given as a drip in hospital. We can dispatch them, packed with a temperature logger, to the oncology pharmacy of the treating hospital; the steps are explained under temperature-controlled delivery to hospitals in India. Famitinib and the three NTRK medicines are capsules taken by mouth.

Treatment with these medicines often runs for many months. Manufacturer programs, state and central schemes and cancer charities that may lower the expense are collected on our patient support and access programs page.