Five years ago, checkpoint inhibitor immunotherapy was a treatment category that most Indian oncology centres had limited access to — expensive, largely imported, and available through relatively few distribution channels. In 2026, the landscape looks fundamentally different. Multiple checkpoint inhibitors are now available in India across different mechanisms, different indications, and increasingly different price points. The clinical evidence base has expanded dramatically. And the number of Indian cancer patients who are candidates for checkpoint inhibitor therapy — based on approved indications alone — has grown considerably.

For hospital oncology departments and procurement teams, this growth creates both opportunity and complexity. More options means more decisions — about which agent to stock, how to manage infusion scheduling across multiple checkpoint inhibitors with different dosing intervals, how to handle immune-related adverse events across a heterogeneous patient population, and how to source these cold chain-sensitive biologics reliably and cost-effectively.

This article is a 2026 overview of the checkpoint inhibitor landscape in India — covering what is available, what the clinical evidence shows, and what hospitals need to consider from a procurement and operational perspective.

What Are Checkpoint Inhibitors — A Brief Recap

Checkpoint inhibitors are monoclonal antibodies that block inhibitory immune checkpoints — the molecular brakes that cancer cells exploit to evade immune surveillance. By releasing these brakes, checkpoint inhibitors restore the immune system’s ability to recognise and attack tumour cells.

Three checkpoint pathways are currently targeted by approved medicines:

PD-1 (Programmed Death-1) — expressed on T cells
PD-1 inhibitors block the PD-1 receptor on T lymphocytes, preventing tumour cells from sending the “do not attack” signal through the PD-1/PD-L1 interaction. Available agents include Tishtha (Nivolumab) and Tevimbra (Tislelizumab).

PD-L1 (Programmed Death-Ligand 1) — expressed on tumour cells
PD-L1 inhibitors block the ligand on the tumour cell rather than the receptor on the T cell. Available agents include Imfinzi (Durvalumab).

CTLA-4 (Cytotoxic T-Lymphocyte Antigen-4) — expressed on T cells
CTLA-4 inhibitors block a different immune checkpoint that regulates T cell activation earlier in the immune response. Available agents include Yervoy (Ipilimumab) and Imjudo (Tremelimumab).

These mechanisms are complementary — which is why combination checkpoint inhibitor regimens (PD-1 plus CTLA-4, PD-L1 plus CTLA-4) have become an important part of the immunotherapy landscape for certain tumour types, producing synergistic immune activation that neither agent achieves alone.

For the foundational clinical science of checkpoint inhibition, the National Cancer Institute’s immunotherapy overview and the American Society of Clinical Oncology (ASCO) provide comprehensive reference material.

The Checkpoint Inhibitors Available in India in 2026

Tishtha (Nivolumab) — PD-1 Inhibitor

Nivolumab was among the first checkpoint inhibitors to reach Indian oncology centres and remains one of the most broadly approved agents in the class. According to the approved prescribing information, Nivolumab is indicated across multiple tumour types including non-small cell lung cancer, melanoma, renal cell carcinoma, classical Hodgkin lymphoma, squamous cell carcinoma of the head and neck, urothelial carcinoma, colorectal cancer with MSI-H/dMMR, hepatocellular carcinoma, gastric and gastro-oesophageal junction cancer, and oesophageal squamous cell carcinoma.

The breadth of Nivolumab’s approved indications makes it the checkpoint inhibitor that the widest range of Indian oncology departments will encounter — from thoracic oncology to gastrointestinal oncology to head and neck cancer to melanoma. For hospitals building a checkpoint inhibitor formulary from the ground up, Nivolumab’s broad indication coverage means it can serve multiple departments with a single product.

Key supporting trials include CheckMate-017 and CheckMate-057 (NSCLC), CheckMate-238 (melanoma adjuvant), CheckMate-214 (renal cell carcinoma), CheckMate-649 (gastric and GEJ cancer), and CheckMate-577 (oesophageal cancer post-chemoradiation) — among many others across its approved indications.

Tevimbra (Tislelizumab) — PD-1 Inhibitor

Tislelizumab, developed by BeiGene, is one of the newer PD-1 inhibitors available in India and represents an important addition to the checkpoint inhibitor landscape — particularly for oesophageal squamous cell carcinoma and gastric cancer, where the RATIONALE-302 and RATIONALE-305 trials established its clinical credentials.

According to the approved prescribing information, Tislelizumab is indicated for adults with unresectable, locally advanced, or metastatic oesophageal squamous cell carcinoma following prior platinum-based chemotherapy, and for certain gastric cancer indications.

The RATIONALE-302 trial, published in the Journal of Clinical Oncology, demonstrated that Tislelizumab significantly improved overall survival compared to chemotherapy in previously treated oesophageal squamous cell carcinoma — with overall survival benefit seen across all PD-L1 expression subgroups. For Indian oncology centres managing oesophageal cancer — a cancer with significant incidence in India — Tislelizumab represents a clinically validated option from a growing body of evidence.

Imfinzi (Durvalumab) — PD-L1 Inhibitor

Durvalumab’s approved indications span four distinct clinical settings — Stage III unresectable NSCLC following chemoradiation (PACIFIC), extensive-stage small cell lung cancer in combination with chemotherapy (CASPIAN), advanced biliary tract cancer in combination with gemcitabine-cisplatin (TOPAZ-1), and unresectable hepatocellular carcinoma in combination with Tremelimumab (HIMALAYA).

The TOPAZ-1 indication is particularly relevant for India — biliary tract cancers including cholangiocarcinoma and gallbladder cancer have a higher incidence in Indian patients compared to Western populations, and the survival benefit demonstrated in TOPAZ-1 (24-month overall survival nearly doubling with the addition of Durvalumab) represents a meaningful clinical advance for this patient population.

The PACIFIC trial data — with 5-year overall survival approaching 43% in Stage III unresectable NSCLC patients receiving Durvalumab consolidation following chemoradiation — remains one of the most impactful results in lung cancer immunotherapy and has established consolidation Durvalumab as standard of care in this setting per international guidelines.

Yervoy (Ipilimumab) — CTLA-4 Inhibitor

Ipilimumab, developed by Bristol Myers Squibb, was the first checkpoint inhibitor to receive FDA approval — in 2011 for melanoma — and established the proof of concept for immune checkpoint blockade in oncology. In 2026, Ipilimumab is most commonly used in combination with Nivolumab rather than as monotherapy, with the CheckMate-214 trial establishing the Nivolumab plus Ipilimumab combination as a standard of care in first-line metastatic renal cell carcinoma, and CheckMate-227 supporting the combination in NSCLC.

For Indian oncology centres treating melanoma and renal cell carcinoma, Ipilimumab in combination with Nivolumab represents the most clinically validated combination checkpoint inhibitor regimen currently available.

Imjudo (Tremelimumab) — CTLA-4 Inhibitor

Tremelimumab is approved specifically in combination with Durvalumab for unresectable hepatocellular carcinoma — the HIMALAYA STRIDE regimen — using a novel approach of a single high-dose priming injection of Tremelimumab followed by ongoing Durvalumab maintenance. This regimen represents the first approved dual checkpoint inhibitor combination in HCC and provides a meaningful alternative to Sorafenib-based therapy in this indication.

For hospitals treating HCC — another cancer with significant incidence in India given the prevalence of hepatitis B and C infection — the Durvalumab/Tremelimumab combination is worth understanding from a procurement perspective as both agents will need to be stocked for patients on the HIMALAYA regimen.

What Has Changed in 2026 — The Key Shifts

1. Indication expansion across the class

The number of approved indications for checkpoint inhibitors has continued to expand. Indications that did not exist two years ago — including biliary tract cancer, certain gastric cancer settings, and oesophageal cancer — are now standard of care in some settings per international guidelines. Indian oncology centres that built formularies around the early checkpoint inhibitor approvals need to review whether their current stocking reflects the current approved indication landscape.

2. Combination regimens are now standard

Single-agent checkpoint inhibitor therapy remains appropriate for some indications — Durvalumab consolidation in Stage III NSCLC after chemoradiation being the clearest example. But across an increasing number of indications, checkpoint inhibitors are now used in combination — with chemotherapy, with targeted therapies, or with each other. The Nivolumab plus Ipilimumab combination in renal cell carcinoma, the Durvalumab plus Tremelimumab STRIDE regimen in HCC, and various checkpoint inhibitor plus chemotherapy combinations in lung, gastric, and biliary tract cancer all require hospitals to stock and manage multiple agents simultaneously.

From a procurement perspective, this means that a hospital managing a comprehensive immunotherapy service in 2026 is likely to need multiple checkpoint inhibitors in formulary — not just one. Supply planning needs to account for this complexity.

3. Biomarker selection is increasingly standard

The early checkpoint inhibitor trials treated broadly — all patients with a given tumour type, regardless of biomarker status. The evidence has evolved to identify biomarker subgroups that derive particularly strong benefit, and regulatory approvals increasingly reflect this refinement.

PD-L1 expression testing, tumour mutational burden (TMB), and mismatch repair deficiency (dMMR)/microsatellite instability (MSI-H) testing are now standard components of pre-treatment assessment for many checkpoint inhibitor indications. For hospitals managing checkpoint inhibitor patients, ensuring that the relevant biomarker testing infrastructure is available — either in-house or through a reference laboratory — is as important as ensuring medicine supply.

4. Immune-related adverse event management has matured

The clinical community’s understanding of immune-related adverse events (irAEs) — the toxicities that arise from checkpoint inhibitor-induced immune activation — has matured significantly since the first agents were approved. Grading systems, management algorithms, and corticosteroid tapering protocols are now well established. The ESMO Clinical Practice Guidelines on immunotherapy toxicity and ASCO irAE management guidelines provide comprehensive reference frameworks.

For Indian oncology centres, particularly those that are newer to checkpoint inhibitor therapy, building familiarity with irAE recognition and management protocols is as important as understanding the clinical indications. An oncology centre that can administer checkpoint inhibitors safely and manage irAEs effectively will achieve better patient outcomes than one that administers the medicine without adequate irAE management capacity.

Biomarker Testing — What Oncology Centres Need in Place

Before a patient can start checkpoint inhibitor therapy, the treating oncologist needs specific biomarker information to determine which agent is appropriate and whether the patient is likely to benefit.

PD-L1 expression testing by immunohistochemistry (IHC) is required for many checkpoint inhibitor indications — but the scoring system matters. Different checkpoint inhibitors use different PD-L1 testing platforms and different scoring thresholds for treatment eligibility. The treating oncologist specifies which PD-L1 assay is required for the specific checkpoint inhibitor being considered.

MSI-H/dMMR testing identifies tumours with defective mismatch repair — a biomarker associated with response to checkpoint inhibitor therapy across multiple tumour types regardless of histology. NGS-based MSI testing or IHC testing for MMR protein expression are the standard approaches.

Tumour mutational burden (TMB) testing is increasingly used as a predictive biomarker for checkpoint inhibitor response, particularly in tumour types where PD-L1 and MSI testing are less informative.

For hospitals where comprehensive biomarker testing is not available in-house, establishing referral pathways to accredited molecular pathology reference laboratories before building out a checkpoint inhibitor programme is important. The medicine is only one part of the patient pathway.

Procurement Considerations for Hospital Pharmacy Teams

Managing a checkpoint inhibitor formulary in 2026 requires attention to several specific considerations that differ from conventional oncology medicine procurement:

Cold chain throughout. Every checkpoint inhibitor discussed in this article requires refrigerated storage between 2°C and 8°C. This is non-negotiable — temperature excursions compromise protein integrity in ways that are not visible at inspection but have real clinical consequences. Complete temperature monitoring documentation for every delivery should be standard practice, not an optional extra.

Dosing interval diversity across agents. Different checkpoint inhibitors have different approved dosing intervals — Nivolumab may be given every 2 weeks, every 4 weeks, or every 6 weeks depending on the indication and the treating oncologist’s preference; Durvalumab is given every 4 weeks in maintenance after initial dosing; Tislelizumab every 3 weeks. Managing infusion scheduling and supply ordering across multiple agents with different intervals requires careful planning.

Combination regimen stocking. For hospitals managing patients on combination checkpoint inhibitor regimens — Durvalumab plus Tremelimumab in HCC, Nivolumab plus Ipilimumab in renal cell carcinoma — both agents must be available simultaneously. A supply failure in one agent disrupts the entire regimen.

Waste management for partially used vials. Some checkpoint inhibitors are supplied as single-dose vials that may not be completely used for a given patient’s dose — weight-based dosing can result in vial wastage that needs to be factored into procurement cost calculations.

Patient numbers and supply consistency. Checkpoint inhibitor therapy is typically given over many months — patients in ongoing treatment create a consistent, predictable demand that allows supply planning on a rolling cycle. Establishing a reliable supply relationship with a licensed specialty distributor is more efficient than managing ad hoc orders, and more important given the cold chain requirements.

A.K. Pharma is a licensed medicine distributor in Delhi and pharmaceutical distributor in Delhi — one of Delhi’s trusted pharmaceutical distribution companies — supplying the full range of checkpoint inhibitors to hospitals and oncology centres across India with cold chain-compliant delivery and complete batch documentation:

• Tishtha (Nivolumab) — PD-1 inhibitor, broadest indication coverage
• Tevimbra (Tislelizumab) — PD-1 inhibitor for oesophageal and gastric cancer
• Imfinzi (Durvalumab) — PD-L1 inhibitor for NSCLC, SCLC, BTC, and HCC
• Yervoy (Ipilimumab) — CTLA-4 inhibitor, used in combination with Nivolumab
• Imjudo (Tremelimumab) — CTLA-4 inhibitor, used in combination with Durvalumab in HCC
• Browse all Cancer Medicines at A.K. Pharma
• Browse the full Products range at A.K. Pharma
• Learn about the Named Patient Program for newer checkpoint inhibitors not yet commercially available in India
• Learn about the Patient Assistance Program for eligible patients

Contact A.K. Pharma at 011 4172 6999 or WhatsApp +91 9810034827 for availability, pricing, and supply planning support for your oncology department’s checkpoint inhibitor requirements.

Frequently Asked Questions

Q. What are checkpoint inhibitors and how do they work?
Checkpoint inhibitors are monoclonal antibodies that block inhibitory immune checkpoints — molecular signals that cancer cells use to suppress T cell activity and evade immune attack. By blocking these signals, checkpoint inhibitors restore the immune system’s ability to recognise and destroy cancer cells. The three main checkpoint pathways targeted by currently approved medicines are PD-1, PD-L1, and CTLA-4.

Q. What checkpoint inhibitors are available in India in 2026?
The main checkpoint inhibitors available in India through licensed specialty distributors in 2026 include Tishtha (Nivolumab), Tevimbra (Tislelizumab), Imfinzi (Durvalumab), Yervoy (Ipilimumab), and Imjudo (Tremelimumab) — covering PD-1, PD-L1, and CTLA-4 checkpoint pathways across multiple approved indications.

Q. What cancers can be treated with checkpoint inhibitors in India?
Per the approved prescribing information for agents available in India, checkpoint inhibitor therapy is indicated across multiple cancer types including non-small cell lung cancer, small cell lung cancer, melanoma, renal cell carcinoma, gastric and gastro-oesophageal junction cancer, oesophageal squamous cell carcinoma, hepatocellular carcinoma, biliary tract cancer, colorectal cancer with MSI-H/dMMR, classical Hodgkin lymphoma, head and neck squamous cell carcinoma, and urothelial carcinoma — among others. Eligibility for specific agents and indications is determined by the treating oncologist.

Q. What biomarker testing is required before starting checkpoint inhibitor therapy?
Depending on the specific agent and indication, biomarker testing may include PD-L1 expression by IHC, MSI-H/dMMR testing, and tumour mutational burden (TMB) testing. The treating oncologist specifies which tests are required for each patient based on the tumour type and the checkpoint inhibitor being considered.

Q. What are immune-related adverse events and how are they managed?
Immune-related adverse events (irAEs) are toxicities that arise from checkpoint inhibitor-induced immune activation affecting normal tissues. They can involve the lung (pneumonitis), liver (hepatitis), bowel (colitis), endocrine glands (thyroiditis, hypophysitis, adrenal insufficiency), skin, and other organs. Management typically involves temporary treatment interruption and corticosteroid therapy, with severity-based protocols per the approved prescribing information and ESMO/ASCO irAE management guidelines.

Q. Why do checkpoint inhibitors need to be stored in a fridge?
Checkpoint inhibitors are monoclonal antibodies — large, complex protein molecules that are sensitive to temperature. Storage outside the required 2°C to 8°C range can cause protein denaturation or aggregation that reduces clinical efficacy and may cause infusion reactions. Cold chain compliance throughout the supply chain is essential.

Q. Can checkpoint inhibitors be used in combination with each other?
Yes — combination checkpoint inhibitor regimens are now standard of care in several indications. Nivolumab plus Ipilimumab is approved in renal cell carcinoma and other settings. Durvalumab plus Tremelimumab (the HIMALAYA STRIDE regimen) is approved in hepatocellular carcinoma. Combinations of checkpoint inhibitors with chemotherapy are also standard across multiple indications. The treating oncologist determines the appropriate regimen for each patient.

Q. Is Pembrolizumab (Keytruda) available in India?
Pembrolizumab availability in India should be confirmed with a licensed specialty distributor. Contact A.K. Pharma at 011 4172 6999 for current status.

Q. How can hospitals source checkpoint inhibitors reliably in India?
Checkpoint inhibitors should be sourced through licensed specialty pharmaceutical distributors with verified cold chain infrastructure and complete batch documentation. A.K. Pharma supplies the full range of checkpoint inhibitors available in India to hospitals and oncology centres across the country with cold chain-compliant delivery. Contact us at 011 4172 6999 or WhatsApp +91 9810034827.

Q. What is the price of checkpoint inhibitors in India?
Pricing varies by agent, dose, and order quantity. Contact A.K. Pharma at 011 4172 6999 or WhatsApp +91 9810034827 for current pricing across the full checkpoint inhibitor range.

Disclaimer: This article is intended for informational and sourcing/procurement purposes only and does not constitute medical or clinical advice. All treatment decisions including checkpoint inhibitor selection, combination regimens, biomarker testing requirements, and irAE management should be made by a qualified oncologist in accordance with the approved prescribing information and current clinical guidelines. A.K. Pharma is a licensed medicine distributor and does not provide clinical guidance.