KARACHI: Many conventional and modern medicines used in the treatment of different cancers, including breast, bladder, head and neck, lung, melanoma, cervical, stomach, colorectal and Hodgkin lymphoma cancers, are currently unavailable in Pakistan, forcing patients to rely on unregistered or smuggled drugs from neighbouring countries such as India and Bangladesh, The News reported citing oncologists and patients.
Cancer specialists warn that the shortage is affecting access to both traditional and advanced therapies, leaving thousands of patients struggling to obtain life-saving medicines through regulated channels and increasing the risk of patients turning to informal markets where the authenticity and safety of drugs cannot be guaranteed.
Ahmed Alam, a bladder cancer patient in Karachi, said he had been advised by his oncologist to receive intravesical Bacillus Calmette Guerin (BCG) therapy using OncoTice, a widely used treatment for non- muscle invasive bladder cancer, but the medicine is not available through authorised supply channels in Pakistan.
“My oncologist has prescribed me OncoTice BCG but it is not available in Pakistan,” he said. “I was told that a version manufactured by an Indian pharmaceutical company is available in the black market and I have been forced to arrange it through informal sources.”
Medical experts explain that OncoTice is a biological therapy derived from the Bacillus Calmette Guerin vaccine and has been used for decades to treat certain types of bladder cancer by stimulating the immune system to attack cancer cells inside the bladder.
Oncologists in Pakistan say that in addition to such conventional therapies, several modern cancer immunotherapy medicines are also not readily available in the country, creating serious treatment challenges.
One such medicine is pembrolizumab, a widely used immunotherapy drug that helps the body’s immune system recognise and destroy cancer cells. It is considered an important treatment option for several cancers including head and neck cancers, lung cancer, melanoma, cervical cancer, stomach cancer, colorectal cancer and Hodgkin lymphoma.
Similarly, another immunotherapy medicine nivolumab is also largely unavailable through registered supply channels in Pakistan. The medicine is widely used internationally for advanced cancers and has improved survival rates in several malignancies.
Because the original versions of these medicines are extremely expensive, patients often try to obtain lower priced biosimilar or alternative versions from India or Bangladesh. However, doctors warn that these products are not registered in Pakistan and therefore their quality, storage conditions and authenticity cannot always be verified.
Several oncologists said that the lack of availability of these drugs has become a serious public health concern in a country where cancer cases are rising every year.
“Unavailability of both modern and conventional cancer medicines is creating enormous difficulties for patients,” said a senior oncologist associated with a major healthcare facility in Karachi who requested anonymity. “It is the responsibility of the government and the Drug Regulatory Authority of Pakistan to ensure that effective cancer treatments are available to patients at affordable prices.”
Healthcare professionals say one of the major reasons behind the shortage of several important medicines is the delay in official price notification by the federal government.
Officials in the pharmaceutical sector say the Drug Pricing Committee of the Drug Regulatory Authority of Pakistan had already finalised prices of several important medicines, which were later endorsed by the DRAP Policy Board and reviewed by a special committee constituted by the prime minister and headed by Federal Finance Minister Muhammad Aurangzeb.
However, the federal cabinet has not yet issued the statutory regulatory orders required to formally notify the prices of these medicines, preventing pharmaceutical companies from importing or marketing them legally in Pakistan.
Among the medicines awaiting price notification are modern anti-cancer therapies, including nivolumab, pembrolizumab and nilotinib hydrochloride, which are widely used internationally for the treatment of leukemia and several other advanced malignancies.
Healthcare experts say these medicines are now considered standard treatment in many parts of the world and their absence in Pakistan significantly limits treatment options for patients.
Other medicines awaiting price notification include tacrolimus hydrochloride, an immunosuppressant used to prevent organ transplant rejection, and verapamil hydrochloride used in cardiac therapy. Several vaccines including typhoid Vi polysaccharide vaccine, poliomyelitis vaccine and pneumococcal vaccines are also awaiting notification.
Experts warn that when essential medicines are not available through regulated channels, patients often turn to informal markets where smuggled, substandard or counterfeit drugs may circulate.
Chairman Pakistan Chemists and Druggists Association Abdul Samad Budhani said patients frequently approach pharmacies, asking for medicines that are not registered or legally available in the country.
“When patients cannot find these medicines through authorised supply chains, they start looking for them in the grey market,” he said. “This creates space for counterfeit and falsified medicines and puts patients’ lives at risk.”
Healthcare professionals and pharmaceutical industry representatives have urged the government to expedite the price notification process so that essential cancer medicines and other life-saving therapies can be legally marketed in Pakistan and made accessible to patients who urgently need them.