Combining Therapies: How Chemotherapy, Immunotherapy & Targeted Therapy Work Together in India

Cancer treatment today is no longer about choosing one drug over another — it’s about choosing the right combination. The modern oncologist is less a prescriber and more a strategist, combining chemotherapy, immunotherapy, and targeted agents in ways that deliver maximum benefit with minimal toxicity.

Understanding the Rationale

Every cancer is biologically unique. Chemotherapy attacks rapidly dividing cells, immunotherapy unlocks the patient’s immune system, and targeted therapy zeroes in on specific mutations driving tumor growth. Alone, each has limitations. Together, they can complement one another — like different instruments in an orchestra producing harmony instead of noise.

For example, combining chemotherapy with immunotherapy can increase tumor antigen release, making cancer more visible to immune cells. Similarly, targeted therapies can modulate the tumor microenvironment, improving immune recognition. These synergistic effects are now the cornerstone of many advanced cancer treatment protocols.

The Indian Experience: Science Meets Pragmatism

In India, oncologists face a dual challenge: balancing the best global evidence with real-world affordability. Combination therapy has shown survival benefits in lung, breast, head and neck, and GI cancers — but the cost of adding immunotherapy or targeted agents can multiply the expense several times. Thus, personalization becomes not only biological but economic.

Indian cancer centers are increasingly using molecular testing and PD-L1 analysis to decide which patients will genuinely benefit from combination regimens. The goal is not to “add more drugs,” but to add more value. Real-world registries and academic studies from Indian institutions are starting to generate local data to guide such choices — a welcome step toward rational precision oncology.

Toxicity and Monitoring: The Hidden Complexity

While combination therapy can improve efficacy, it also increases the risk of side effects. Immune-related adverse events may be aggravated by concurrent chemotherapy. Targeted drugs can alter liver enzymes or interact with cytotoxics. Therefore, careful sequencing, close monitoring, and patient education are essential. The emphasis must be on balance — not just escalation.

At the same time, new formulations and dosing schedules are helping mitigate these challenges. Weekly or metronomic chemotherapy, for instance, is being integrated safely with immunotherapy in Indian practice, maintaining efficacy while reducing toxicity and cost.

Future Directions

The future of oncology in India will likely revolve around adaptive combination therapy — tailoring regimens not only by tumor biology but also by patient response and affordability. Artificial intelligence may soon help predict which combinations work best for individual patients, minimizing trial and error.

Ultimately, the success of combination cancer therapy lies in thoughtful integration. When science, safety, and sustainability align, we move closer to the true goal of cancer care — not just longer life, but better life.

— Dr. Amol Akhade | Fortis Cancer Institute Mumbai@SuyogCancer