The debate around immunotherapy vs chemotherapy has gained fresh attention after comedian Rahul Dua’s remarks about cancer treatment sparked criticism from oncologists. His comments presented the two approaches in a way that sounded like patients simply had to choose between an older, harsher treatment and a newer, better one. Cancer specialists, however, say the reality is much more complicated.
Cancer is not one disease with one standard treatment. There are hundreds of cancer types, different stages, different tumour characteristics and major differences between individual patients. Treatment decisions can depend on the location of the tumour, how advanced the disease is, the patient’s overall health, molecular characteristics and specific biomarkers.
That is why doctors have pushed back against the idea that immunotherapy is automatically better than chemotherapy. In some cancers, immunotherapy has changed outcomes dramatically. In others, chemotherapy remains extremely important. Quite often, doctors use both together rather than treating them as competing options.
Cancer Treatment Is Not Binary
According to oncologists quoted in the recent discussion, cancer treatment cannot be reduced to a simple choice between chemotherapy and immunotherapy.
Dr Kumar Prabhash, medical oncologist and researcher at Tata Memorial Centre in Mumbai, explained that treatment depends on factors including tumour stage and biomarkers. Some cancers can respond exceptionally well to immunotherapy, while other patients may benefit from a combination of chemotherapy and immunotherapy.
This distinction matters because cancer behaves differently from patient to patient.
A person diagnosed with lung cancer, for example, may undergo a completely different treatment plan from another lung cancer patient because their tumours have different molecular characteristics. Even when the cancer develops in the same organ, its biology can vary considerably.
Doctors therefore look at the complete clinical picture before recommending a treatment.
How Chemotherapy Actually Works
Chemotherapy has been part of cancer care for decades and remains an important treatment for many patients.
The medicines used in chemotherapy generally target rapidly dividing cells. Because cancer cells often multiply quickly, these drugs can damage or destroy them and slow the growth of tumours.
Chemotherapy can be used at different stages of treatment. Doctors may recommend it before surgery to reduce tumour size, after surgery to destroy remaining microscopic cancer cells, alongside radiation treatment or for controlling advanced cancer.
One reason chemotherapy has a difficult reputation is its side effects. Because the medicines can also affect some healthy rapidly dividing cells, patients may experience problems such as fatigue, nausea, appetite changes, lowered blood counts and hair loss, depending on the drugs being used.
But side effects do not mean chemotherapy has become outdated.
For many cancers, chemotherapy continues to play an important role in achieving remission, preventing recurrence or controlling disease.
What Makes Immunotherapy Different
Immunotherapy takes a different approach.
Instead of directly attacking cancer cells in the same way as conventional chemotherapy, many immunotherapy medicines help the body’s immune system recognise and attack cancer.
Some of the best-known immunotherapy drugs are immune checkpoint inhibitors, including pembrolizumab, nivolumab, durvalumab and atezolizumab. These medicines have become important treatment options across several types of cancer.
The development of these drugs has been one of the major advances in modern oncology.
In certain cancers, patients have experienced long-lasting responses that were difficult to achieve with older treatment approaches. Melanoma is one prominent example where immunotherapy has significantly changed the treatment landscape.
However, that success does not mean every cancer responds to immunotherapy.
That is where the comparison with chemotherapy becomes misleading.
Biomarkers Can Change Treatment
One of the most important factors in deciding whether immunotherapy may work is the presence of particular biomarkers.
Biomarkers are measurable characteristics that provide information about a tumour and can sometimes help doctors predict whether a particular treatment is likely to benefit the patient.
Tests involving markers such as PD-L1 expression and other molecular features can influence decisions about immunotherapy in certain cancers.
This is one reason modern cancer treatment is becoming increasingly personalised.
Two people can have the same broad cancer diagnosis but receive different medicines because their tumours have different biological characteristics.
Dr Shyam Agarwal, a senior oncologist quoted in the discussion, stressed that cancer treatment depends on cancer type, stage and other factors, while biomarkers can help determine whether immunotherapy is likely to work.
So, before asking whether immunotherapy is better than chemotherapy, the more useful question is whether a particular treatment is appropriate for that particular tumour.
Sometimes Both Treatments Work Together
The biggest misconception in the debate may be the idea that immunotherapy has to replace chemotherapy.
In modern oncology, doctors frequently combine different treatment approaches when evidence shows that doing so can improve outcomes.
For selected cancers, immunotherapy may be given with chemotherapy before surgery or radiation. The combination can allow doctors to attack the disease through different mechanisms.
This approach has become relevant in several cancers, including selected cases involving the breast, lung, rectum, stomach and urinary bladder.
So the future of cancer treatment is not necessarily about choosing between old and new medicine.
It is increasingly about understanding which combination works best for a particular patient.
Immunotherapy Has Its Own Risks
Immunotherapy is often described as a treatment with fewer conventional side effects, but that does not mean it is risk-free.
Because these medicines stimulate the immune system, they can sometimes cause the immune system to attack healthy tissues.
Patients can develop inflammation involving organs such as the lungs, liver, intestines or thyroid. Some immune-related complications can become serious and require immediate medical attention.
This means patients receiving immunotherapy still need regular monitoring.
The treatment also does not work equally well for everyone. Certain cancers have shown major progress with immunotherapy, while other tumour types have seen considerably less benefit so far.
Brain cancers, gliomas and some soft-tissue cancers remain examples where immunotherapy has not delivered the same kind of breakthrough seen in certain other cancers.
Cost Is Another Major Factor
Treatment decisions are also influenced by accessibility and affordability, particularly in India.
Some newer immunotherapy medicines can be extremely expensive, creating a major financial burden for families. Pembrolizumab, one of the widely used checkpoint inhibitors, has been an important example of this affordability challenge.
The cost of prolonged treatment can reach several lakhs of rupees, depending on the cancer, dosage, duration and treatment schedule.
This creates a difficult situation for patients.
A treatment may be medically appropriate, but that does not automatically mean every patient can realistically access it.
Recent research from Tata Memorial Centre and ACTREC has also highlighted affordability concerns surrounding modern cancer medicines, including immunotherapy drugs.
India therefore faces two connected challenges: identifying patients who are most likely to benefit from advanced treatments and making those treatments financially accessible.
Cancer Numbers Are Rising Globally
The discussion comes at a time when the global cancer burden is already increasing.
According to estimates cited in the recent medical discussion, around 20 million new cancer cases and 9.7 million cancer deaths were recorded globally in 2022. The number of new cancer cases could rise to around 35 million annually by 2050.
India is also dealing with a substantial cancer burden, with recent estimates indicating more than 15.6 lakh new cases each year and more than nine lakh deaths.
These numbers make treatment innovation extremely important.
But innovation does not mean abandoning treatments that have already proven effective.
Chemotherapy, immunotherapy, surgery, radiation, hormone therapy and targeted medicines can all have important roles depending on the disease.
The Real Question Is Personalised Care
The most useful takeaway from the Rahul Dua controversy is not that one cancer treatment is better than another.
It is that cancer treatment needs to be personalised.
A doctor may recommend chemotherapy alone for one patient, immunotherapy alone for another, or a combination for someone else. Another patient may require surgery, radiation or targeted therapy depending on the cancer’s characteristics.
The decision should come after proper diagnosis, staging, pathology and, where appropriate, biomarker or molecular testing.
Patients should therefore be cautious about broad claims suggesting that one treatment is universally superior.
Conclusion
The debate over immunotherapy vs chemotherapy highlights how easily complicated medical decisions can become oversimplified in public conversations. Immunotherapy has transformed cancer care for many patients, but chemotherapy remains an essential and effective treatment for numerous cancers. In some cases, the two are used together because they can complement each other. The right treatment depends on cancer type, stage, biomarkers, overall health, expected benefits, possible side effects and affordability. For patients and families facing a cancer diagnosis, the most important step is not choosing a treatment based on general claims, but discussing the individual case with a qualified oncology team and understanding why a particular treatment has been recommended
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