At the crossroads of targeted treatment and resistance in melanoma.

An editorial in The Lancet Oncology stated “It could be argued that since access to—and resources for—cancer treatment are so limited in developing countries, the answer lies in a greater reliance on generic drugs.” We agree, but the real question is how best can such generic drug production be stimulated? India provides one model to answer this question. India encouraged generic production fi rst by updating, in 2011, its national essential medicines list (EML), a formulary that guides both supply and demand of key medicines, to include modern antineoplastics, such as imatinib. Second, India pledged fi nancing for the procurement of EML medicines for public-sector clinics and hospitals. Three states in India—Tamil Nadu, Kerala, and now Rajasthan—are supplying all medicines on the EML in public health facilities at no cost to patients. Third, India’s Government has planned to issue compulsory licenses for onpatent drugs for which no substitute medicines exist in the country and importation is too expensive. The country’s fi rst compulsory license was for generic production of the kinase inhibitor sorafenib. Two breast cancer drugs, trastuzumab and ixabepilone, and dasatinib for chronic myeloid leukaemia, might soon become available under similar circumstances. Fourth, govern ments, civil society, and patient groups must work together to challenge the monopoly power of transnationals. Novartis is fi ghting a legal battle against India’s patent laws. Such steps can hinder access to crucial medicines. Of note, although domestic generic companies in India produce drugs at low-cost rates, the fi nal price of these drugs is 100–5000% higher than the cost of production. At least for 348 drugs on the EML, prices should be directly controlled by government pricing regulations (eg, original cost-based pricing proposed in 1979). Such actions can be helpful worldwide to reduce costs and increase access with generic drugs for cancer, particularly in the context of universal health coverage.