Keytruda vs Opdyta: Cost and Indications in India
Keytruda (pembrolizumab) and Opdyta (nivolumab) are both PD-1 checkpoint inhibitors, approved for different — sometimes overlapping — cancers, priced very differently in India, and only one of the two now has a domestic biosimilar. This page compares them factually; which drug, if either, suits a specific patient is a decision for the treating oncology team, never a cost comparison.
Medically reviewed by Dr. Bharati Devi Gorantla, Medical Oncologist, MBBS · MD · DM (Adyar, Chennai) · ECMO · MRCP SCE (UK) · Last reviewed August 2026
How Do Keytruda and Opdyta Prices Compare in India?
Opdyta (nivolumab) generally costs less per vial than Keytruda (pembrolizumab) in India, and the gap widened further after a nivolumab biosimilar, Tishtha, launched domestically in January 2026 at roughly a quarter of the originator price. Exact prices vary by pharmacy, city and stockist, and neither figure below is a CION rate.
| Brand (India) | Active ingredient | Typical vial strengths | Indicative price per vial (Aug 2026) |
|---|---|---|---|
| Keytruda | Pembrolizumab | 100 mg/4 mL | Roughly ₹1,50,000 – ₹2,16,000+ (originator; no Indian biosimilar yet) |
| Opdyta | Nivolumab (originator) | 40 mg/4 mL; 100 mg/10 mL | Roughly ₹23,000 – ₹46,000 (40 mg); ₹65,000 – ₹99,500 (100 mg) |
| Tishtha (nivolumab biosimilar) | Nivolumab (biosimilar) | 40 mg; 100 mg | About ₹13,950 (40 mg); ₹28,950 (100 mg) — launched Jan 2026, ~1/4 of Opdyta's price |
Prices are indicative, as of August 2026, drawn from published pharmacy and distributor listings — not a CION price list. Actual cost per treatment course also depends on dose and cycle count, which only your oncology team can estimate for your specific plan; see Immunotherapy Cost Comparison: All Approved Medicines in India for how these two sit alongside every other approved checkpoint inhibitor.
Did you know?
A single Keytruda cycle can cost more than three to four cycles of the nivolumab biosimilar Tishtha — but the two drugs are not interchangeable for every cancer type, so cost alone should never be the basis for choosing between them.
Which Cancers Is Each Approved For in India?
Keytruda and Opdyta are both PD-1 inhibitors with overlapping approvals in melanoma, non-small cell lung cancer, head-and-neck cancer and Hodgkin lymphoma, but each also carries approvals the other doesn't — the right choice depends on cancer type, stage, biomarkers and prior treatment, decided case by case by the treating oncology team.
| Cancer type / setting | Keytruda (pembrolizumab) | Opdyta (nivolumab) |
|---|---|---|
| Melanoma | Approved | Approved |
| Non-small cell lung cancer | Approved (multiple lines, PD-L1-based) | Approved (multiple lines) |
| Head & neck squamous cell cancer | Approved | Approved |
| Classical Hodgkin lymphoma | Approved | Approved |
| Urothelial (bladder) cancer | Approved | Approved |
| Renal cell carcinoma | Approved (combination regimens) | Approved (combination regimens) |
| MSI-High/dMMR tumours | Approved tumour-agnostic (any site) | Approved for colorectal cancer specifically |
| Gastric / gastro-oesophageal cancer | Approved | Approved |
| Oesophageal cancer | Approved | Approved |
| Hepatocellular carcinoma (liver) | Not a primary approved indication | Approved |
| Cervical cancer | Approved | Not approved |
| Endometrial cancer | Approved | Not approved |
| Triple-negative breast cancer | Approved (with chemotherapy) | Not approved |
| Malignant pleural mesothelioma | Not approved | Approved (with ipilimumab) |
This lists broad approval categories only, not every stage, biomarker requirement or combination detail. Eligibility for a specific cancer and stage should always be confirmed against current CDSCO-approved labelling and NCCN, ASCO or ESMO guidance by the treating oncologist — never assumed from this table or from international approvals alone.
Who Keytruda and Opdyta Are Not For
Most people reading about these medicines are not candidates for either one right now. As a class, PD-1 inhibitors such as pembrolizumab and nivolumab are generally not used for:
- Cancers or stages that don't have a CDSCO-approved or guideline-supported indication for either drug — a positive biomarker alone does not create an indication that doesn't exist.
- Patients with an active autoimmune disease requiring ongoing systemic immunosuppression, where a PD-1 inhibitor can trigger a serious flare.
- Solid organ or stem-cell transplant recipients, in whom checkpoint inhibition carries a meaningful risk of triggering organ or graft rejection.
- Pregnant or breastfeeding patients — these medicines are not established as safe in pregnancy and are generally avoided.
- Anyone with a known hypersensitivity to pembrolizumab, nivolumab, or an excipient in either formulation.
- Patients whose overall fitness, organ function or prior treatment history leads the oncology team to judge that the risk outweighs the likely benefit in their specific case.
Neither drug is chosen because it is cheaper, newer, or more heavily advertised — eligibility is a clinical decision made against the current approved indication for the specific cancer, not a preference either patients or this page can substitute for.
What Has the Nivolumab Biosimilar Changed?
Zydus Lifesciences launched Tishtha, the world's first nivolumab biosimilar, in India in January 2026 — priced at roughly a quarter of Opdyta's cost. It doesn't change what nivolumab is approved to treat; it meaningfully lowers the cost barrier for patients whose cancer specifically calls for nivolumab rather than pembrolizumab.
The biosimilar reached the market after a patent dispute: Bristol Myers Squibb challenged Zydus in the Delhi High Court, which allowed the biosimilar to be sold in India; the Supreme Court of India later upheld that decision in February 2026, prioritising patient access. Nivolumab's own Indian patent lapsed separately, on 2 May 2026 — so further nivolumab biosimilars from other manufacturers may follow over time. For a closer look at Opdyta against this specific biosimilar rather than against Keytruda, see Originator vs Biosimilar Nivolumab: Opdyta vs Tishtha.
Pembrolizumab has no equivalent yet in India. Its patent protection is expected to begin lapsing only around 2028–29, so Keytruda's price is unlikely to fall the way nivolumab's effective market price already has, until a pembrolizumab biosimilar is approved and actually launched here.
Because prices vary this widely across sellers, buy either medicine only through your treating hospital's pharmacy or a verified, licensed source. Counterfeit checkpoint inhibitors have been reported entering the Indian market as genuine products approach patent expiry, and a fake vial cannot be identified by appearance alone.
Do Keytruda and Opdyta Work the Same Way?
Yes, mechanistically — both block the PD-1 receptor on T-cells, releasing a brake the tumour uses to hide from the immune system. They differ mainly in dosing schedule, specific approved indications and price, not in their basic mechanism of action.
| Keytruda (pembrolizumab) | Opdyta (nivolumab) | |
|---|---|---|
| Typical adult dosing | 200 mg every 3 weeks, or 400 mg every 6 weeks (flat dose) | 240 mg every 2 weeks, or 480 mg every 4 weeks (flat dose); weight-based dosing in some regimens |
| Administration | IV infusion, around 30 minutes, day-care setting | IV infusion, around 30–60 minutes, day-care setting |
| Common combinations | Sometimes with chemotherapy or targeted therapy, by cancer type | Sometimes with ipilimumab or chemotherapy, by cancer type |
| Class-level side effects | Both can cause immune-related adverse events (irAEs) affecting the gut, lungs, liver, hormones, skin and other organs — the pattern is broadly similar for either drug because both belong to the same PD-1 inhibitor class. | |
Exact dose and schedule are set by the treating oncologist, not read off this table. For what to watch for on either drug, see Immune-Related Adverse Events (irAEs) Explained Simply.
Keytruda vs Opdyta: Your Questions Answered
How do Keytruda and Opdyta prices compare in India?
Opdyta (nivolumab) is generally cheaper per vial than Keytruda (pembrolizumab) in India, and the gap widened after Zydus launched a nivolumab biosimilar, Tishtha, in January 2026 at roughly a quarter of Opdyta's price. Indicatively, as of August 2026, Keytruda 100 mg runs roughly ₹1.5 lakh to over ₹2 lakh per vial; Opdyta ranges roughly ₹23,000–₹46,000 (40 mg) to ₹65,000–₹99,500 (100 mg); Tishtha is priced at about ₹13,950 (40 mg) and ₹28,950 (100 mg). These are published pharmacy/distributor listings, not CION rates, and the actual cost per cycle also depends on dose and number of cycles.
Which cancers is each medicine approved for?
Both are PD-1 inhibitors with overlapping approvals in melanoma, non-small cell lung cancer, head-and-neck cancer, classical Hodgkin lymphoma and urothelial (bladder) cancer. Each also carries approvals the other doesn't: Keytruda additionally covers cervical, endometrial and triple-negative breast cancer and a tumour-agnostic MSI-High/dMMR approval; Opdyta additionally covers hepatocellular carcinoma and, combined with ipilimumab, malignant pleural mesothelioma. Which drug applies, if either, depends on cancer type, stage, biomarkers and prior treatment — always a decision for the treating oncology team, not this comparison.
What has the nivolumab biosimilar changed?
Zydus Lifesciences launched Tishtha, the world's first nivolumab biosimilar, in India in January 2026 at roughly a quarter of Opdyta's cost, after the Delhi High Court allowed its sale and India's Supreme Court upheld that decision in February 2026. Nivolumab's own Indian patent lapsed on 2 May 2026. The biosimilar doesn't change what nivolumab is approved to treat — it lowers the cost barrier for patients whose cancer specifically calls for nivolumab rather than pembrolizumab, which has no Indian biosimilar yet.
Is Opdyta the same medicine as Opdivo?
Yes. Opdyta is the brand name Bristol Myers Squibb sells nivolumab under in India — the same molecule marketed internationally as Opdivo. Tishtha is a separate product: Zydus Lifesciences' biosimilar version of nivolumab, launched in India in January 2026 at a substantially lower price, not a renamed version of Opdyta itself.
Is there a biosimilar for Keytruda (pembrolizumab) in India yet?
No, not as of August 2026. Pembrolizumab's patent protection in India is expected to begin lapsing only around 2028-29, several years after nivolumab's did. Until a biosimilar is approved and launched, Keytruda's price in India is unlikely to fall the way nivolumab's effective market price has since Tishtha entered.
Can a patient switch from one drug to the other mid-treatment?
Switching between PD-1 inhibitors isn't routine and isn't done on cost grounds alone. It is a clinical decision the treating oncology team makes based on how the current drug is being tolerated, the response seen on scans, the specific approved indication for the cancer type, and whether switching is even supported by evidence for that situation — never a request to make unprompted based on price.