Pembrolizumab vs Nivolumab: What Is the Difference?
Pembrolizumab and nivolumab are both PD-1 checkpoint inhibitor immunotherapy medicines — sold internationally as Keytruda and Opdivo — so they are the same drug class, not two different kinds of treatment. The real differences are in approved indications, dosing schedule, and cost in India, not general effectiveness. Neither is "better"; the right one depends on your diagnosis and your oncologist's protocol.
Medically reviewed by Dr. C. Raghavendra Reddy, Medical Oncologist, MBBS (Gold Medal) · DNB · DM (Medical Oncology, Gold Medal) · Last reviewed August 2026
Are pembrolizumab and nivolumab the same class of drug?
Yes. Pembrolizumab (Keytruda) and nivolumab (Opdivo, and its Indian biosimilar versions) are both PD-1 immune checkpoint inhibitors — monoclonal antibodies that block the PD-1 receptor on T cells so the immune system can recognise and attack cancer cells. They belong to the same mechanism class; the meaningful differences between them sit elsewhere — in which cancers each is approved for, how each is dosed, and what each currently costs in India.
Both antibodies bind the same PD-1 receptor, though at slightly different sites, and are manufactured by different companies — pembrolizumab by Merck (MSD), nivolumab originally by Bristol Myers Squibb and now also available in India as a domestic biosimilar. Because the underlying mechanism is shared, both drugs also carry a broadly similar profile of immune-related adverse events (irAEs) — the class matters more here than the brand.
Do pembrolizumab and nivolumab treat the same cancers?
No — their approved indications overlap substantially but are not identical. Both are approved for certain advanced melanomas and non-small-cell lung cancers, but pembrolizumab additionally holds a broader tumour-agnostic approval for MSI-High/dMMR solid tumours regardless of where the cancer started, while nivolumab is more often paired with ipilimumab in specific settings.
For example, nivolumab plus ipilimumab is a recognised combination in advanced renal cell carcinoma, a setting where pembrolizumab is not typically used the same way. Your cancer type and biomarker results decide which drug applies to you — not which name you heard first.
A framework for the conversation with your oncologist, not a substitute for it — the approved label for your specific diagnosis governs, not this table.
Does the cost of pembrolizumab and nivolumab differ in India?
Yes, and the gap has widened recently. Nivolumab's Indian patent lapsed in May 2026, and a domestic biosimilar launched in January 2026 at roughly a quarter of the reference product's price (indicative, as of August 2026). Pembrolizumab has no biosimilar option in India yet, since its patent protection is not expected to lapse until around 2028-29.
These are general market figures reported in Indian pharmaceutical industry news, not a CION price list — actual cost to a patient depends on dose, brand or biosimilar chosen, hospital, and the overall treatment plan. As genuine biosimilars have entered the market ahead of patent expiry on some products, counterfeit checkpoint inhibitors have also been reported in India; sourcing either drug only through a licensed hospital pharmacy with documented cold-chain handling is a patient-safety matter, not just a cost one.
Who this comparison is — and isn't — for
This page is for patients and caregivers who have been offered pembrolizumab or nivolumab, or who are trying to understand why an oncologist chose one over the other, and want a factual, side-by-side explanation.
It is not: a claim that either drug is right for your specific cancer; a price quote; a suggestion that you can request one drug over the other without your oncologist's assessment; or a suitability check. Most people researching either drug are not, in fact, eligible for either one — eligibility depends on your exact cancer type, stage, and biomarker results (such as PD-L1, MSI-High/dMMR status), which only your treating oncology team can confirm from your own reports.
If both work the same way, how does an oncologist choose between them?
The choice is rarely pembrolizumab vs nivolumab in isolation — it follows from your cancer type's approved label, whether a combination partner is indicated, your biomarker results, and which drug or biosimilar the treating hospital's protocol and formulary use. It is a clinical decision built around your specific case, not a brand preference or a general ranking of one drug over the other.
In practice this means two patients with different cancers, or the same cancer at different biomarker levels, can reasonably be prescribed different checkpoint inhibitors — and that is not a sign either drug is "better," only that each has a defined, approved role. If you were specifically told why one was chosen for you, that reasoning came from your oncologist's read of your own reports, not from a general comparison like this one.
Pembrolizumab vs Nivolumab: Frequently Asked Questions
Are pembrolizumab and nivolumab the same class of drug?
Yes. Pembrolizumab (Keytruda) and nivolumab (Opdivo, and its Indian biosimilar versions) are both PD-1 immune checkpoint inhibitors — monoclonal antibodies that block the PD-1 receptor on T cells so the immune system can recognise and attack cancer cells. They bind the same receptor at slightly different sites and are made by different companies, but the underlying mechanism class is identical, which is also why both carry a broadly similar profile of immune-related side effects (irAEs).
Do pembrolizumab and nivolumab treat the same cancers?
Their approved indications overlap substantially but are not identical. Both are approved for use in certain advanced melanomas and non-small-cell lung cancers in India. Pembrolizumab additionally holds a broader tumour-agnostic approval for MSI-High/dMMR solid tumours regardless of where the cancer started; nivolumab is more often used in combination with ipilimumab in specific settings such as advanced renal cell carcinoma. Which applies to a given patient depends on cancer type and biomarker results, not on which drug name came up first.
Does the cost of pembrolizumab and nivolumab differ in India?
Yes, and the gap has widened recently. Nivolumab's Indian patent lapsed in May 2026, and a domestic biosimilar launched in January 2026 at roughly a quarter of the reference product's price (indicative, as of August 2026). Pembrolizumab has no biosimilar option in India yet — its patent protection is not expected to begin lapsing until around 2028-29 — so its cost picture has not moved the same way. These are general market figures, not a CION price list; actual cost depends on dose, brand, hospital and your treatment plan.
Is pembrolizumab better than nivolumab, or the other way round?
Neither is generally "better" — that framing doesn't match how these two medicines are actually used. Both are PD-1 inhibitors from the same class with overlapping but distinct approved indications, and oncologists choose between them based on the specific cancer type's approved label, any required combination partner, biomarker results, and the hospital's treatment protocol — not on a general superiority ranking. A drug that is standard for one cancer type may not even be approved for another.
Can a patient be switched from one to the other during treatment?
Sometimes, but it is a specialist decision made case by case, not a routine substitution. Reasons an oncologist might consider switching within the same drug class include a change in approved options, a supply or cost consideration, or how a patient tolerated a previous checkpoint inhibitor course. This is never a decision to make or request based on cost alone without your treating oncology team's assessment of your specific case and prior response.
Are both pembrolizumab and nivolumab approved for use in India?
Both originator medicines are approved and marketed in India for a number of specific cancer indications under CDSCO, though the exact approved indication list differs between the two and can change over time. A domestic biosimilar version of nivolumab has also been approved and marketed in India since January 2026; pembrolizumab does not currently have an approved biosimilar in India. Always confirm the current approved indication for your specific diagnosis with your treating oncologist rather than assuming either drug applies.