Polatuzumab Vedotin: Uses and Availability in India

Large B-cell lymphoma in adults, and mostly diffuse large B-cell lymphoma. It is approved in two settings: with R-CHP chemotherapy in previously untreated disease, and with bendamustine and rituximab in relapsed or refractory disease in adults who cannot have a stem cell transplant. It has no role in solid tumours.

The target is CD79b, a protein that sits on the surface of B lymphocytes as part of the B-cell receptor. That single fact explains most of what this medicine can and cannot do. A lymphoma that arises from B cells carries the target almost as a class feature, so no separate biomarker test is ordered before treatment — a real difference from the other vedotin in this cluster, brentuximab vedotin, which is used only where a biopsy has shown the CD30 protein. A cancer that does not arise from B cells has no target at all.

Diffuse large B-cell lymphoma is the reason the molecule matters in India. Roche India puts the number of people diagnosed with it here at approximately 25,000 a year, and describes it as the most common lymphoma subtype in adults.

In two places, and both are defined by what has already happened. First line, it takes the place of the vincristine in R-CHOP, so the regimen becomes polatuzumab vedotin plus R-CHP. In relapse, it sits with bendamustine and rituximab — but only for adults who are not candidates for a stem cell transplant.

That second restriction is the part most pages leave out, and in India it is written into the approval itself. A Central Drugs Standard Control Organisation Subject Expert Committee item reported in November 2024 recommended extending the relapsed or refractory indication to the 30 mg vial presentation, carrying forward the condition attached to the original approval: that the drug be prescribed only for patients who are not eligible for a transplant procedure, as certified by the tumour board of the hospital.

For a family already reading about transplant and CAR-T, that wording is worth understanding rather than skipping. It means the relapsed-setting question is not "can we obtain this medicine" but "what has the tumour board recorded about transplant eligibility". Those are different conversations, and the second one comes first.

Yes, and that is worth stating plainly, because several molecules written about in this cluster are not. Roche Products (India) Pvt Ltd is the listed Indian marketer, under the brand name Polivy. Both the 30 mg and the 140 mg single-dose vial presentations are listed here. No Indian biosimilar of the molecule is marketed as of August 2026.

Indian regulatory position, as of August 2026. Roche India states on its own product page that the Drug Controller General of India approved Polivy in combination with R-CHP for adults with previously untreated diffuse large B-cell lymphoma in September 2023, and describes the combination as the first new therapy approved for first-line treatment of the disease in nearly twenty years. The relapsed or refractory indication was already approved for the 140 mg presentation and, per the reported November 2024 Subject Expert Committee item, was extended to the 30 mg presentation under the transplant-ineligibility condition described above.

Being available and being affordable are different things. Because there is no Indian similar biologic, the price behaves the way an imported single-supplier product behaves. Rituximab, which is given alongside polatuzumab vedotin in both regimens, went the other way years ago: several approved Indian versions compete, and the cost of that component of the same prescription fell steeply. One line of the bill has a mature Indian market behind it and the other does not. The list of immunotherapy medicines that do have Indian biosimilars sets out which is which.

Indian pharmacy listings put the maximum retail price of a Polivy vial at about Rs 2.22 lakh, with discounted listings running roughly Rs 1.7 lakh to Rs 1.96 lakh. Those figures are indicative, as of August 2026, drawn from published Indian listings. They are not a price offered by any hospital on this page, and no hospital rate for this molecule appears anywhere on it.

Check the strength before you compare the number. Some Indian listings show the same maximum retail price against both the 30 mg and the 140 mg pack, and both cannot be right. Before any planning, the strength printed on the vial should be matched against the strength named on the invoice. That one check is worth more than any published range.

A vial price is not a dose price. The dose is 1.8 mg per kilogram, given every 21 days, and the approved product information advises against exceeding 240 mg in a cycle. An adult of about 60 kilograms therefore needs roughly 108 mg per cycle. That is drawn from one 140 mg vial, or from four 30 mg vials, and the standard course is six cycles. These are single-dose vials with no preservative, so a part-used vial is not carried over to another patient or another cycle, and the difference discarded is a real line item.

And the molecule is only one line of the bill. The bendamustine, rituximab and R-CHP components each carry their own cost, as do day-care charges, growth-factor support, imaging, blood tests and any admission for a complication. An itemised written estimate that separates the medicine from everything around it makes every other question answerable; a single total does not.

Anyone whose cancer is not a large B-cell lymphoma — and, in the relapsed setting, anyone who is still a candidate for a stem cell transplant. The second half of that sentence surprises people, because it means the medicine can be available, affordable and still not the right next step.

• Not for solid tumours. Breast, lung, oral, colorectal, prostate and every other solid cancer are outside this medicine's scope entirely. CD79b is a B-cell protein; a solid tumour does not carry it.
• Not for lymphomas that are not B-cell lymphomas. Hodgkin lymphoma and T-cell lymphomas are treated with different agents. The vedotin in the name is only the payload, shared with other antibody-drug conjugates that target completely different proteins.
• Not for relapsed disease where a transplant is still possible. The approved relapsed indication is written for adults who are not candidates for a haematopoietic stem cell transplant, and in India that ineligibility is certified by the hospital tumour board. Someone who is transplant-eligible sits on a different pathway.
• Not straightforward where nerve damage already exists. Long-standing diabetic neuropathy, or neuropathy left over from earlier vincristine or platinum chemotherapy, changes the risk calculation, because pre-existing neuropathy can worsen. That is a judgement for the treating team after a baseline examination, not a decision to take from a web page.
• Not for anyone with known hypersensitivity to polatuzumab vedotin or to any excipient in the formulation.
• Not in pregnancy, and not while breastfeeding. The payload can harm a developing baby. Effective contraception is advised for women during treatment and for a period afterwards, and men are advised not to father a child during that period; the interval is set by the treating team.
• Not alongside live vaccines, which are avoided during treatment because the immune system is suppressed.
• Not a substitute for a transplant or for CAR-T where either is indicated. Choosing it in place of a recommended pathway is not a cost saving, and the sequence is a tumour-board decision.

It is also not interchangeable with the other vedotins. Brentuximab vedotin targets CD30, enfortumab vedotin targets Nectin-4, and this one targets CD79b. They share a payload family and nothing else that matters clinically. Confirming which molecule a prescription actually names, before any cost planning begins, is a five-second check that occasionally saves a great deal.

Both, joined into one molecule. The targeting half is a monoclonal antibody against CD79b. The payload is monomethyl auristatin E, a chemotherapy agent. Indian hospital billing and insurance paperwork usually file it under immunotherapy because of the antibody. The side effects that follow are largely chemotherapy side effects.

This is the quiet confusion behind a lot of anxious reading. A family is told the word immunotherapy, pictures a checkpoint inhibitor, and then reads about hair loss and low blood counts and cannot reconcile the two. Both descriptions are accurate. The class name describes how the medicine is built; the side-effect list describes what it carries.

Peripheral neuropathy and low blood counts lead the list. In the first-line safety population described in the approved product information, peripheral neuropathy was reported in about 53 per cent of patients, nausea in about 42 per cent, neutropenia in about 38 per cent and diarrhoea in about 31 per cent. Febrile neutropenia was the most common serious reaction, at about 11 per cent.

Two of the entries in the table below are not side effects to manage at home under any circumstances. New confusion, changed vision or speech, or weakness down one side of the body needs hospital assessment the same day. So does fever with a low blood count, or new breathlessness. These are hospital events, not wait-and-see events.

As an intravenous infusion on day one of a 21-day cycle, for six cycles, in a day-care setting. The first infusion runs over 90 minutes with observation. If it is tolerated, later infusions may run over 30 minutes. Premedication is given before every cycle. It is not a tablet, and it is not given at home.

In the first-line regimen the polatuzumab vedotin, rituximab, cyclophosphamide and doxorubicin are all given on day one, after prednisone, which continues on days one to five. Cycles seven and eight are rituximab alone. In the relapsed regimen the bendamustine runs on days one and two of each cycle alongside rituximab on day one.

The vial travels cold, and that matters. Polivy is a cold-chain biologic stored between 2 and 8 degrees Celsius and reconstituted in the hospital pharmacy. Where a medicine is expensive, imported and single-supplier, the sensible precautions are the ordinary ones: source it through the treating hospital's pharmacy or a manufacturer-authorised distributor, keep the invoice, and photograph the carton so the batch number and expiry date reach the patient file before it is discarded. How to verify an immunotherapy vial is genuine sets out the same checks in full, and they apply to every high-value biologic, not only this one.

The engineering ideas behind this molecule are showing up across blood cancers, which is why the reading often widens. Isatuximab and elotuzumab in myeloma covers naked antibodies aimed at a different blood cancer, and teclistamab, talquetamab and the myeloma bispecifics covers the T-cell-engaging design that followed. None of them substitutes for another, and each has its own eligibility rules.

• Glofitamab, Mosunetuzumab and Epcoritamab in Lymphoma — the other newer class being discussed in relapsed large B-cell lymphoma, and how it differs in design.
• Isatuximab and Elotuzumab in Myeloma — antibodies without a payload, in a different blood cancer.
• Teclistamab, Talquetamab and Myeloma Bispecifics — the T-cell-engaging generation, and what it asks of a patient.
• Brentuximab Vedotin: Uses, Cost and Side Effects — the other vedotin, targeting CD30, and why the two are not interchangeable.
• Immunotherapy Medicines Explained — the index of checkpoint inhibitors, antibodies and molecule-by-molecule Indian cost pages.
• Immunotherapy at CION — what this family of treatments does, who it suits, and who it does not.

Editorial information about a named medicine — not an offer, a price list, or a recommendation to use it, and no comparative quality claim between manufacturers or between treatments. All regulatory, pricing, dosing and safety statements on this page are indicative and dated to August 2026, drawn from the approved product information for the molecule, Roche India's published regulatory statement, a reported CDSCO Subject Expert Committee item and published Indian pharmacy listings. Whether polatuzumab vedotin applies to a particular lymphoma, and at what point, is a decision for the treating haematologist or medical oncologist and the hospital tumour board, on the full clinical picture.