Immunotherapy Medicines · Reference Table

Which Checkpoint Inhibitor for Which Cancer: A Reference Table

There is no single checkpoint inhibitor used for every cancer. Each one is approved for particular cancer types, often only within a specific stage, treatment line and biomarker group — the table below sets out the broad pattern by molecule, to read alongside your own oncologist's reasoning, not instead of it.

Medically reviewed by Dr. C. Raghavendra Reddy, Medical Oncologist, MBBS (Gold Medal) · DNB · DM (Medical Oncology, Gold Medal) · Last reviewed August 2026

Prescription-only medicine. Every checkpoint inhibitor named on this page is a prescription-only oncology medicine, used only under specialist supervision as part of a wider treatment plan — none is available over the counter or without a prescribing oncologist. Nothing on this page is a recommendation to use this medicine. It is not suitable for most patients — see "Who this is not for" below.
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Which checkpoint inhibitor is used for which cancer?

Checkpoint inhibitors are grouped by which immune "checkpoint" protein they block — PD-1, PD-L1 or CTLA-4 — and each approved medicine within a group is licensed for a specific list of cancers, not for cancer in general. PD-1 inhibitors such as pembrolizumab and nivolumab, and PD-L1 inhibitors such as atezolizumab and durvalumab, cover overlapping but not identical territory: lung, skin, kidney, bladder, liver, head and neck, and several other cancers appear across the group, but which molecule applies to which cancer, and at which stage, differs case by case.

This is exactly the question patients ask after being offered one drug and wondering why not another. The table below is the master reference for this section — a broad map of molecule, class, associated cancer types, typical treatment line and the biomarker usually considered, built to be scanned in one view rather than pieced together across separate pages.

Master Reference

Checkpoint inhibitors by class, cancer association and biomarker

This table reflects broadly published, commonly cited approved-use patterns for these molecules. It is a general map, not an exhaustive label reference or an India-specific approval list for every line — always confirm current indication and approval status with your treating oncologist.

Molecule Target / class Commonly associated cancers Typical treatment-line pattern Biomarker usually considered
Pembrolizumab Anti-PD-1 Lung (NSCLC), melanoma, head & neck, cervical, some gastric/oesophageal, MSI-H/dMMR tumours across sites First-line where biomarker-high; second-line after chemotherapy elsewhere PD-L1 (TPS/CPS), MSI-H/dMMR, TMB-high
Nivolumab Anti-PD-1 Lung (NSCLC), melanoma, kidney (RCC), liver (HCC), head & neck, some Hodgkin lymphoma First-line combination (often with ipilimumab) or second-line monotherapy PD-L1 in some indications; not required in others
Atezolizumab Anti-PD-L1 Lung (NSCLC and small-cell), liver (HCC, combined with a targeted agent), some triple-negative breast, bladder First-line combination in several indications PD-L1 in some indications
Durvalumab Anti-PD-L1 Lung (stage 3 NSCLC after chemoradiation), liver (HCC), biliary tract cancer Consolidation after chemoradiotherapy; first-line combination in liver/biliary cancers Not routinely required
Ipilimumab Anti-CTLA-4 Melanoma, kidney (RCC), some liver cancer, MSI-H colorectal cancer Almost always combined with a PD-1 inhibitor rather than used alone MSI-H/dMMR in colorectal use
Cemiplimab Anti-PD-1 Skin (cutaneous squamous cell carcinoma), lung (NSCLC) First-line or second-line depending on indication PD-L1 in lung use

Newer checkpoint inhibitors approved elsewhere are not all listed here because Indian availability and approval status is still settling for several of them — see "Regulatory status" below rather than assuming a molecule not shown is unavailable.

Did you know?

Anti-PD-1 and anti-PD-L1 medicines block the same signalling pathway from two different sides of it, which is one reason their approved cancers overlap so heavily — the choice between an anti-PD-1 and an anti-PD-L1 medicine for the same cancer is often about trial evidence and combination partners, not a fundamentally different mechanism.

Treatment Line

At which line of treatment are these medicines typically used?

Checkpoint inhibitors are used at different points in a treatment plan depending on the cancer and the biomarker result. In cancers where PD-L1 expression is high, a checkpoint inhibitor may be used as first-line treatment — sometimes alone, sometimes combined with chemotherapy or with a second checkpoint inhibitor such as ipilimumab. Where biomarker support is weaker or absent, the same medicine is more often reserved for second-line use, given after an initial chemotherapy-based regimen has been tried and has stopped working.

A smaller group of cancers use checkpoint inhibitors as adjuvant treatment after surgery, or neoadjuvant treatment before it, to reduce the chance of recurrence rather than to treat a currently measurable tumour. Which line applies to a specific patient is decided by the treating oncology team using stage, biomarker testing and prior treatment history together — the table above shows the general pattern, not a rule that holds for every diagnosis.

Biomarker

With which biomarker is each checkpoint inhibitor typically paired?

The biomarker that matters most varies by cancer type rather than by molecule alone. PD-L1 expression — reported as a Tumour Proportion Score (TPS) or Combined Positive Score (CPS) depending on the cancer — is the most widely used marker, and often decides whether a checkpoint inhibitor is offered first-line, in combination, or later in treatment. Microsatellite instability-high (MSI-H) or mismatch repair-deficient (dMMR) status is a separate marker that applies across many cancer types largely independent of the organ of origin, and can support checkpoint inhibitor use even when PD-L1 expression is low. Tumour mutational burden (TMB-high) is considered in some settings, though it is used less universally than PD-L1 or MSI-H/dMMR status.

None of these markers guarantees a response — a "positive" biomarker identifies patients more likely to benefit, not a certainty. Biomarker testing is arranged by the treating oncologist as part of standard diagnostic work-up; it is not something a patient requests independently of that process.

Who this reference table is not for

This table is for patients, caregivers and researchers who want a broad, sourced map of which checkpoint inhibitor is generally associated with which cancer, treatment line and biomarker — before or alongside a conversation with an oncologist.

It is not: a tool for choosing your own medicine; a substitute for your oncologist's assessment of your specific diagnosis, stage and prior treatment; a complete or India-specific label reference for every indication and sub-line of every molecule; or applicable without change to paediatric use, off-label use, or clinical-trial settings, none of which this table covers. If you are trying to understand why a particular medicine was chosen — or not chosen — for your own case, that conversation belongs with your treating oncology team, not with this page.

Beyond The Table

If two checkpoint inhibitors are both approved, how does an oncologist pick one?

Approval for the same cancer does not make two checkpoint inhibitors interchangeable in practice. Oncologists weigh which stage and biomarker sub-group the trial evidence for each medicine actually covers; whether it is approved as monotherapy or in combination for that exact situation; the patient's organ function and other conditions, since anti-CTLA-4 medicines such as ipilimumab carry a higher immune-related side-effect burden than anti-PD-1 or anti-PD-L1 medicines alone; and practical factors including dosing schedule, prior treatment, and what is accessible through insurance or scheme coverage.

This is also the honest answer to "why did my oncologist choose this drug and not the other one" — cost and convenience can be part of a reasonable decision alongside evidence, and asking about the reasoning is a fair question, not a challenge to the treatment plan.

Cost Context

Does price reflect which checkpoint inhibitor is "better"?

No — price differences between checkpoint inhibitors approved for the same indication are not a marker of clinical superiority. Indian cost context is shifting for reasons unrelated to how well a medicine works: a domestic nivolumab biosimilar launched in January 2026 at roughly a quarter of the originator's price, after the original patent lapsed in May 2026, while pembrolizumab's patent protection is not expected to lapse until around 2028-29. These are indicative, published-source figures as of August 2026, not a CION price list against either molecule.

Counterfeit checkpoint inhibitors have also been reported entering the Indian market ahead of patent expiry on some products — a genuine patient-safety issue, not a scare tactic. Sourcing any checkpoint inhibitor through a registered pharmacy and treating hospital matters as much as which molecule is chosen.

Regulatory Status

Is every checkpoint inhibitor in this table approved in India for every use shown?

Not necessarily for every listed cancer or line. CDSCO approval and marketing status is granted indication by indication, not molecule by molecule as a whole, and it changes over time as new trial data and approvals come through. A checkpoint inhibitor widely used for one cancer internationally may be approved in India for that cancer but not yet for another use shown in a global label — or the position may still be unconfirmed at the time this page was last reviewed. Where genuine uncertainty exists, the honest answer is that the status is unconfirmed, not an assumption in either direction; your treating oncologist and hospital pharmacy can confirm the current approved status for your specific situation.

Related Reading

Going deeper on cost, choice and specific comparisons

This page is an editorial reference for patient education. It does not claim that any named checkpoint inhibitor is superior to another, does not state that CION stocks or dispenses any medicine named here, and carries no CION price against any molecule. Indication and biomarker information reflects broadly published patterns as of this page's review date and should always be confirmed with your treating oncologist against your own diagnosis and current CDSCO-approved labelling.

Common questions

Checkpoint inhibitors by cancer type: your questions answered

Which checkpoint inhibitor is used for which cancer?
There is no single checkpoint inhibitor used for all cancers — each one is approved for specific cancer types, often within a particular stage or biomarker group. PD-1 inhibitors such as pembrolizumab and nivolumab are commonly linked to lung, skin (melanoma), kidney, bladder, head and neck, and liver cancers; PD-L1 inhibitors such as atezolizumab and durvalumab cover overlapping ground; and the CTLA-4 inhibitor ipilimumab is mostly used combined with a PD-1 inhibitor rather than alone. The table on this page maps the broad pattern by molecule, but the exact medicine for any patient is decided by the treating oncologist from diagnosis, stage and biomarker results — not cancer type alone.
At which line of treatment are checkpoint inhibitors typically used?
Checkpoint inhibitors are used at different points depending on the cancer and biomarker result. Where PD-L1 expression is high, a checkpoint inhibitor may be first-line — alone or combined with chemotherapy or another checkpoint inhibitor. Where biomarker support is weaker, the same medicine is more often reserved for second-line use, after an initial chemotherapy regimen. A smaller group of cancers use checkpoint inhibitors as adjuvant or neoadjuvant treatment, around surgery, to lower recurrence risk. Which line applies depends on stage, biomarker testing and prior treatment, decided by the treating oncology team — not a fixed rule across every diagnosis.
Which biomarker decides whether a checkpoint inhibitor might apply?
The relevant biomarker varies by cancer type. PD-L1 expression — reported as a TPS or CPS score — is the most widely used marker, often deciding whether a checkpoint inhibitor is used first-line, in combination, or later. Microsatellite instability-high (MSI-H) or mismatch repair-deficient (dMMR) status is used across many cancer types largely independent of the organ of origin, and can support use even when PD-L1 is low. Tumour mutational burden (TMB-high) is considered in some settings, less universally. None of these markers guarantees a response — they identify patients more likely to benefit — and testing is arranged by the treating oncologist, not requested independently.
Does a more expensive checkpoint inhibitor work better than a cheaper one?
Not necessarily. Price is not a reliable marker of clinical superiority between checkpoint inhibitors approved for the same indication. Indian cost differences increasingly reflect originator-versus-biosimilar status rather than how a medicine works — a domestic nivolumab biosimilar, for instance, launched at roughly a quarter of the originator's price after the original patent lapsed. Two checkpoint inhibitors approved for the same cancer and biomarker profile are generally comparable options, not a superior-and-inferior pair. An oncologist's selection is usually guided by approved indication, trial evidence for that cancer, dosing schedule and practical availability — not price alone.
Can I ask my oncologist for a different checkpoint inhibitor than the one prescribed?
You can always discuss the choice with your oncologist, but it isn't simply a matter of preference. Only medicines approved for your specific cancer, stage and biomarker profile are appropriate, and even within that group, prior treatment, organ function, other health conditions and scheme or insurance coverage narrow the practical choice further. Asking why one checkpoint inhibitor was chosen over another is reasonable, and a good oncologist will explain the reasoning. What this page cannot do is say whether switching suits your own case — that depends on details only your treating team has.
Are all checkpoint inhibitors named on this page approved and available in India?
Not uniformly. Approval and marketing status differs by molecule and indication, and changes over time. Some checkpoint inhibitors are approved in India for only a subset of cancers approved elsewhere, and newer molecules can take time reaching the Indian market after global approval. This page reflects broadly published, commonly recognised indications as general patient-education reference — not a substitute for a medicine's current CDSCO-approved label. Status should always be confirmed with your treating oncologist or pharmacist before assuming a specific medicine is available for your situation.