Karachi: The worsening shortage of modern cancer medicines in Pakistan has triggered an alarming surge in counterfeit and falsified drugs in the local market, with oncologists warning that desperate patients are being exposed to ineffective and potentially dangerous treatments.
Senior cancer specialists say the absence of registered immunotherapies and targeted therapies has created a vacuum that is now being filled by smuggled, substandard and fake medicines, many of them believed to be sourced from across the border or manufactured under questionable conditions.
“I have seen patients bringing pembrolizumab, marketed globally as Keytruda by Merck, which they claim to have purchased for just a few thousand rupees. This is simply not possible,” said a senior oncologist in Karachi, requesting anonymity. “Even the vial did not look original. The solution was not clear, there were visible particles, and the quantity appeared less than the standard 100 mg dose presentation. These are clear signs of falsified products.”
Pembrolizumab and nivolumab are among the most widely used cancer immunotherapies worldwide, significantly improving survival in patients with lung cancer, melanoma, head and neck cancers and several other malignancies. However, both drugs remain largely unavailable through authorised supply chains in Pakistan.
Doctors say that in the absence of regulated access, patients and their families are increasingly turning to informal “grey channels” to procure these medicines, often without any assurance of quality, storage conditions or authenticity.
Citing multiple cases, oncologists said patients who used such medicines showed no clinical benefit, and in some instances their disease progressed more aggressively, raising serious concerns that the drugs being administered were either substandard or entirely fake.
“What we are seeing is extremely dangerous. There are indications that some of these products may be stolen hospital supplies, relabelled biosimilars or completely falsified medicines being sold through a network of unscrupulous operators,” the oncologist added, warning that such practices could cost patients their lives.
The Pakistan Medical Association has also expressed grave concern over the situation, calling it a humanitarian crisis driven by the chronic unavailability of life saving oncology medicines. It said thousands of patients are effectively being pushed towards smugglers to access treatment, undermining both patient safety and the integrity of the healthcare system.
The association noted that the shortage is not merely a supply issue but reflects deeper regulatory and administrative failures, including delays in approving and notifying prices of essential medicines, which prevent their legal import and availability in the country.
Healthcare experts say several critical cancer drugs, including pembrolizumab, nivolumab and nilotinib, have already had their prices finalised by the Drug Regulatory Authority of Pakistan and endorsed at multiple levels, but remain unavailable due to delays in formal notification by the federal cabinet.
As a result, pharmaceutical companies are unable to import and market these medicines legally, creating space for black market operators to exploit vulnerable patients.
Chairman Pakistan Chemists and Druggists Association Abdul Samad Budhani said pharmacies are increasingly approached by patients seeking medicines that are not registered in Pakistan, reflecting the growing disconnect between clinical needs and regulatory availability.
“When patients cannot find these medicines through authorised channels, they are forced to turn to the grey market, where counterfeit and falsified drugs are circulating,” he said.
The PMA has urged the government to immediately address the crisis by ensuring the availability of essential cancer medicines, expediting regulatory approvals and taking strict action against those involved in the illegal drug trade.
Medical experts warn that unless urgent steps are taken to restore the legal supply of modern cancer therapies, the proliferation of counterfeit medicines will continue to grow, putting thousands of already vulnerable patients at even greater risk.
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