Abstract / Summary
Immune checkpoint inhibitors (ICIs) have revolutionized cancer care in high-income countries, delivering durable responses across multiple malignancies. Yet >75% of global cancer deaths occur in low- and middle-income countries (LMICs), where ICIs remain largely inaccessible due to high costs, regulatory delays, diagnostic gaps, workforce shortages, and exclusion from pivotal trials. Access within LMICs is highly heterogeneous and stratified by geography, sector, and socioeconomic status, reproducing global inequities at the local level. Emerging solutions—including biosimilars, voluntary licensing, pooled procurement, regional manufacturing, telepathology, nurse-led delivery models, inclusive clinical trials, and dose-optimization strategies—demonstrate that substantial price reductions and safe deployment are achievable. Coordinated policy actions, such as adding programmed cell death protein 1 and programmed cell death ligand (PD-1/PD-L1) inhibitors to the World Health Organization (WHO) Essential Medicines List, regulatory harmonization, Trade-Related Aspects of Intellectual Property Rights (TRIPS) flexibilities, and investment in diagnostics and training, are now required to translate these advances into equitable, population-level impact. Without deliberate global action, immunotherapy will remain a privilege rather than a universal tool in cancer control.