Iran conflict disrupts platinum supply, leaving Indian doctors rationing chemotherapy
Hospitals across India face a critical shortage of cisplatin and carboplatin, two of the most widely used chemotherapy drugs in the country, forcing oncologists to ration treatment in ways that would have been unthinkable months ago. The Lancet, in a World Report published June 27, documents how the crisis, driven by the Iran conflict disrupting raw material supplies and compounded by frozen price caps and import duties, is leaving patients with delayed, substituted, or denied treatment.
Two drugs, 70% of patients
Cisplatin and its second-generation analog carboplatin are platinum-based alkylating agents that have been backbone chemotherapy drugs since the 1970s. They are first-line treatments for head and neck cancers, lung cancer, ovarian cancer, cervical cancer, bladder cancer, testicular germ cell tumors, and some breast and gastrointestinal malignancies.
Dr Shyam Aggarwal, chairman of medical oncology at Sir Gangaram Hospital in Delhi, told The Lancet that “nearly seven in 10 patients in my clinic need one of these drugs.” At Tata Memorial Hospital in Mumbai, India’s largest cancer center, director Dr C.S. Pramesh confirmed that the shortage was flagged to the National Pharmaceutical Pricing Authority (NPPA) through the National Cancer Grid.
The shortage has been acute since mid-May 2026. Sir Gangaram Hospital reported “barely one or two days’ supply” remaining as of early June. An AIIMS Delhi surgical oncologist told the ANI news agency that these are “backbone drugs in treating common malignancies.”
How doctors are rationing
With supply insufficient to treat all patients, hospitals have been forced into explicit triage decisions. Curative-intent patients, those with treatable cancers such as germ cell tumors, early-stage non-small cell lung cancer, and neoadjuvant breast cancer, are being prioritized for remaining vials. Palliative patients, who cannot be cured but could still benefit from platinum-based therapy, are being denied standard-of-care.
Dr Wajahat Ahmed, a senior government radiation oncologist in Jammu and Kashmir, described the situation to News18 as a “silent clinical crisis.” He said: “Cornerstone cancer drugs cisplatin and carboplatin are vanishing from pharmacy shelves. For thousands of cancer patients, a delay in chemotherapy isn’t an inconvenience, it’s a death sentence.”
Other coping strategies include dose reduction, schedule modification, substitution with less effective and more expensive alternative regimens, and inter-hospital stock-sharing. Dr Raajit Chanana, director of surgical oncology at Dharamshila Narayana Superspeciality Hospital, said the alternatives have “inferior results and are costlier.” Dr Mandeep Singh Malhotra of CK Birla Hospital noted there are “no true substitutes” for these drugs.
The root cause is multi-layered
The Lancet identifies the trigger as the Iran conflict disrupting raw material supplies. But the deeper story involves a compound crisis of geopolitics, economics, and regulation.
Platinum price surge. The price of platinum, the active metal in both drugs, rose from approximately ₹2,000 per gram in mid-2025 to between ₹5,000 and ₹8,000 per gram by mid-2026, a 150–250% increase. Contributing factors include mining disruptions in South Africa and Russia, the Strait of Hormuz crisis disrupting Gulf imports (the UAE alone supplies nearly half of India’s platinum imports), and demand from the semiconductor and AI data center industries.
Frozen price caps. Cisplatin and carboplatin are listed under India’s Drug Price Control Order (DPCO), meaning their maximum retail prices are set by the NPPA and cannot be adjusted without government approval. These caps had been frozen while manufacturing costs soared, making production financially unviable. Cisplatin was capped at roughly ₹70 to ₹300 per vial (depending on strength) and carboplatin at ₹61.10 per 10 mg/ml vial.
Manufacturer pullback. Companies like Naprod Life Sciences halted production entirely. An anonymous industry veteran told News18: “It’s not a supply shortage born from scarcity, it’s a rational business decision.” Per-unit margins had collapsed from approximately ₹200 to negative territory.
Import barriers. A government-imposed import duty on platinum was raised from 6.4% to 15.4%, and import permits currently require three to four months to process. The combination made it effectively impossible for manufacturers to source raw material at commercially viable prices.
The government response
The NPPA invoked Paragraph 19 of the DPCO, 2013, a rarely used provision allowing emergency price revisions, and on June 12 notified a 50% ceiling price increase for both drugs:
- Cisplatin 1 mg/ml: from ₹7.26/ml to ₹10.89/ml
- Carboplatin 10 mg/ml: from ₹60.49/ml to ₹90.74/ml
The increase is a one-time measure, to be reviewed after six months. The NPPA also exempted the drugs from Paragraph 13(2) of the DPCO, allowing companies that had previously sold below the old ceiling to raise prices. Tata Memorial Hospital and the National Cancer Grid had flagged the shortage directly to the NPPA.
The Lancet notes that the price increase may help restore production incentives, but it does not address the underlying platinum supply disruption, the import duty, or the three-to-four-month import permit delay.
What this means
A delay of more than four weeks in curative-intent chemotherapy can increase mortality risk by 6% to 10%, according to analysis cited by Mint. With India’s cancer burden estimated at over 1.4 million new cases annually, and with the majority of patients paying out of pocket, even a temporary disruption in the supply of first-line agents has consequences measured in avoidable deaths.
Kumar Ajit, a 57-year-old patient from Bihar, told Reuters: “I managed to get this dose, but I don’t know how I’ll arrange the next one.”
The Lancet report frames the shortage not as a temporary supply chain hiccup but as a case study in how geopolitical instability, regulatory rigidity, and market economics can converge, with the most vulnerable patients paying the price.
Sources:
1. Lateef, S. “India drug shortage leaves doctors rationing chemotherapy.” The Lancet 407, 2589–2590 (2026). DOI: 10.1016/S0140-6736(26)01280-8
2. NPPA. Gazette notification on ceiling price revision, June 12, 2026.
3. Reuters, News18, Indian Express, The Economic Times. Various reporting, June 2026.