Akeso Inc.'s PD-1/VEGF bispecific antibody Ivonescimab has demonstrated compelling clinical differentiation in Phase III lung cancer trials, establishing new benchmarks for efficacy while maintaining a favorable safety profile. The dual-action therapy combines immune checkpoint inhibition with anti-angiogenic properties in a single molecule, addressing both immune evasion and tumor vascularization mechanisms.
Phase III Trial Results Show Significant Efficacy Gains
The HARMONi trial results revealed that Ivonescimab reduced progression-free survival risk by 48% compared to chemotherapy alone in patients with EGFR-mutated, platinum-resistant non-squamous NSCLC (HR: 0.52; p<0.00001). This statistically significant improvement was consistent across both Asian and ex-Asia populations, demonstrating broad clinical applicability.
In the HARMONi-2 trial, a head-to-head comparison against pembrolizumab in PD-L1-positive NSCLC showed Ivonescimab achieved a median PFS of 11.14 months versus 5.82 months for pembrolizumab, representing a 49% reduction in progression risk (HR: 0.51). These results highlight Ivonescimab's superior efficacy over established PD-1 inhibitors in critical lung cancer indications.
The HARMONi-6 trial further validated the drug's potential, reporting a 48% reduction in disease progression or death risk in advanced squamous NSCLC patients compared to chemotherapy alone. Notably, these results were consistent across both PD-L1-positive and PD-L1-negative subgroups, addressing a broader patient population than traditional immunotherapies.
Dual Mechanism Offers Unique Therapeutic Advantage
Ivonescimab's mechanism simultaneously blocks PD-1 and VEGF pathways, offering advantages over monotherapies or combination regimens requiring separate agents. This dual inhibition activates T-cells while starving tumors of oxygen and nutrients, addressing two core mechanisms of tumor evasion and growth. The safety profile remains favorable, with no new safety signals reported in Phase III trials despite the addition of chemotherapy.
Regulatory Progress Accelerates Globally
In China, Ivonescimab has secured two NMPA approvals in 2025: one for first-line PD-L1-positive NSCLC and another for EGFR-TKI-resistant non-squamous NSCLC. These approvals have been bolstered by inclusion in the National Reimbursement Drug List (NRDL), ensuring broad patient access and early revenue generation.
Summit Therapeutics, Akeso's U.S. partner holding rights for the U.S., European, and Japanese markets, is actively evaluating the timing of its Biologics License Application (BLA) filing. The FDA has granted Fast Track designation for the HARMONi trial setting, signaling optimism about addressing unmet needs in EGFR-mutated NSCLC. While the FDA has emphasized the need for statistically significant overall survival benefit for marketing authorization, Ivonescimab's OS trend (HR: 0.79) is clinically meaningful in a setting where no approved regimens have demonstrated OS improvements.
Strategic Partnerships Drive Global Expansion
Akeso's collaboration with Summit Therapeutics has enabled global Phase III trials across multiple lung cancer subtypes, including HARMONi-3 (squamous and non-squamous NSCLC) and HARMONi-7 (PD-L1-high NSCLC). The partnership with Pfizer to combine Ivonescimab with antibody-drug conjugates in solid tumors opens new therapeutic avenues, while Summit's collaboration with Revolution Medicines explores combinations with RAS(ON) inhibitors in RAS-mutant cancers.
The company is expanding Ivonescimab's indications into pancreatic and triple-negative breast cancers, where its dual mechanism may overcome immunosuppressive tumor microenvironments. With over 12 Phase III trials ongoing, Akeso is building a robust pipeline positioning Ivonescimab as a cornerstone of next-generation immunotherapy.
Market Potential and Commercial Outlook
The projected $500 million market size for Ivonescimab in 2025 reflects growing adoption in China and the Asia-Pacific region, driven by rising cancer incidence and healthcare investments. Akeso's revenue from Ivonescimab and cadonilimab grew 25% year-on-year in 2024 to RMB 2 billion, demonstrating commercial strength. The hospital-administered 100 mg formulation dominates the market, aligning with specialized delivery channels.
With a 15% CAGR projected through 2033, the lung cancer market presents significant growth opportunities. Analysts estimate that U.S. approval could unlock $2 billion in annual sales by 2030, assuming 15% market penetration in first-line squamous NSCLC. Akeso's integrated R&D platforms, including ACE and Tetrabody technologies, provide competitive advantages in developing first-in-class therapies, while its first ADC candidate AK138D1 entering Phase I trials diversifies the pipeline.
