Saudi Arabia Becomes First Country to Approve Anktiva for Lung Cancer Treatment
Key Insights
The Saudi Food and Drug Authority granted conditional approval for Anktiva (nogapendekin alfa inbakicept) for advanced lung and bladder cancers, making Saudi Arabia the first country to approve this IL-15-based immunotherapy for non-small cell lung cancer.
Anktiva works by activating natural killer cells and memory CD8+ T cells to target cancer cells, representing a distinct immunologic strategy compared to conventional chemotherapy or checkpoint inhibitors.
The approval is based on clinical evidence showing potential survival improvements in lung cancer patients whose disease progressed after prior therapies, including immune checkpoint inhibitors.
The Saudi Food and Drug Authority has granted conditional approval for Anktiva (nogapendekin alfa inbakicept), an IL-15-based immunotherapy developed by Patrick Soon-Shiong's biotechnology company ImmunityBio, for the treatment of advanced lung and bladder cancers. This marks Saudi Arabia as the first country globally to approve this therapy for non-small cell lung cancer (NSCLC), expanding beyond its current U.S. indication for a specific type of bladder cancer.
Mechanism of Action and Clinical Approach
Anktiva functions as an IL-15 receptor agonist immunotherapy designed to activate and expand natural killer (NK) cells and memory CD8+ T cells. Unlike chemotherapy or gene therapy, the treatment amplifies endogenous immune effector pathways rather than directly targeting tumor cells.
"Anktiva is that IL-15. It is the switch that actually binds to the NK cell and activates and proliferates them," Soon-Shiong explained. According to ImmunityBio, it represents "the first FDA-approved immunotherapy that activates what's called a natural killer cell to target and kill non-muscle-invasive bladder cancer cells."
The therapy is administered differently depending on cancer type. For advanced NSCLC, it is given as an injection under the skin, while for high-risk bladder cancer, it is delivered directly into the bladder via catheter.
Clinical Evidence and Efficacy Data
The Saudi approval is based on clinical evidence demonstrating Anktiva's potential benefits for patients with limited treatment options. In NSCLC trials involving patients whose disease progressed after prior therapies, including immune checkpoint inhibitors, the treatment showed possible improvement in survival outcomes.
For bladder cancer, the FDA's April 2024 approval was supported by a single-arm clinical trial enrolling 77 patients with BCG-unresponsive stage 0 non-muscle-invasive bladder cancer. Key efficacy findings included:
- Complete response rate: 62%
- 58% of responders remained disease-free at 12 months or longer
- 40% remained disease-free at 24 months or longer
These outcomes are considered clinically meaningful in a population where cystectomy is often the only curative option.
Safety Profile and Adverse Events
Common side effects vary by cancer type and administration route. In bladder cancer trials, reported adverse events included elevated creatinine, painful or difficult urination, blood in the urine, urinary urgency or frequency, urinary tract infections, increased potassium levels, muscle and bone pain, chills, and fever.
For lung cancer trials, injection-site reactions such as redness, pain, or itching were most common, along with chills, fatigue, fever, nausea, flu-like symptoms, and loss of appetite. Nearly 1,000 patients have reportedly received Anktiva across studies and expanded use programs.
Regulatory Landscape and Global Implications
The Saudi approval represents a more expansive regulatory position compared to the FDA's approach. While U.S. regulators have declined to broaden Anktiva's label to additional bladder cancer subtypes, Saudi authorities have approved the therapy for two malignancies under their national regulatory framework.
"We want this for our nation, and we're not going to follow the FDA. We want to be first," Soon-Shiong stated. "This is now approved first for lung cancer and bladder cancer, and they offered that this will be approved for all other tumors as we proceed with this work now in Saudi Arabia."
The conditional approval requires further studies to confirm long-term benefits, aligning with the Saudi FDA's approach to expanding access to advanced treatments under the Health Sector Transformation Program, a key initiative of Saudi Vision 2030.
Broader Cancer Applications
Soon-Shiong emphasized the therapy's potential across multiple cancer types: "There's now really significant proof, multiple trials, 10 years of work in which we've shown that this actually prolongs survival, whether it's breast cancer, lung cancer and even pancreatic cancer, now glioblastoma. So this is a universal treatment."
The developer has self-funded the drug's development over the past decade. "The money spent to develop this drug over the last decade has been out of my pocket. We've not received any government support, and that was never the intention. The idea was to find a way to cure cancer. This has been a life dream, and we are very close now," Soon-Shiong said.
Clinical Context and Expert Perspective
Dr. Steven Finkelstein, national director of radiation oncology for U.S. Urology Partners, highlighted the broader clinical need: "There's so many patients with cancers, afflicted with cancer, that we could do so much more for. It's so important to figure out if it works, to get it to a place where everyone gets access."
The Saudi approval positions the country as a potential global testing ground for broader oncologic applications of Anktiva, while providing new treatment options for patients with serious cancers and setting a precedent in regulatory approvals for innovative immunotherapies.