Western pharma is licensing in, not building, PD-(L)1 x VEGF drugs. Five deals worth over $30B connect Chinese originators to global partners: Summit/Akeso (ivonescimab), BMS/BioNTech, AbbVie/RemeGen, Pfizer/3SBio, and Merck/LaNova. Only ivonescimab has reached approval, in first-line NSCLC in China.

100 total programs tracked. 26 are clinical-stage, 53 preclinical, and the remainder identified from patent filings. Bispecific antibodies account for all 4 Phase III programs and the sole approval, but at the preclinical stage they represent only 21 of 53 programs. Trispecific antibodies (11 preclinical), fusion proteins (10), and ADCs (4) are diversifying the early pipeline.

NSCLC is the primary battleground with 16 active competitors. CRC and HCC tie at 12 programs each, but HCC has zero Phase III trials, leaving a wider window. Mid-tier indications cluster at 7-9 competitors each.

Ivonescimab is the near-term catalyst for the class. It beat pembrolizumab head-to-head in China's HARMONi-2 trial and will generate 4 readouts by mid-2027, roughly 18 months before any competitor reports pivotal data. HARMONi-3 interim PFS in squamous NSCLC is the binary event. Pfizer's SSGJ-707 has the only other 2026 readout but is China-only monotherapy. BMS/BioNTech's pumitamig will not report global Phase III PFS until late 2028 or 2029.

Preclinical depth signals broad conviction in the mechanism. Most of the 53 preclinical programs remain single-company efforts without licensing partners, suggesting early-stage sponsors are building positions before seeking deals.