Stephanie Sirota: Something feels different this year at ASCO, the annual meeting of the American Society of Clinical Oncology, where clinicians, researchers, and industry leaders discuss the latest innovation in cancer treatment.
Historically, attention has gone to large trials by big pharma, often in first-line settings where the patient populations are biggest.
But this year, the mix looks a little different. There's a lot of focus on late-stage data readouts across some of the most important, hardest-to-crack areas of oncology, much of it coming from biotech, not just big pharma. So, the question is—are we starting to see real progress in some of the hardest-to-treat cancers?
Welcome to the RTW Podcast, where we aim to keep our audience healthy, wealthy, and wise. To give us a walkthrough of the oncology landscape ahead of this monumental conference, I'm joined by Chris Liu, Senior Research Analyst at RTW, who is responsible for oncology research and coverage of life sciences companies in China. Chris, thanks for joining us today.
Chris Liu: Hi, Steph. Thanks for having me.
The Evolution of Cancer Treatments
Stephanie Sirota: So, before we get into what's new, give us a simple mental model. How have cancer treatments evolved? And what are the main ways that we're trying to fight them today?
Chris Liu: Cancer cells are super fast-growing cells, right? They're growing so much faster than normal cells. So, the treatment for cancer cells started with surgery.
And then that evolved into chemotherapy, and also radiation therapy, which kills both cancer cells and normal cells. And since then, people started to find ways to target just cancer cells but not normal cells.
So, then we had targeted therapies: either small molecules or monoclonal antibodies. We want to improve on chemotherapy and radiation therapy. That gives us new tools that we call antibody drug conjugates, which technically delivers a chemotherapy just into tumor cells.
And also we have radioligand therapy applying the same principle. With those targeted therapies, there's a new problem coming out, which is cancer resistance.
So, for whatever target you're trying to deliver into cancer, cancer cells keep mutating. People discovered and developed this new modality called immunotherapy, which utilizes immune cells, which are T-cells.
It can be either internally, your own T-cells in your body, or people have external T-cells, which we call CAR T therapies. Those therapies tend to generate really long-lasting responses and can keep the cancer cells in check.
Stephanie Sirota: Are some of these newer therapies like ADCs, radio therapy, and CAR T, is that specific to certain cancers?
Chris Liu: Historically we always think about where the original organ of the cancer comes from, right? It could be lung cancer, because it comes from lungs. Breast cancer comes from breasts.
But more and more, after we developed targeted therapies, we're looking at cancer types in terms of their genetic subtypes. For example, HER2, which is an original kind of target discovered in breast cancer, but the HER2 agent right now is approved in multiple cancer types, ranging from breast cancer to some smaller cancer types, which have less patients.
Unmet Needs in Oncology
Stephanie Sirota: What are some of the highest unmet needs in oncology today?
Chris Liu: Some types of cancers are really lacking in new treatment options. For example, pancreatic cancer or brain tumors, like glioblastoma.
The only standard of care available for patients nowadays is just old chemotherapy or radiation therapy. We need some innovative therapies to prolong patients' lives.
And then in some other cancer types where we have good therapies nowadays, I think the broader goal for those patients is that we're trying to work towards curative treatment to improve their quality of life.
Stephanie Sirota: Now, when people hear terms like immunotherapy or hot and cold tumors, what does that actually mean in laymen's terms?
Chris Liu: Immunotherapy is effectively using the immune system to try to kill cancer cells.
For some tumors—pancreatic cancer, glioblastoma—they have a very thick outer layer of tissues. That makes T-cells or any type of immune cells very hard to penetrate, even for drugs. On the scan, it's not lighting up. And in those cases, we call them cold tumors.
On the opposite end, some tumor types are much easier for those T-cells to get in.
In the cancer space, people generally think some hot tumors are lung cancer, melanoma, and kidney cancer.
So, when you see those tumor scans on the imaging tool, you will see them light up. That's why we call it hot.
Stephanie Sirota: It used to be predominantly pharma that was developing the big cancer drugs. How should we think about the role that biotech plays together with pharma, particularly when it comes to the development of these new treatments?
Chris Liu: When a patient is initially diagnosed with cancer, the first treatment he or she receives, we call it front-line therapy.
And then you have second-line therapy if the first-line therapy doesn't work. And then third-line, et cetera. If we think about the number of patients available to treat, earlier-line gives you a bigger population, right?
Front-line will be the biggest opportunity for any company to look for. But also, because of that, you will need to run bigger trials. So, it will cost you more. Drug development is super costly. Pharma can afford to run a big front-line study to begin with.
Where biotech may come in and say, "Oh, maybe I would run a smaller study to prove that my drug is working," in a much later line setting where the trial can be smaller and the enrollment and recruitment can be faster. So, you have a quicker proof of concept or even commercialization. You can generate revenue to fund your next bigger trial, moving that drug from late line to earlier line.
Stephanie Sirota: Is that what drives some of the partnerships between pharma and biotech?
Chris Liu: Absolutely. When you are trying to develop earlier-line new therapies you're trying to combine with the current standard of care. Then you have to have this type of collaboration with big pharma companies.
Stephanie Sirota: One topic that also often comes up is pricing. There's this perception that cancer drugs are really expensive. How should we think about that in the context of the cost of development, failure rates, and the regulatory bar?
Chris Liu: Cancer trials usually are more expensive than other therapy trials. The reason being cancer patients not only need to receive the treatment of the investigation or drug, but also there's a lot of supportive care. That adds a lot of cost on a per-patient basis. If you look at late-stage, phase 3, randomized trials being conducted in any therapeutic area, oncology actually has one of the highest failure rates.
Oncology has a hard end point, which is usually overall survival. In other therapeutic areas, sometimes you can get away with a non-inferiority trial, which means you run a trial randomized to the current standard of care, and you just prove that this is as good as the current therapy. In cancer, we don't allow that. The FDA usually requires you to beat the current standard of care on a hard end point, which is overall survival.
The FDA encourages more and more accelerated development paths, where in some late-line trials you can get away with an accelerated end point.
Sometimes it can be overall response rate, which measures how much tumor shrinkage you had on the drug. Or sometimes it's called progression-free survival rate, which means how long can the patients stay on the drug without tumor growth.
Before any cancer drug goes into this randomized phase 3 trial, their earlier experience is usually only in single arm, which means they're small sample size.
They're tested in a non-randomized fashion. That's why the signal of the drug effect is harder to predict coming from those earlier data sets.
Stephanie Sirota: Since immuno-oncology hit the scene big time about 11 years ago, there really hasn't been a lot of talk around the evolution of some of these really important cancer developments. Why has that been?
Chris Liu: Immunotherapy definitely raised the bar for a lot of cancer treatment. If you look at anti-PD-1, which is one type of immunotherapy, there are many marketed drugs that are targeting PD-1 in many indications.
So, in a lot of tumor treatments nowadays, you have to think about how your comparator is immunotherapy, which is not an easy bar to beat. One example I can give you is head and neck cancer.
In head and neck cancer, if you want to develop a new drug, you have to show that it can beat PD-1 plus chemo, which has an overall survival around two years. Your new drug has to be meaningfully better.
That's why I think it makes a new drug a little bit challenging. And then the unmet need for other hard-to-treat tumors where immunotherapy hasn't been approved, that's just because those tumor types are harder. I do think there is an under appreciation of how many new cancer drugs are being developed. If you look at the statistics, I do think the U.S. cancer patient median survival rate has been significantly improved compared to ten years ago.
Treating Pancreatic Cancer
Stephanie Sirota: Pancreatic is one of the cold tumors, one of the hardest cancers to treat. It's hard to catch early on, so it's progressed substantially before people discover it and then start to treat it. What are some other reasons that pancreatic has been such a tough cancer to go after?
Chris Liu: The majority of pancreatic cancer is driven by one type of a gene mutation, which is called RAS mutation. RAS mutation leads to more aggressive cancer cells.
So, they grow and mutate faster. RAS proteins have been a very hard target for drug developers to get new drugs for. Nowadays, we have a new class of drug that can really attack RAS proteins. And we have a new toolbox where we can design new molecules to go after those RAS mutations. I think that will dramatically change the field of pancreatic cancer care.
Stephanie Sirota: Certainly, there's going to be a lot of talk at this year's ASCO. Tell us about these specific approaches and trials that could make a real dent in pancreatic.
Chris Liu: RAS protein, historically, has been considered an undruggable target. Those proteins have a very round shape. When you are trying to develop a small molecule drug against a protein, usually you are trying to find a hole on its surface.
You can stick in a small molecule drug, which can either block its function or stop its signaling pathway downstream. For the RAS protein, because it's so rounded, there's no surface area where you can find a drug pocket.
There's a company called Revolution Medicines. What they have done is they introduced another protein, cyclophilin A. When you have two proteins together, your small molecule can find a novel pocket to bind those two together. I think that just unlocks a whole new wave of how we think about drugging RAS proteins.
Stephanie Sirota: We've seen top-line data from Rev Med and we'll see the full set of data at ASCO this year. Why could that potential phase 3 data matter beyond pancreatic?
Chris Liu: Revolution Medicines—their drug, which are oral pills, has generated a median overall survival of 13.2 months.
It’s doubled what standard of care can do in the second-line setting, which in their trial showed about 6.7 months. If you're a pancreatic cancer patient, you have been through chemotherapy. Now you basically have no other options except to change to another chemotherapy. With Revolution Medicines’ new drug, you have doubled the chances of being alive, and you are taking an oral pill instead.
It definitely has a broader implication beyond just pancreatic tumors. The RAS mutation has accounted for about 30% of all tumor types, and pancreatic cancer is the largest population. But right after that we also have colon cancer.
RAS mutation is about 40-50% of colon cancer patients. And then we have non-small-cell lung cancer, which is about 25-ish of non-small-cell lung cancer patients that had that RAS mutation. So, I do think this pancreatic cancer data is just the first validation of this entire class.
And we will see a lot of tumor types with this new class of drug being approved and used in patients. For all the targeted therapy or all cancer treatment, there's never been just one company. There's an entire class of RAS inhibitor companies coming along with Rev Med.
I think through better chemistry, through better drug development, we will see better drugs coming out of this class and improve patients' lives upon what has already been achieved by Rev Med.
Stephanie Sirota: That's one step in the right direction, for sure. What does it take, then, for that drug to actually make it and displace the current front-line standard?
Chris Liu: They would need to conduct a randomized large phase 3 trial, which they're starting right now. And they compared their single drug to either combine with the chemotherapy or just chemotherapy, current standard of care alone.
The Importance of ASCO
Stephanie Sirota: So, let's go back to now ASCO.
For people less familiar, what makes ASCO so important, not just this year, but every year? And also give us some context. How big is it? How many people attend—and who attends?
Chris Liu: ASCO every year has been in Chicago in a huge conference center. There are tens of thousands of attendees coming from around the globe. And it's not just the pharma companies. There are biotech companies, physicians, industry stakeholders, service partners, and investors like us. There are also policy makers. I would call it the biggest event for the oncology community every year.
And people are there to really witness the next practice-changing drug. It could be in early-stage where people see it for the first time, and be like, "Wow, this can have a big impact on cancer patients' lives." Or it could be a confirmatory phase 3 study and people know that physicians are going to prescribe those drugs in the coming month with their patients.
The Revolution Medicines phase 3 data will be featured in the plenary presentation at this year's ASCO. There are other trials which are also exciting. There's a company called Akeso, which is a Chinese company.
They're developing this bispecific antibody which is called ivonescimab. It's a PD-1 on the one arm, trying to bind PD-1, and VEGF on another arm, which is another cancer target which we have developed cancer drugs for in the past before. So, this new drug is basically combining two old targets together, which we believe could generate better therapeutic effect. And what they're going to present this year at ASCO, right before Revolution Medicines' presentation, is their phase 3 data in front-line non-small-cell lung cancer.
And that is randomized against Keytruda plus chemotherapy, which is the current standard of care. So, in a way, if that trial shows super positive results, we can imagine that will un-gate a big wave of next-gen immunotherapy across multiple tumor types.
This drug has an ex-China partner which is called Summit Therapeutics. They're developing this drug globally. Their first global phase 3 is also expected to read out this year.
The Rise of Chinese Biotech
Stephanie Sirota: I would love for you to tell us a little bit about how the global landscape in oncology is changing, particularly between the U.S. and China. Years ago, a lot of Chinese VCs were coming to the U.S., acquiring early drugs and then building cancer companies in China.
And now we're seeing sort of the reverse model: a lot of Chinese companies acquiring the molecule and then developing it here in the West in the U.S., and running global trials. Tell us a little bit about the China/U.S. landscape in oncology these days.
Chris Liu: We're seeing many examples of China's innovative drugs entering the global stage. A few years ago, Chinese biotech companies were looking for U.S. drugs and bringing them back to China.
I think there's a historic context there because the Chinese CDE—which is the equivalent of the U.S. FDA— back in the day, the regulatory hurdles were very high in China. So, the development of a new drug in China has been very costly. And it was very hard for innovative drugs in China to move all the way to approval.
That's why people are looking for more established drugs in the U.S. and trying to bring that back to China to give it a faster path to commercialization.
We have seen a dramatic increase of early phase 1 trials and a steady growth of drug approvals in China year by year. I will say China is not only catching up to the rest of the world, it's almost kind of leading the speed of drug development nowadays.
There are a lot of innovative drugs being put into the clinic faster than the rest of the world and generating proof-of-concept data where we can get a sense of risk benefit. And we see that a lot more U.S. companies are taking those drugs and trying to develop in a global scale.
Akeso is one of the earlier examples. When somebody licenses their drug from Akeso, they already have hundreds of patients' data in China. And they're trying to really develop this drug in all currently approved immunotherapy indications and beyond. And we think if this ASCO presentation is highly positive, that will be a really meaningful moment for the space.
Stephanie Sirota: So, it sounds like there's healthy competition and that's going to lead us to faster drug development. Around data and AI: how can that help drive some of the productivity?
Chris Liu: We're still in the very early innings. People are trying to really broadly apply AI in all aspects of drug development.
And even on the commercialized product, how to get better patient access, how to reach the broader patient population more efficiently. I do think AI is going to change how fast we develop new drugs.
Stephanie Sirota: Does every company then have their own data systems that they're using to accelerate their processes?
Chris Liu: To leverage AI better you need a ton of data. And that's kind of one of the barriers for health care because patient data is very sensitive information.
Most of the applications we've seen today, the data is still within the companies themselves. There's not much of the public shared data. There hasn't been much published failed data yet either.
There's a super high failure rate. But most of the data sets we have in the public domain are successful trials. In order really to train AI better, I think there needs to be an industry-wide effort to put out more negative data.
The regulatory agencies are realizing that too, so they're pushing companies to publish failed clinical trial data as well. The end goal is to really get patients better drugs faster.
Stephanie Sirota: What are you most excited about as we head into ASCO?
Chris Liu: This ASCO will be a very special ASCO. As we mentioned, usually ASCO is a stage for big pharma. This is the ASCO where I feel like a lot of biotech will shine. We talked about Revolution Medicines' phase 3 in pancreatic cancer and Akeso's phase 3 in front-line non-small-cell lung cancer.
There are more, and they're coming from biotech, ranging from late-stage phase 3 data to early-stage phase 1 data. ASCO is exciting not just because of the phase 3 data, it's also because there are novel targets, novel drugs for the first time showing their phase 1 data where it could be changing the entire treatment landscape a few years down the road.
Stephanie Sirota: I think biotech in general has been really underappreciated over the last five years.
And 2025 was the year that the sector came back and flows started coming back in. It's great to see that there are some really game-changing emerging therapies and news. Tell us a headline we might read in two to three years from now.
Trends in Oncology
Chris Liu: Right now, there's a huge new wave of immunotherapy. Bispecifics like Akeso's drug, PD-1 VEGF.
And there are new T-cell engagers, which are also bispecific antibodies. But they engage your internal T-cells. So, you're utilizing your own immune system trying to kill cancer. And we have seen that being hugely successful in blood cancer. I think in two to three years we will see a dramatic impact in solid tumors as well.
And again, in cell therapy there's CAR Ts, there's TCRT. For cell therapy, we saw the success in blood cancer as well. I expect we're seeing that dramatic therapeutic effect in solid tumors in two to three years as well.
Stephanie Sirota: We've seen already M&A this year: cancer companies being snapped up. Do you expect more M&A or some deals to be announced at or after ASCO?
Chris Liu: Yes. It's really important to have enough capital to push your drug faster into earlier lines and broader indications to benefit the patient more. M&A means we can bring those drugs faster and to bigger populations.
Stephanie Sirota: Let's hope that this comes true. And in five years where do we see that median survival rate?
Chris Liu: In the earlier days of melanoma, the chemotherapy standard of care median OS was just about a year. And then we had immunotherapy. Nowadays, with front-line immunotherapy combination, the five-year median survival has been reached. For pancreatic cancer, there's a blue-sky scenario where we may see that similar thing replicated here again. I'm hopeful.
Stephanie Sirota: I'm hopeful too. Chris, thank you so much for joining us today. I want to keep rooting for biotech and pharma to work together to crack the code on cancer.
Chris Liu: Thank you. It's been a pleasure.
Credits: The RTW Podcast was produced and directed by Devon Leaver at the RTW headquarters in New York, and edited by Dominique Guerra with Production Coordinator YingYu Lin and production support by Annabelle Chan. Our research consultants were Chris Liu, Senior Research Analyst, Lauren Lee, Research Analyst, and Julia Harper, Senior Director and Head of Investor Relations at RTW Investments. Executive Editorial Advisor was our Partner, Chief Business Officer Stephanie Sirota.
This interview was given by Chris Liu, Senior Research Analyst, and moderated by Partner and Chief Business Officer Stephanie Sirota at RTW Investments. Statements reflect RTW's views and opinions as of the date hereof and not as of any future date.
All expressions of opinion are subject to change without notice and are not intended to be a forecast of future events or results. The views expressed by guests are their own, and their appearance on the program does not imply an endorsement of them or any entity they represent.
