Cancer: a surge in clinical trials – how China is challenging the world with smart drugs

Still in the context of stomach cancer, but this time in patients with CLDN18.2-positive and HER2-negative disease, the G-HOPE-001 study, conducted in China and Japan, evaluated arcotatug tavatecan, a new ADC developed by Innovent Biologics. In the approximately 460 patients who had already undergone at least two lines of treatment, median overall survival increased from 6.9 to 10.2 months, with a 43 per cent relative reduction in the risk of death. Progression-free survival, in the updated analysis, was 7.1 months compared with 3.1 months. These are significant results in a population with few treatment options.

Chinese research is also making progress in the field of breast cancer. The PANKU-Breast01 study, conducted on 383 patients with HR-positive/HER2-negative breast cancer, has shown that izalontamab brengitecan, developed by Baili/SystImmune, reduces the relative risk of disease progression or death by 59 per cent compared with chemotherapy. The median progression-free survival was 8.2 months compared with 4 months. Data on overall survival are not yet available.

ADCs are drugs based on highly advanced technology, consisting of an antibody that recognises a protein present on cancer cells, a highly potent cytotoxic agent (known as the payload) and a chemical linker that holds the two components together and helps determine where and when the drug is released. In practice, they are ‘smart missiles’ that deliver a highly potent and extremely targeted form of chemotherapy.

Daiichi Sankyo’s DXd platform utilises a derivative of exatecan, a potent topoisomerase I inhibitor, combined with a cleavable linker. This technology has played a decisive role in the success of next-generation ADCs, but it is not the only one. In the United States, for example, Seagen – now part of Pfizer – has developed enfortumab vedotin, which carries MMAE, an agent that interferes with microtubules. Trodelvy, developed by Immunomedics and now owned by Gilead, uses SN-38, an active metabolite of irinotecan. Finally, Elahere, from ImmunoGen (now part of AbbVie), utilises DM4, a maytansine derivative.

China, too, as we have seen, is entering this race with original technological solutions. It does not merely produce new versions of existing drugs; it creates new ones. The challenge concerns the entire molecular architecture: the choice of target, the potency of the cytotoxic payload, the stability of the linker, the amount of drug carried by each antibody, and the ability to target neighbouring tumour cells as well, through the so-called bystander effect.

Technological innovation is not necessarily synonymous with clinical superiority. Furthermore, there are currently no head-to-head trials demonstrating that Chinese ADCs are superior to their Japanese or American counterparts. Furthermore, many studies have been conducted exclusively or predominantly in Asian populations: their efficacy, safety and transferability to European clinical practice will need to be confirmed.

But the message coming out of ESMO 2026 is unequivocal. Japan retains an extraordinary legacy of innovation, and the United States continues to dominate many areas of biotechnology research, but there is a new player demanding a seat at the table. China is no longer merely the world’s factory: it is establishing itself as one of the world’s leading centres for precision oncology. In short, Chinese research appears to be very well thought out.