Our Take
The industry is optimizing for consensus, not data: lung cancer got the attention first, so lung cancer gets the capital, even as early evidence points elsewhere.
Why it matters
Bispecific antibodies represent a major investment class in oncology right now. If companies are allocating R&D and clinical resources to the wrong indication, the field is burning capital on a herd play rather than on biology.
Do this week
Oncology portfolio leads: map your PD-1/VEGF programs by indication and pull liver-cancer efficacy signals from Phase 1b/2 data this week so you can flag misdirected Stage 2+ commitments to your CMO.
The lung cancer consensus
Pharmaceutical companies are concentrated on PD-1/VEGF bispecifics as a class, with the majority of development effort focused on lung cancer indications. This makes intuitive sense: lung cancer is a large market, anti-PD-1 monotherapy is established standard-of-care, and adding VEGF inhibition to checkpoint blockade has shown clinical benefit in that disease.
But clinical data from early trials suggests a different story. Evidence emerging from Phase 1b and Phase 2 studies indicates that the liver may offer a stronger therapeutic window and potentially more durable responses than lung cancer when using PD-1/VEGF bispecifics. The distinction matters because oncology development timelines are long and capital allocation happens early.
Why companies may be chasing the wrong cancer
Three factors explain the lung-cancer cluster. First, the regulatory playbook is well-worn: anti-PD-1 monotherapy already works in non-small-cell lung cancer, so adding VEGF inhibition feels like a natural extension. Second, lung cancer trial recruitment is faster and cheaper than rare liver malignancies. Third, once a few companies file in lung, others follow to de-risk their own programs. Consensus builds quickly, often independent of new data.
What the evidence suggests is that hepatocellular carcinoma and other liver malignancies may have biological features that favor dual PD-1/VEGF blockade more than lung tumors do. The immune microenvironment in liver cancer is distinct, angiogenesis plays a different role, and early clinical signals point to stronger efficacy in that space. Yet the majority of the industry's pipeline capital is aimed at lung.
This is not a critique of the bispecific modality itself. It is a critique of indicationselection based on market size and regulatory precedent rather than on emerging clinical signal.
What to do now
If you are responsible for an oncology pipeline, audit your PD-1/VEGF program's indication strategy against the latest Phase 1b/2 data. Look specifically at hepatocellular carcinoma, cholangiocarcinoma, and other liver tumors in your competitive landscape. If your program is committed to lung cancer because that is where the market is, not because that is where the biology points, your timeline and capital efficiency are both at risk.
Regulatory agencies are becoming more skeptical of "me-too" programs in crowded indications. A bispecific with a stronger clinical signal in liver cancer will move faster through review than a me-too in lung. And patients with liver cancer have fewer effective options. The commercial case and the clinical case align here, which is rare.
This is not a call to abandon lung cancer programs. It is a call to ask whether your indication choice reflects your data or your competitor's data.