Zanubrutinib

iStock, Khafizh Amrullah In its latest five-year plan, China has set its sights on developing five drugs that could each rake in more than $1 billion globally by 2030. Experts say it’s well on its way, with two medications having already met that bar. Crucial to China’s goal of becoming a global biopharma juggernaut by 2030 is delivering at least five domestically developed blockbuster drugs with global sales topping $1 billion annually. Experts tell BioSpace that the Asian giant is already well on its way to hitting this target. “Two have already crossed the [blockbuster] threshold,” Mark Lansdell, director at the life sciences intelligence firm Evaluate, told BioSpace in an email. And according to Evaluate data, at least four more are forecast to follow. The industry considers products that make $1 billion in annual sales to be blockbuster drugs. Indeed, BeOne Medicines’ BTK blocker Brukinsa, first approved in late 2019 for mantle cell lymphoma, brought in $3.9 billion last year across what has become a broad range of indications. Meanwhile, Legend Biotech’s Johnson & Johnson partnered CAR T therapy Carvykti, indicated for relapsed or refractory multiple myeloma, hit $1.89 billion last year. Next up is likely to be Guangdong-based Akeso’s ivonescimab, on which the company has partnered with Summit Therapeutics and is expecting an initial FDA approval as early as November . Evaluate expects the PD-1xVEGF to hit $4.4 billion in sales by 2030 across several indications, according to Lansdell. Beyond Brukinsa, Carvykti and ivonescimab, Evaluate projects four other Chinese-developed medicines will bring in at least $1 billion yearly by 2030. Below, BioSpace takes a closer look at the products that could help the Asian giant hit the bold five-year goal and solidify its position as a global biopharma behemoth. China China plans to transform biotech sector into $522B powerhouse by 2030 A new five-year biotech plan has been released by the Chinese government, revealing ambitious goals such as achieving five blockbuster medicines on the global markets in that time. September 18, 2026 · 2 min read · Annalee Armstrong Read more BeOne’s Brukinsa, already a blockbuster, poised for expansion Topping Evaluate’s list is BeOne’s BTK inhibitor Brukinsa , which is approved for a wide range of cancers, including mantle cell lymphoma, chronic lymphocytic leukemia and Waldenström’s macroglobulinemia. Brukinsa already crossed the blockbuster bar, surging 49% year-on-year in 2025 to bring in $3.9 billion. The drug has continued to grow, with a 31% increase in Q2 sales to hit $1.2 billion. Evaluate forecasts the drug to reach $6.5 billion in annual global sales by 2030, according to data provided by Lansdell. BeOne continues to study Brukinsa in other indications, including treatment-naive mantle cell lymphoma. Phase 3 data in June showed that Brukinsa plus the anti-CD20 antibody rituximab met the primary endpoint of progression-free survival in the Phase 3 MANGROVE study, reducing the risk of progression or death by 43% versus rituximab plus chemotherapy. A regulatory submission in this indication is slated for this year. The company is also working to expand Brukinsa into marginal zone lymphoma and primary membranous nephropathy. Legend Biotech’s J&J-partnered Carvykti faces potential competitive headwinds Also already past the blockbuster line is the CAR T therapy Carvykti, originally developed by Legend Biotech, which was founded in 2015 as a subsidiary of the Nanjing-based contract developer GenScript. In 2017, Legend scored a powerhouse partner in J&J, which fronted $350 million to work with the Chinese company to advance an anti-BCMA CAR T therapy that, in February 2022, would ultimately win the FDA’s go-ahead and hit the market as Carvykti. The multiple myeloma therapy made blockbuster status last year, bringing in $1.89 billion worldwide —nearly double its 2024 sales. And Carvykti continues to climb, already surpassing full-year 2025 sales in the first nine months of this year with $1.96 billion, according to J&J’s most recent earnings report. But there are some competitive headwinds on the horizon. By Dec. 23 , the FDA is scheduled to release a verdict for Gilead’s anitocabtagene autoleucel (anito-cel), another CAR T therapy that is being proposed for relapsed or refractory multiple myeloma. While the potential approval will be for fourth-line or later use, falling outside Carvykti’s established position in the second-line setting , Gilead plans to push anito-cel earlier, with a second-line filing ready as early as next year, the pharma said in its third quarter report . Legend and J&J are continuing to test Carvykti as a frontline option for multiple myeloma. Summit lines up ivonescimab as next major cancer backbone Ivonescimab has emerged as one of the leading candidates for China’s blockbuster aspirations. The drug—originally developed by Guangdong-based Akeso and being tested globally in partnership with Summit Therapeutics—first captured the industry’s attention in September 2024 when it beat Merck’s mega-blockbuster therapy Keytruda in a head-to-head late-stage non-small cell lung cancer study. And while there have been some hiccups, including an overall survival miss in a Phase 3 global study in May last year, analysts still expect that ivonescimab could be a commercial powerhouse. Other cancer drugmakers appear to agree, with AstraZeneca, Pfizer and more teaming up with Summit to pair their own assets into ivonescimab combos. “If the data do pan out, then simply put, ivonescimab has the potential to replace Keytruda as the next major backbone of treatment in cancer—and in turn, to become the next best-selling oncology drug of all time,” Graig Suvannavejh, managing director and senior biotech and biopharma analyst at Mizuho Securities, told BioSpace . Evaluate has estimated that ivonescimab could grow to an estimated $4.4 billion in global sales by 2030. Cancer Drugmakers rush to pair up with Summit’s ivonescimab ahead of key verdict With companies including AstraZeneca, Pfizer and Revolution Medicines clamoring to get in on Summit Therapeutics’ Akeso-partnered PD-1xVEGF antibody, one analyst calls the asset “the next major backbone” of cancer treatment. November 2, 2026 · 6 min read · Tristan Manalac Read more BeOne’s Tevimbra set for blockbuster status as early as 2027 BeOne’s second appearance on this list is for the PD-1 inhibitor Tevimbra, which according to Evaluate’s Lansdell is “forecast to pass $1 billion in annual sales as early as 2027.” First approved by the FDA in March 2024 for esophageal squamous cell carcinoma, Tevimbra has since expanded into gastroesophageal adenocarcinoma. In the European Union, Tevimbra is also indicated for non-small cell lung cancer, small cell lung cancer and nasopharyngeal carcinoma. Across these indications, the drug last year jumped 19% from 2024 to earn $737 million globally. Tevimbra continues to trend upward, making $229 million in the second quarter, an 18% year-on-year increase—and a roughly 7% beat versus analyst expectations, according to an Aug. 6 note from Leerink Partners. BeOne in August announced that the FDA approved the first-line use of Tevimbra, alongside Jazz Pharmaceuticals and Zymeworks’ anti-HER2 bispecific Ziihera, for advanced HER2+ gastric, gastroesophageal junction or esophageal adenocarcinoma. In a Jan. 6 note, Leerink said the Tevimbra-Ziihera combo was “clearly practice-changing” in this indication. BeOne is also developing Tevimbra for urothelial bladder carcinoma and is working on a subcutaneous formulation for the drug. Both are in late-stage development. Kelun-Biotech and Merck aim to replace chemo in NSCLC with Sac-TMT Another Big Pharma–partnered asset on this list is sacituzumab tirumotecan (sac-TMT), an antibody-drug conjugate (ADC) that was originally developed by Chengdu-based Kelun-Biotech. Merck in December 2022 paid $175 million upfront —and gambled up to $9.3 billion in milestones—for an exclusive global license to the asset and six other Kelun ADCs outside mainland China, Hong Kong and Macau. Sac-TMT is currently being studied for several cancer types, including non-small cell lung cancer (NSCLC), bladder cancer, breast cancer and gastric cancer. Early Phase 3 NSCLC data presented in July showed that sac-TMT plus Merck’s blockbuster drug Keytruda improved progression-free survival and showed a positive overall survival trend versus Keytruda plus chemotherapy. These findings suggest that sac-TMT could replace platinum-based chemotherapy as a first-line NSCLC treatment option. Merck also presented data last month at the 2026 European Society for Medical Oncology (ESMO) meeting in Madrid showing that sac-TMT slashed the risk of death by 32% in a late-stage trial of endometrial cancer. Based on these results, the FDA accepted Merck’s application for approval of sac-TMT in this indication and granted priority review. In December 2025, the FDA awarded sac-TMT a Commissioner’s National Priority Voucher , which can shorten review times from the typical 10–12 months to just 1–2 months. However, Leerink Partners analysts have noted that “it’s unclear to us whether the CNPV is still active after Commissioner Makary’s departure from FDA.” Still, the group said, Merck “is in discussions with the FDA and is hopeful for an earlier approval.” Assuming U.S. approval and launch next year, Evaluate’s Lansdell projects sac-TMT to cross the blockbuster bar in 2029 and hit $2 billion in sales by 2030. The ADC is already approved in China for various types of breast cancer, but Kelun has yet to provide sales numbers. Hansoh’s Ameile nears blockbuster status even without US approval Another likely Chinese blockbuster is Hansoh Pharma’s Ameile, which first hit the global biopharma markets in 2020 after being approved in China for second-line treatment of patients with advanced NSCLC carrying the T790M EGFR mutation. The drug has since expanded into other NSCLC types and treatment settings in the Asian country. Ameile is also approved outside China. In June 2025, the U.K.’s Medicines and Healthcare products Regulatory Agency greenlit the drug under the brand name Aumseqa, opening up use for certain NSCLC patients. The European Union in February likewise gave the go-ahead for Aumseqa, but walked back this decision in September after a legal challenge from AstraZeneca alleged that the regulatory submission for Hansoh’s drug violated data protection policies. Hansoh resubmitted the application last month. There is no ongoing application for Ameile, also known as aumolertinib, in the U.S. Despite the EU setback, Lansdell said Evaluate continues to project that Ameile will hit blockbuster status by 2030, though he didn’t provide a specific sales forecast for the drug. In its annual 2025 and interim 2026 reports, Hansoh provided no sales figures for Amelie, but according to a September analysis by analytic and content platform VCBeat, Ameile made RMB 5.53 billion ($830 million) last year, making it the top-selling innovative drug in China.

*仅供医学专业人士阅读参考 在肿瘤治疗领域，小分子靶向药的研发始终充满着挑战。是一条在试错中不断迭代、在突破中持续跃升的演进之路。从早年间解决“能否结合”的从无到有，到如今向“强效、精准、安全”的深水区挺进，药物设计逻辑早已演变为对靶点结合力、选择性与药代动力学等多维度的精密权衡——核心挑战始终围绕：如何实现足够强的靶点结合力以彻底击溃肿瘤克隆？如何保证极高的靶点选择性以避免“误伤”正常组织？如何优化药代动力学参数以实现疗效与安全性的最佳平衡？在这场探索中，BCL2靶点无疑是一块严苛的试金石。三十年间，从最初面对蛋白质-蛋白质相互作用（PPI）的束手无策，到经历几代分子的折戟与淬炼，BCL2抑制剂的迭代，正是整个靶向药研发理念不断升级的生动缩影。面对这些核心挑战，新一代BCL2抑制剂索托克拉交出了一份系统性的答卷，树立了BCL2靶向治疗的新标杆。究竟是怎样的打磨，使其此外BCL2“理想之钥”的破局者？本文将从靶点机制、结构优化到临床证据，深度解析其“锻造”逻辑。 从“不可成药”到“打开局面”：两次折戟的启示 1985年，BCL2在滤泡性淋巴瘤（FL）的染色体断点处被发现：t(14;18)染色体易位直接驱动了BCL2的过表达，这是极其明确的致病机制。而在其他血液肿瘤中，高表达的BCL2同样成为了肿瘤细胞逃避凋亡、赖以生存的“免死金牌”——BCL2的异常高表达广泛存在于多种血液肿瘤中：在约95%的慢性淋巴细胞白血病（CLL）、93%的套细胞淋巴瘤（MCL）、80%的华氏巨球蛋白血症（WM），以及急性髓系白血病（AML）和t(11;14)型多发性骨髓瘤（MM）中，BCL2异常高表达，让肿瘤细胞获得了本不该有的生存优势[1-6]。面对如此广泛的疾病覆盖和迫切的临床需求，研发出能精准抑制BCL2的药物，成为血液肿瘤领域迫切的临床未竟之需。 然而，针对这一靶点的药物研发面临着结构困境：传统靶向药作用于深而窄的酶活性口袋，小分子可以牢牢嵌入；而BCL2需要阻断的是蛋白质-蛋白质相互作用（PPI），小分子面对的是一片平坦浅阔的蛋白表面，能借力的地方极少——BCL2一度被视为“不可成药”[7]。 图1 BCL2家族蛋白与仅含BH3结构域的蛋白、BCL2抑制剂的结合模式图 破局始于ABT-737。研究者发现，P2和P4是BCL2结合沟槽中的关键疏水口袋，基于片段的策略由此展开。但ABT-737口服生物利用度有限，只能静脉给药，走不出病房。随后的口服化分子navitoclax（ABT-263）跨过了这道门槛，却引发了剂量依赖性的血小板减少：BCL-XL是维持血小板存活的“命门”，而navitoclax对BCL2与BCL-XL的结合抑制几乎不加区分（Ki分别约为≤1 nmol/L与≤0.5 nmol/L）[8]。 两次折戟留下了一个清晰的教训：理想的BCL2抑制剂，不仅要“能结合、能口服”，还要“能分辨”——BCL2这扇门，需要一把更精准的钥匙。 维奈克拉：推开大门，获益边界逐渐显现 维奈克拉作为真正实现临床转化的第一代BCL2抑制剂，将BCL2/BCL-XL的选择性提升至约1:325[9]，于2016年在美国获批，正式将BCL2从“不可成药”中除名。然而，随着真实世界临床应用的不断深入，这把初代“钥匙”的分子药理学特征，也逐渐显现出临床获益边界。 在疗效层面，部分人群的缓解深度与持久性面临挑战。在CLL中，其联合阿可替尼治疗初治患者的不可测量的微小残留病（uMRD）率约34%[10]，高危患者的有限周期治疗可行性仍需进一步探索[11,12]；在AML中，无论是适合强化疗（fit）还是不适合强化疗（unfit）的人群，联合方案均未能带来显著的生存突破，unfit人群复发率达52%，复发/难治性（R/R）人群的完全缓解（CR）率仅19%[16-21]；在MCL领域，III期SYMPATICO研究虽在无进展生存期（PFS）和CR率上有所改善，但最终未显示OS获益，未能获批相应适应症。这种难以彻底清除顽固克隆，究其深层原因，维奈克拉对靶点的抑制效力与模式尚存在局限，可能难以彻底清除顽固的肿瘤克隆。 在安全性层面，患者长期用药的耐受性受到一定制约。在CLL中，≥3级治疗期间出现的不良反应（TEAE）发生率高达54%~80%[10,13-15]；在AML中，AE导致的停药或减量比例可达30%~40%[22-26]。剂量暴露不足，往往又会进一步影响疗效的兑现。这背后的药理学原因，一方面在于维奈克拉分子的长半衰期（约26小时）带来的潜在蓄积风险；另一方面，其对维持血小板存活的BCL-XL仍存在一定程度的交叉抑制，血小板减少的风险仍存在；同时，维奈克拉与BCL2的解离较为缓慢 [表面等离子共振（SPR）实验提示反应RU值持续＞15[9,27-28]]，可能延长对正常淋巴细胞等依赖BCL2存活的正常细胞的抑制时间，从而增加治疗相关的毒性风险。 此外，长期用药后的获得性耐药也是临床面临的实际问题。随着治疗时间的推移，BCL2 G101V等耐药突变的出现，可能大幅降低维奈克拉与靶点的结合力，给后续治疗带来挑战。这些短板相互交织，共同促成多重临床中隐忧——门虽开了，但患者仍在呼唤一把真正更精准、更安全的“理想之钥”。 强而能收，进而能退：索托克拉的多维“锻造” 维奈克拉的设计边界，促使研究者将目光重新拉回药物作用机制本身：BCL2抑制剂血药浓度升至有效水平时，激活BAX/BAK，触发线粒体外膜通透化（MOMP）。这是一个由峰浓度驱动的“一触即发”过程，此后无需药物继续存在。而药物及时解离，缩短非必要占据时间，有利于降低相应毒性。这一机制认知，勾勒出了理想BCL2抑制剂的轮廓——这把BCL2“理想之钥”，既要严丝合缝，又要随插随拔。 基于这一深刻认知，研究者再次将目光聚焦于新一代BCL2抑制剂的研发。索托克拉、利沙托克拉等创新药物相继涌现，而不同的分子设计与机制参数，宛如蝴蝶效应一般，在临床疗效与安全性上拉开差距。其中，索托克拉直面前代药物留下的多重约束，通过多维度的分子优化，锻造出一把真正“强而能收，进而能退”的“理想之钥”。 “紧密咬合”：三重协同，强化靶点占据 要解开维奈克拉留下的“深度不足”困局，首先得让“钥匙”与“锁孔”咬合得更紧密。维奈克拉与P2口袋的相互作用以常规的疏水作用与π-π堆积为主；索托克拉在此基础上，额外引入了三重协同作用——异丙基苯基的苯环与口袋内蛋氨酸残基形成硫-π作用，吡咯烷基团与缬氨酸残基之间形成氢键，异丙基还在P2口袋上方诱导出一个全新的疏水腔。三种作用力的空间协同，将分子精准锚定于P2口袋。TR-FRET测定显示，索托克拉对BCL2的IC50 为0.014 nmol/L，靶点抑制力较维奈克拉（0.20 nmol/L）增强约14倍，而利沙托克拉（0.35 nmol/L）在此维度上甚至有所减弱。而更高强度的靶点占据，意味着在相同浓度下能更彻底地解除BCL2对BAX/BAK的“扣押”，释放出更多促凋亡蛋白，从而更高效地触发MOMP。凋亡执行得越彻底，肿瘤细胞被清除得越干净——这正是深度缓解的分子起点。 图2 索托克拉分子结构图 “分辨清晰”：在BCL2与BCL-XL之间划定界限 仅仅咬合得紧还不够，这把钥匙还需要极强的分辨力。在BCL2与BCL-XL这对高度同源的“孪生兄弟”之间，索托克拉实现了约1:2000的分辨精度，是维奈克拉（1:325）的6倍。而分辨越清晰，理论上对依赖BCL-XL的正常组织的“误伤”就越少——血小板前体细胞的存活信号得以保全，避免了因失去保护而过早凋亡，从而在临床端转化为更低的血小板减少风险，切实保障患者的治疗获益。 “快速撤离”：完成触发后缩短靶点占据时间 机制分析表明，BCL2抑制剂与靶点的结合，恰如一次“点火”，一旦点燃，不再需要引物继续燃烧。而BCL2抑制剂完成“触发”之后，继续占据靶点并不会增强抗肿瘤效果，却会延长对正常细胞生存信号的压制。而药物从靶点上“撤离”的速度，则是决定这一“非必要压制”持续多久的关键。 SPR实验中，索托克拉与BCL2的平衡解离常数（KD=Koff/Kon）为0.046 nmol/L，与维奈克拉（1.1 nmol/L）相差超20倍[9,27,28]；更关键的是，索托克拉的解离曲线斜率比维奈克拉更陡——当血药浓度回落时，索托克拉从靶点上脱落的速度更快。这一动力学差异意味着：即便血药浓度下降，维奈克拉仍可能长时间“卡”在正常细胞的靶点上，持续施加抑制压力；索托克拉将随着血药浓度的回落更快“撤离”，让其它依赖BCL2存活的正常组织得以“喘息”。 图3 索托克拉（左）和维奈克拉（右）结合解离曲线 “短时暴露”：以短半衰期降低蓄积风险 最后，索托克拉在体内停留的时间也经过了精心设计——半衰期缩短至约5小时，从药代动力学角度减少了与正常细胞的长时间接触。在临床给药方案下，其血药浓度可有效覆盖治疗阈值，同时远低于对正常造血干细胞的毒性阈值，为“足量足疗程完成治疗”创造了药理学条件。“短暴露+快解离”，共同构成了其毒性风险更低的动力学基础。这种“收放自如”的特性，将进一步转化为临床中更低的减量与停药率——患者不再因为难以耐受的毒性而被迫中断治疗，从而最大化地释放抗肿瘤疗效。 图4 索托克拉多日给药的PK模拟曲线[30] “不负索托”：从实验室到临床，“理想之钥”的真实转动 索托克拉分子设计的优越性，在临床数据中得到了真切的兑现。它不仅在CLL中展现出了亮眼的缓解深度，更在MCL这一难治的“锈锁”中实现了关键突破。 在CLL领域，面对BTK抑制剂经治的R/R患者，索托克拉交出了亮眼的成绩：ORR达77.0%，CR/CRi率25.0%，uMRD4率高达77.9%——各项指标均数值上优于维奈克拉和利沙托克拉（跨研究比较）[31-35]。更令人惊喜的是，与泽布替尼（ZS）联合的一线诱导：ORR直达100%，且缓解深度随时间推移持续加深——外周血uMRD4率第24周81.2%，第48周升至91.8%，第96周98.2%；并且TP53突变、del(17p)、del(11q)及IGHV未突变等因素均未影响深度缓解获益；320mg剂量组30个月无进展生存期（PFS）率达100%[36]——在高度依赖BCL2的CLL中，这把钥匙实现了深度的“疾病清剿”。 在MCL领域，索托克拉已凭借坚实证据，成为目前全球首个获批R/R MCL适应症的BCL2抑制剂*——BGB-11417-201研究中，入组患者100%既往接受过BTK抑制剂和抗CD20单抗治疗，属于重度经治人群。在这一极具挑战的背景下，索托克拉单药实现了52.4%的ORR，显著优于预设历史对照的30%（P<0.0001）；即便在TP53突变的高危亚组中，ORR依然高达59.1%；中位缓解持续时间（DOR）达15.8个月[37]。在中国人群中同样获益，且展现了长期生存优势——中位PFS达11.9个月，CR率为26.5%[37]。而ZS联合方案更是将ORR推高至80%，高危亚组依然稳健[38]。2026年，索托克拉先后获得国家药品监督管理局（NMPA）附条件批准与美国食品药品监督管理局（FDA）加速批准，并斩获突破性疗法认定——在棘手的R/R MCL面前，这把钥匙同样精准破局。 与此同时，这把钥匙不仅能高效开锁，更用良好的安全性印证了分子设计的精准。临床数据显示，非头对头比较中，索托克拉单药治疗R/R CLL的严重TEAE发生率仅为25%，维奈克拉为52%；导致剂量降低（4%）、停药（2%）的比例均更低；≥3级血小板减少（13%）、贫血（5%）均处于BCL2抑制剂同类中的较低水平；TLS发生率为0。联合治疗中，因TEAE导致的停药比例，在初治CLL中仅2.3%，在R/R MCL中仅7.4%，在数值上均优于维奈克拉联合方案。 从临床深度的持续突破，到安全耐受的宽裕边界，索托克拉的分子设计逻辑在临床数据中得到了双重验证。而它的潜力，不仅在于CLL与MCL领域的突破，更在于它正将这套全面优化的分子学优势，迅速拓展至整个血液肿瘤版图。 在WM领域，索托克拉是目前唯一将其作为核心适应症方向、系统性推进注册研究的BCL2抑制剂*，并已获得FDA快速通道认定。在R/R WM的II期研究中，320mg剂量组实现了100%的ORR，全程无TLS发生，无相关死亡[39]。 针对高度依赖BCL2的t(11;14)亚型R/R MM，索托克拉是目前唯一积极布局该适应症的BCL2抑制剂*。在重度经治患者中，联合地塞米松治疗的ORR达78.2%，其中49.1%达到非常好的部分缓解及以上（≥VGPR）；联合卡非佐米+地塞米松（Kd方案）的ORR达80.0%，≥VGPR率达55.6%，展现出强有力的深度缓解能力[40]。 在AML领域，BGB-11417-103研究显示，索托克拉联合阿扎胞苷一线治疗unfit AML患者，总体ORR达75%，CR率达51%，μMRD率达35%，诱导了深层次的疾病缓解[41]。 总结与展望 在肿瘤靶向药的进化长河中，索托克拉无疑提供了一个极具启发的“模范样本”——它通过“结合更紧、解离更快、暴露更短、分辨更清”的系统性重构，实现了深度缓解与安全耐受的平衡兼顾。BCL2抑制剂的三十年进化，至此在一个分子上获得了更完整的兑现。 正是这份分子层面的突破，让这把历经打磨的“理想之钥”具备了真实的力量。在临床实践中，它正在解开一个又一个曾经无解的“死结”，将BCL2这一靶点的治疗潜力，切实转化为跨越多个难治血液肿瘤的生存希望。这份答卷，不仅彻底改写了BCL2“不可成药”的判决，更标志着BCL2抑制剂正式进入了深度缓解与安全耐受并重、多瘤种全面开花的新纪元。 *：截至文章撰写及发布时间，结合全网公开资料所得结论。 参考文献： [1] Delbridge AR, et al. 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