Akeso CEO Michelle Xia, who worked in the lab during the biotech’s initial stages after founding.
Courtesy Akeso
From a small team of researchers and skipped salaries, CEO Michelle Xia has steered Akeso to become one of the most exciting companies in the industry today.
When Akeso was starting out some 13 years ago, the leadership team had $3 million and a bold goal to move China’s drug industry toward innovation.
“When Akeso was first established, China’s biopharmaceutical industry was still in its infancy,” CEO Michelle Xia told
BioSpace
in an email interview. “To put it simply, very few were engaged in innovative drug discovery at that time; the sector was overwhelmingly dominated by generics. Against this backdrop, pursuing innovative drug development required tremendous effort.”
As Xia tells it, China during the early 2010s had no “mature ecosystem for innovation.” The local industry amounted to companies that made generic versions of drugs that had already launched in Western countries years earlier. Over the years, however, Akeso has grown explosively to become one of the leading faces of an ascendant Chinese biotech industry. Today, the company is worth more than $15 billion—a far cry from the $3 million angel fundraising that kicked things off for Xia and her team.
In large part, Akeso’s recent worldwide renown is thanks to its partnership with California-based Summit Therapeutics, which in December 2022 paid
$500 million upfront
plus up to $5 billion in potential milestones to partner with the rising Chinese star. At the heart of this partnership is ivonescimab, an asset that in the past year has not only arrested the attention of the biopharma industry but has also come to symbolize an emerging approach to cancer.
Ivonescimab is a bispecific antibody that targets two key cancer pathways. It blocks PD-1 signaling, preventing cancer cells from evading the immune system, and inhibits the VEGF cascade, which tumors use to create new blood vessels to supply nutrients and oxygen, supporting unchecked growth. In September last year, Akeso and Summit announced that ivonescimab
bested
Merck’s Keytruda, a cornerstone cancer therapy, in a Phase III study of non-small cell lung cancer (NSCLC).
That clinical win cemented Akeso as a serious global contender, but Xia insists that the biotech is much more than ivonescimab and a signal of China’s biotech boom. Akeso’s beginnings may have been humble, but Xia’s dreams for the company are big.
A ‘Natural’ Choice
When Xia returned to China in 2008, striking out on her own was never part of the plan.
A biochemistry graduate of Sun Yat-sen University, Xia had spent more than two decades away from home. She had picked up postgraduate degrees from Newcastle University and Glasgow University in the U.K. before finding her way to the United States in 1996 to focus on cancer immunotherapy at the University of Louisville.
Akeso CEO Michelle Xia/
Courtesy Akeso
Eventually, Xia decided to leave the confines of academia and test her mettle in industry. She went through a couple of companies—Bayer among them, as a senior scientist in 2006—before settling down at Crown Bioscience, a contract research organization focused on oncology and immuno-oncology.
There, she climbed the ranks until 2008, when Crown decided to open a subsidiary in China. With Xia’s help, Crown marked the Asian giant’s “first-ever comprehensive outsourced collaboration” for antibody drug development with a global pharma company, she said.
Aside from allowing her to flex her executive skills, Xia’s return to China opened up her eyes—not just to the biomedical needs of the domestic market, but also to its promise.
“My return to China represented a significant transition in my career,” she said. “It provided me with valuable insights into the landscape of innovative drug development and clinical needs in the Chinese market.”
Even so, Xia didn’t exactly expect to become the CEO of her own biotech.
“Before returning to China, I hadn’t seriously considered launching my own venture,” she said. But the experience with Crown made her realize that China could be a world leader in drug discovery.
“Choosing China felt natural,” Xia said. “We saw tremendous unmet needs and opportunities.” Taking inspiration from the name of the Greek goddess of healing, Xia and three other co-founders launched Akeso in 2012, confident in their abilities. “Each of us had already gained substantial international experience in our respective fields,” Xia said, which helped provide a “solid foundation” for their new venture.
Yet Akeso’s early days proved to be a struggle. China’s biopharma industry at the time was “still in its infancy,” Xia said. Talent and capital were wanting, and infrastructure was poor. Patients were severely underserved, with treatments lagging decades behind other countries.
There was little confidence in what they were trying to do, too. Doctors, investors and regulators were all skeptical, Xia told
BioSpace
. “We had to work tirelessly to earn the trust of physicians and key stakeholders,” she said. “Every idea was new, and nothing came easily.”
Xia and her team rented out a small office space, hired a handful of researchers and, when needed, went without salary for a couple of months. The origins of Akeso were a far cry from the cushy, well-resourced corporations that they were used to.
Thirteen years later, Xia’s gamble has paid off. From its unpolished beginnings in the 2010s, China’s biotech sector has grown rapidly and systematically. At the heart of this transformation is a change in the country’s regulatory regime; the government after 2015 updated drug regulations to meet international standards, giving drugmakers the chance to play on the global stage.
Over the years, private equity and venture capital in China likewise gained momentum, providing companies that all-important financial bloodline with which to run their operations. It hasn’t all been smooth—other biotech companies operating in
China have told
BioSpace
that the region has experienced a similar drop in financing in recent years as companies in America. This has pushed them to seek licensing agreements with multinational corporations.
But according to Xia, the Chinese biotech sector provides a “conducive ecosystem for biopharma innovation
.”
The talent pool has grown and the country’s capital market system has matured. China’s size is also an advantage, with a large patient population to power clinical trials and a market hungry for novel and effective therapies.
“These elements contribute to rich clinical resources essential for drug development,” Xia said. China has a “sizable market with strong demand, efficient capital utilization, and clinical outcomes as well as regulatory reviews that meet the rigorous requirements of markets such as the United States and Europe.”
Looking back on Akeso’s journey, Xia is glad she stuck with it. “Every bit of that perseverance has been worth it,” she said.
The 2.0 Era
Like the rapid and major evolution of the Chinese biotech industry, Akeso’s business and pipeline have grown from a domestic view to a global mindset. There’s ivonescimab, of course, which in April
won Chinese approval
as a first-line treatment in patients with PD-L1-positive NSCLC. Over in the U.S., though, the treatment has run into issues after missing the overall survival target in a global Phase III study, an outcome that the FDA had deemed crucial for an approval. Even so, ivonescimab is the first-ever PD-1/VEGF therapy to reach the market.
Summit
intends
to Biologics License Application for the drug and to push forward with ivonescimab’s Phase III development. The biotech is running
HARMONi-3
and
HARMONi-7
, which are pitting the bispecific against Keytruda. The studies are expected to complete in 2028 and 2029, respectively.
Xia wants it known, however, that Akeso is much more than ivonescimab. In June, cadonilimab became what she characterized as “the world’s first cancer immunotherapy bispecific antibody” when China’s health authority
approved
the drug—and included it for insurance coverage—for patients with cervical cancer. Like ivonescimab, the drug targets two key cancer markers, PD-1 and CTLA-4, both of which allow tumors to evade the immune response.
These two are “foundational assets” for Akeso, according to Xia, emblematic of the company’s growth strategy of pushing immuno-oncology “into the 2.0 era.” Akeso is the only biopharma player so far to have two approved immuno-oncology bispecifics, Xia pointed out.
Akeso also has a single U.S.-approved product in penpulimab, indicated in a combo with cisplatin or carboplatin and gemcitabine as a first-line option for recurrent or metastatic non-keratinizing nasopharyngeal carcinoma. The approval,
granted in April this year
, also allowed the use of penpulimab monotherapy in patients who had progressed on or after platinum chemotherapy.
Following in the footsteps of these pipeline leaders is AK146D1, a bispecific antibody-drug conjugate (ADC)—a molecule that can simultaneously target two cancer markers while also carrying a toxic payload. The asset, according to Xia, is being studied both in China and abroad, testing its therapeutic potential in advanced cancers. Other pipeline assets include bispecific antibodies targeting PD-1/LAG-3 and TIGIT/ TGFβ, as well as what Xia calls “dual-payload” ADCs.
Of course, partnerships remain top-of-mind for Akeso, though Xia wouldn’t provide specifics. “We consistently adopt an open approach to seek more international collaborations,” she said.
And while Akeso is currently putting much of its energy into cancer, the company is also leveraging its bispecific technology in other therapeutic areas like autoimmune and neurodegenerative diseases. In February, Chinese regulators
accepted the investigational new drug application
for AK139, which Xia said is “the world’s first IL-4R/ST2 bispecific antibody” to enter the clinic. It’s being tested in respiratory and skin conditions.
Farther into the future, Xia revealed that Akeso also wants to break out of the bispecific space and explore other modalities, such as mRNA and siRNA therapies, as well as cell and gene editing.
“We aim to become a globally influential pharmaceutical innovator,” Xia said.