One arm grabs the cancer cell. The other grabs a T-cell. The bispecific forces them together.
CAR-T cell therapy works but takes weeks to manufacture and costs $400K+ per patient. T-cell engager bispecific antibodies do the same job as an injectable drug - no cell extraction, no manufacturing delay. Ten are now FDA-approved across myeloma, lymphoma, leukemia, and solid tumors, competing directly with CAR-T in the same diseases.
Pfizer, Amgen, Lilly, Merck, and Astellas all failed at IGF-1R in cancer. Then a shelved Roche antibody became the only effective treatment for thyroid eye disease. Same receptor, completely different biology.
Five major pharmas spent two decades chasing IGF-1R as a cancer target. Every Phase 3 trial failed. The only IGF-1R drug ever approved is for thyroid eye disease — Tepezza, which generated $1.9 billion in 2024 and 8x exceeded its acquirer's peak forecast. Eleven more IGF-1R-for-TED programs are now in clinical trials, including the literal cancer-graveyard compound being resurrected by Sling Therapeutics. Targets don't travel. Disease context decides.
Every approved IBD drug fights inflammation. None of them touch fibrosis. TL1A does both.
30% of Crohn's disease patients will need surgery within ten years of diagnosis - not because their drugs failed to control inflammation, but because no approved drug stops the scar tissue that narrows their bowel. TL1A is the first target that could change that. Here is the biology behind the $18 billion bet.
It took 40 years to drug KRAS. The real competition started the day it worked.
KRAS mutations drive roughly 30% of all cancers. For four decades, no one could drug it. In 2021, sotorasib cracked the target. Now three approaches - next-gen G12C, G12D inhibitors, and pan-KRAS degraders - are racing to turn a proven mechanism into a blockbuster.
