Ge Long Hui·2026-02-27 01:35Core Insights - The introduction of PD-1 inhibitors in 2014 marked a significant turning point in the fight against cancer, with Bristol-Myers Squibb's Opdivo and Merck's Keytruda leading the charge in immunotherapy [1][3] - The competition between Opdivo and Keytruda has evolved over the years, with Keytruda ultimately becoming the top-selling drug globally by 2024 [21][22] Historical Context - The history of cancer immunotherapy began with William Coley's discovery in the late 19th century, which was followed by a long period of stagnation until the late 20th century when key immune cells were identified [4] - The discoveries of James Allison and Tasuku Honjo regarding CTLA-4 and PD-1, respectively, laid the groundwork for the development of PD-1 inhibitors [5][10] Drug Development - Opdivo was developed with strong backing from Bristol-Myers Squibb after acquiring Medarex in 2009, leading to its approval in Japan in 2014 [12] - Keytruda's development faced initial setbacks but was revitalized by Merck's strategic decision to conduct an unprecedented "super I phase" trial, leading to its approval shortly after Opdivo [14][15][16] Market Dynamics - In 2016, a critical competition occurred between Opdivo and Keytruda in the non-small cell lung cancer (NSCLC) market, which is the largest segment in oncology [17] - BMS's failure in the CheckMate-026 trial led to a significant drop in Opdivo's market position, while Merck's more selective approach in the KEYNOTE-024 trial resulted in Keytruda's success [18][19][20] Sales Performance - By 2024, Keytruda's sales reached $29.5 billion, marking an 18% increase and solidifying its position as the top-selling drug globally [21] - Opdivo, while still a major player, saw its sales decline but remained above the $10 billion mark, maintaining its status as a heavyweight in the market [22][23] Competitive Landscape - The global PD-1 inhibitor market is highly competitive, with 527 candidates in development as of early 2025, including 20 approved drugs [26][29] - In China, the market is characterized by intense competition among local manufacturers, with significant price reductions due to national healthcare negotiations [30][31] Future Outlook - Keytruda's core patent is expected to expire in 2028, potentially leading to a significant drop in sales as biosimilars enter the market [32] - A new challenger, Ivonescimab, has shown superior efficacy compared to Keytruda in clinical trials, indicating a shift towards dual-target therapies in cancer treatment [33][35]