Author(s): Prof Shun Lu, MD1; Prof Baogang Liu, MD2; Prof Yongzhong Luo, MD3; Prof Longhua Sun, MD4; Prof Lin Wu, MD3; Prof Zhengxiang Han, MD5; Prof Yun Fan, MD6; Prof Yanqiu Zhao, MD7; Prof Xingya Li, MD8; Prof Haipeng Xu, MS9; Prof Xiangjiao Meng, MD10; Prof Ying Liu, MD11; Prof Zhiye Zhang, MD12; Prof Hui Luo, MS13; Prof Xuelei Ma, MS14; Prof Xuezhen Ma, MD15; Prof Qin Shi, MS16; Prof Zhongmin Zhang, MS17; Prof Runxiang Yang, MS18; Prof Pingli Wang, MD19; Prof Pinhua Pan, MD20; Prof Xiaohong Ai, MS21; Prof Jie Li, MS22; Prof Xingxiang Pu, MD3; Prof Zhiwu Wang, MD23; Prof Jian Fang, MD24; Prof Ming He, MD25; Prof Yong He, MD26; Prof Shuliang Guo, MD27; Prof Juan Li, MD28; Prof Hongbiao Wang, MD29; Prof Junqiang Zhang, MD30; Prof Qian Chu, MD31; Prof Xuewen Liu, MD32; Prof Shenpeng Ying, MS33; Prof Hongcheng Wu, MS34; Prof Hongmei Sun, BS35; Prof Yinghua Ji, MD36; Prof Ming Zhou, MS37; Prof Chao Cao, MD38; Prof Kejing Tang, MD39; Prof Zhengguo Li, BS40; Prof Dairong Li, MD41; Prof Zhihong Zhang, MD42; Prof Jie Li, MD43; Prof Jianya Zhou, MD44; Prof Hongzhong Yang, MD45; Prof Yingying Du, MD46; Prof Hui Yang, MD47; Prof Jian Shi, MD27; Prof Hualin Chen, MD48; Prof Zhiwei Chen, MS1; Wenting Li, MD49; Dongmei Lu, MD49; Mingxiu Hu, PhD49; Zhongmin Maxwell Wang, PhD49; Baiyong Li, MD49; Michelle Y Xia, PhD49;
BACKGROUND
Bispecific antibodies targeting programmed death 1 (PD-1) and vascular endothelial growth factor (PD1–VEGF) have shown promising efficacy in non-small-cell lung cancer (NSCLC). In our previous report of the HARMONi-6 study, we aimed to evaluate the efficacy and safety of ivonescimab plus chemotherapy versus tislelizumab plus chemotherapy as a first-line therapy for patients with advanced squamous NSCLC. Ivonescimab combined with chemotherapy significantly prolonged progression-free survival compared with tislelizumab plus chemotherapy. Here we report the prespecified interim overall survival analysis.
METHODS
HARMONi-6 is a double-blind, randomised, phase 3 trial, which was conducted 50 hospitals across China. Patients aged 18–75 years with previously untreated, pathologically confirmed, unresectable stage IIIB, IIIC, or stage IV squamous NSCLC and an Eastern Cooperative Oncology Group performance status score of 0 or 1 were eligible for inclusion. Eligible patients were randomly assigned in a 1:1 ratio to receive ivonescimab or tislelizumab, in combination with paclitaxel and carboplatin for four cycles, followed by maintenance ivonescimab or tislelizumab monotherapy. The primary endpoint was progression-free survival assessed by the independent radiographic review committee as per Response Evaluation Criteria in Solid Tumours guidelines (version 1.1) in all randomly assigned patients. Overall survival was a key secondary endpoint; an interim analysis was planned when approximately 225 overall survival events were observed, but it was triggered after 204 overall survival events to meet regulatory deadlines. Safety, defined as adverse events and serious adverse events related to treatment, as well as adverse events related to immunity or VEGF blockade, were analysed in all randomly assigned patients who received least one dose of the assigned study treatment. This study is registered ClinicalTrials.gov (NCT05840016), has completed enrolment, and is ongoing for treatment and follow-up.
FINDINGS
From Aug 17, 2023, to Jan 21, 2025, 761 patients were assessed for eligibility, and after 229 exclusions a total of 532 patients were randomly allocated (266 per group). 494 (93%) of patients were male and 38 (7%) of patients were female. The median age was 64 years (IQR 59–69). data cutoff (Feb 27, 2026), 204 deaths had occurred: 84 (32%) patients in the ivonescimab plus chemotherapy group and 120 (45%) in the tislelizumab plus chemotherapy group. With a median follow-up of 21·4 months (95% CI 20·27–21·91), the median overall survival was 27·9 months (95% CI 27·89–not evaluable [NE]) with ivonescimab versus 23·7 months (20·11–NE) with tislelizumab (hazard ratio for death 0·66 [95% CI 0·50–0·87]; pone-sided=0·0017), meeting the prespecified boundary (p
INTERPRETATION
Ivonescimab plus chemotherapy demonstrated a statistically significant and clinically meaningful improvement in overall survival compared with tislelizumab plus chemotherapy in previously untreated patients with advanced squamous NSCLC. This regimen could provide a novel treatment option as first-line treatment in this patient group.
Author Affiliations
1Shanghai Chest Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China; 2Harbin Medical University Cancer Hospital, Harbin, China; 3Hunan Cancer Hospital, Changsha, China; 4The First Affiliated Hospital of Nanchang University, Nanchang, China; 5The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China; 6Zhejiang Cancer Hospital, Hangzhou, China; 7The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China; 8First Affiliated Hospital of Zhengzhou University, Zhengzhou, China; 9Fujian Provincial Cancer Hospital, Fuzhou, China; 10Shandong Cancer Hospital and Institute, Affiliated to Shandong University, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China; 11Jilin Cancer Hospital, Changchun, China; 12The First Affiliated Hospital of Henan University of Science and Technology, Luoyang, China; 13Jiangxi Cancer Hospital, Nanchang, China; 14West China Hospital of Sichuan University, Chengdu, China; 15Qingdao Central Hospital, University of Health and Rehabilitation Sciences, Qingdao, China; 16Fuzhou Pulmonary Hospital of Fujian, Fuzhou, China; 17Linyi People's Hospital, Linyi, China; 18Yunnan Cancer Hospital, Kunming, China; 19The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China; 20Xiangya Hospital Central South University, Changsha, China; 21The First Affiliated Hospital of University of South China, Changsha, China; 22The First Affiliated Hospital of Gannan Medical University, Ganzhou, China; 23Tangshan People's Hospital, Tangshan, China; 24Beijing Cancer Hospital, Beijing, China; 25The Fourth Hospital of Hebei Medical University, Shijiazhuang, China; 26Army Medical Center of Excellent (Daping Hospital), Chongqing, China; 27The First Affiliated Hospital of Chongqing Medical University, Chongqing, China; 28Sichuan Provincial Cancer Hospital, Chengdu, China; 29Cancer Hospital of Shantou University Medical College, Shantou, China; 30Anhui Provincial Hospital, Hefei, China; 31Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; 32Third Xiangya Hospital, Central South University, Changsha, China; 33Taizhou Central Hospital (Taizhou University Hospital), Taizhou, China; 34Ningbo Medical Center Lihuili Hospital, Ningbo, China; 35Jiamusi Tuberculosis Hospital (Jiamusi Cancer Hospital), Jiamusi, China; 36The First Affiliated Hospital of Henan Medical University, Xinxiang, China; 37Affiliated Cancer Hospital and Institute of Guangzhou Medical University, Guangzhou, China; 38The First Affiliated Hospital of Ningbo University, Ningbo, China; 39The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China; 40Gansu Wuwei Tumour Hospital, Wuwei, China; 41Chongqing University Affiliated Cancer Hospital, Chongqing, China; 42Anhui Provincial Cancer Hospital, Hefei, China; 43Jining No 1 People's Hospital, Jining, China; 44The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China; 45Changsha Central Hospital, Changsha, China; 46The First Affiliated Hospital of Anhui Medical University, Hefei, China; 47The Second Affiliated Hospital of Xiamen Medical College, Xiamen, China; 48Affiliated Hospital of Guangdong Medical University, Zhanjiang, China; 49Akeso Biopharma, Zhongshan, China