HeyJaredAsymmetric Learning - Pharmaceutical Innovation
Innovations in Pharmaceutical Innovation A blog/ part-work from Mike Rea, exploring pharmaceutical innovation in general, and more specifically the approach to using the learning process for competitive advantage
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- 11
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- Sep 29, 2026
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- Aug 11, 2026
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What would change the end for ivonescimab in the West? (opens the original)
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On 30 May 2024 Akeso said ivonescimab had beaten Keytruda head-to-head in a Chinese Phase III in PD-L1-positive lung cancer. This month in Seoul the survival data arrived: median OS of 30.8 months against 22.6, hazard ratio 0.73, at an interim analysis on 234 events.Eight months is a very good number. It is also a prespecified interim, in one country, against one comparator, and a median can still move. Hold both at once, because the rest of this piece is about what (I think) you are allowed to
Asymmetry, measured in milliseconds (five years on) (opens the original)
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On 30 May 2024 Akeso said ivonescimab had beaten Keytruda head-to-head in a Chinese Phase III in PD-L1-positive lung cancer. When the full data landed at WCLC that September, median PFS was 11.1 months against 5.8, hazard ratio 0.51. Everyone in oncology knew the result straight away, but what they did with it took rather longer.Five years ago I wrote a short piece inspired by Michael Lewis’s Flash Boys. The high-frequency traders had work
High? Long? Both? (opens the original)
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A finished blockbuster earns about twelve times its best year. The tirzepatide argument is whether it gets the twelve.Humira’s best year, in today’s money, was about $26 billion. Tirzepatide’s run-rate in the first half of 2026 is roughly double that, and it’s year four. On height, “will a GLP-1 be the biggest drug ever” is already answered. It isn’t close.Thanks for reading Asymmetric Learning - Pharmaceutical Innovation ! Subscribe for free to receiv
Opportunity-seeking behaviour, five years on (opens the original)
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A molecule entering Phase I today has, on the latest ten-year Citeline data, a 6.7% chance of approval. Phase II remains the wall: 28% of programmes get through it. And the Phase I transition rate, which sat above 75% in the 2006-08 cohorts, has fallen below 40%. We are not getting better at this. We are, if anything, finding out that we were wrong slightly earlier.Five years ago I wrote a short piece arguing that early-phase development is not/ should not be mainly a risk-mitigation exercise. I
A Plan To Learn (opens the original)
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The usual New Product Planning package is a Target Product Profile, an eNPV, and a Clinical Development Plan. Then the team runs into the same hurdles as everyone else with a similar molecule. A TPP is often not a target at all. It is a projected profile of a path already chosen, a compromise product profile. The forecast sanitizes the choice. The protocol executes it. When biology or the market refuses to cooperate, we treat that as variance around a good plan, rather than evidence that we plan
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