Regulatory & Policy

Pfizer partner RemeGen takes 4th China indication for HER2-ADC disitamab vedotin, in HER2-low breast cancer

IMPORTANT NOTICE: The source material describes a regulatory approval by China's NMPA — not a submission or filing. The article brief requests coverage of a...

RemeGen's Aidixi (disitamab vedotin) has received market approval from China's National Medical Products Administration for a fourth domestic indication, covering adults with unresectable or metastatic HER2-low breast cancer with liver metastases, the company announced on 23 March 2026. The decision marks the first time the HER2-targeted antibody-drug conjugate (ADC) has been authorised in a HER2-low defined population, extending its label beyond the HER2-overexpressing settings for which it was previously approved in gastric cancer, urothelial carcinoma, and HER2-positive breast cancer with liver metastases.

The approved population consists of adult patients with unresectable or metastatic HER2-low breast cancer — defined as IHC 1+ or IHC 2+/ISH-negative — who have liver metastases and have received at least one prior systemic therapy in the metastatic setting, or whose disease recurred during or within twelve months of completing adjuvant chemotherapy.

The NMPA decision rests on data from the Phase III RC48-C012 trial, a randomized, open-label, parallel-controlled, multicenter study conducted in China, the company said. The study (NCT04400695) is a randomized, open-label trial comparing disitamab vedotin with physician’s choice chemotherapy in previously treated patients with HER2-low locally advanced or metastatic breast cancer. The study enrolled adults with prior systemic therapy and was designed to support registrational evaluation against standard-of-care chemotherapy.

The announcement characterised the study as confirming the efficacy and safety of disitamab vedotin in this patient population, though detailed outcome data — including primary endpoints, response rates, and survival figures — were not disclosed in the filing.

Liver metastases represent a clinically distinct and high-unmet-need subset of metastatic breast cancer. According to GLOBOCAN 2022 data cited by RemeGen, approximately 2.3 million new breast cancer cases and 670,000 deaths occur globally each year; in China, the figures are approximately 357,000 new cases and 75,000 deaths annually. Liver involvement occurs in an estimated 17.8% to 35% of metastatic breast cancer patients and carries a five-year survival rate of approximately 20%. Within the HER2-low subgroup — which accounts for roughly 45% to 55% of all breast cancer cases — the three-year survival rate is approximately 20%, with around one-third of patients experiencing recurrence or metastasis and a notably worse prognosis in those with visceral involvement.

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The HER2-low classification, defined by low but non-zero HER2 protein expression, has gained clinical significance following the validation of ADCs capable of activity at reduced receptor density. Trastuzumab deruxtecan (Enhertu), developed by Daiichi Sankyo and AstraZeneca, received US FDA approval in January 2025 for HR-positive HER2-low and HER2-ultralow metastatic breast cancer based on the Phase III DESTINY-Breast06 trial, and had previously received NMPA approval in China for the broader HER2-low population. Disitamab vedotin uses a distinct mechanism — an MMAE microtubule-inhibiting payload conjugated via a protease-cleavable linker to the hertuzumab antibody — compared with trastuzumab deruxtecan's topoisomerase I inhibitor payload and higher drug-to-antibody ratio.

The two agents occupy partially overlapping but not identical label spaces in China. Trastuzumab deruxtecan's NMPA-approved indication for HER2-low breast cancer covers patients with recurrence six months or more after adjuvant chemotherapy, while RemeGen's newly approved label explicitly includes patients relapsing within twelve months of adjuvant chemotherapy — a group historically without targeted options and one associated with chemotherapy resistance. The liver metastases restriction in the disitamab vedotin label also reflects the specific trial population enrolled in RC48-C012, rather than the broader unselected HER2-low population addressed by trastuzumab deruxtecan.

The approval is relevant to Pfizer through its 2021 licensing agreement, via Seagen, for disitamab vedotin. Under the deal, Seagen—now part of Pfizer—obtained rights to develop and commercialize the drug outside Greater China, where RemeGen retains control. Pfizer is continuing global development of disitamab vedotin across multiple solid tumors, including breast and urothelial cancers, in studies conducted outside China.


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