Last August, Sid Sijbrandij and I traveled to Beijing for an experimental scan to look at a biomarker that’s specifically upregulated in his cancer. At that time, the only place we could do this was in China, using a molecule developed by Yang Zhi (杨志)’s group at Beijing Cancer Hospital. So that’s where we went.We were stunned. The whole experience — from international patient check-in, to preparation of the radiotracer, to injection, to imaging, to discussing the result with the physician, to leaving with a glossy printout of the whole-body scan — took two hours. Even in Germany, where clinics are experienced in using developmental tracers, this process would take most of a day. Beijing broadly and the hospital specifically were surprisingly straightforward to navigate for foreigners such as us who speak no Chinese.
The “investigator-initiated trial” (IIT) is an important fundamental concept to understand. Through IITs, individual physicians at major hospitals in China can propose and run studies for cell and gene therapies under the oversight of local scientific and ethics committees. There’s no need to clear a single, centralized national gate before enrolling patients. Compare that to the United States, where early trials are usually company-driven and require formal approval from a national regulatory body (like an IND filing with the FDA) before anything can begin. The tradeoff is pretty straightforward: the US system emphasizes uniform standards and upfront rigor, while China’s IIT model pushes decision-making closer to the doctor and the patient, making it easier to start trials quickly and iterate as data comes in.
Based on what I heard on the ground, it takes about 6 months to go from a first conversation between a doctor and a patient to that patient getting dosed, and people noted that exciting programs with support from senior investigators can go even faster. This means new therapies can get to patients faster, and companies and physicians start learning from and improving the underlying therapies earlier in their development.
On my trip, I was repeatedly quoted a timeline of 18 months from a company having an idea for a therapy to testing it in a patient. My lived experience from my week on the ground backs up this speed. I experienced a sense of urgency at every level. Not just from start-up companies themselves, but also the ecosystem of third-party vendors that perform services for these companies.
During a visit with a CDMO focused on cell therapy manufacturing in Suzhou, I asked the business development rep giving the presentation about the company’s experience with non-viral gene editing. He picked up his phone. As we were preparing to leave 10 minutes later, the principal scientist responsible for the non-viral editing platform caught us by the door. He answered my questions, and we figured out the next steps to evaluate the suitability of their platform for the non-viral editing approach our collaborator is using.
It is ironic to me that the ‘marketplace of reputation’ that seems to govern China’s IIT ecosystem is more market-oriented than the regulatory apparatus we use to govern early-stage trials in the US. Every system has its strengths and drawbacks, China’s included. The parts I saw up close show how the Chinese ecosystem is leaning into its strengths — velocity of science and engineering, urgency, close-knit relationships within the ecosystem, compassion for patients. I’m hopeful that, as a country, we can reflect on and actively lean into our strengths as an ecosystem too.
For more, please visit sytse.com/cancer. Please write to us with thoughts or questions at cancer@sytse.com.
Thanks to Jacob Stern and ChinaTalk. From: Clinical Trial Abundance, Made in China. Flying to China for cancer care. APR 17. 2026. ChinaTalk.
