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Tovecimig plus paclitaxel is an investigational combination regimen consisting of tovecimig (CTX-009), a first-in-class recombinant bispecific monoclonal antibody targeting delta-like ligand 4 (DLL4) and vascular endothelial growth factor A (VEGF-A), and paclitaxel, a microtubule-stabilizing taxane chemotherapy. Tovecimig simultaneously inhibits the DLL4-Notch and VEGF-A signaling pathways to disrupt tumor angiogenesis and overcome resistance to anti-VEGF therapies, while paclitaxel inhibits cell division. The combination is administered intravenously and is primarily being developed by Compass Therapeutics, in collaboration with ABL Bio, Handok, and Elpiscience, for the second-line treatment of patients with unresectable advanced, metastatic, or recurrent biliary tract cancer (including cholangiocarcinoma). In the Phase 2/3 COMPANION-002 trial, the combination met its primary endpoint of overall response rate (17.1% vs. 5.3% with paclitaxel alone) and significantly improved progression-free survival (4.7 months vs. 2.6 months; HR=0.44), leading to FDA Fast Track and Orphan Drug designations.
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