Achieving long-term remission is what drives multiple myeloma researchers as they strive to deliver novel therapies and combinations for people living with this disease. The progress has been remarkable, although high unmet needs remain. Today, people with multiple myeloma are living longer than ever, but they live knowing that more treatment always lies ahead. While there is cause to celebrate the tremendous progress in treating this disease, we also know that there is still no cure and that almost all patients relapse or become refractory to current treatment. We have an opportunity to reflect on how we can continue to improve the lives of those affected by this hematologic malignancy.
We aim to find a cure for multiple myeloma. To achieve this ambitious goal, Janssen relies on a deep understanding of multiple myeloma, the development of novel therapies and approaches, a commitment to treating the disease early, and an emphasis on identifying synergistic combination regimens. We bring a deep, long-lasting focus on science and a drive to innovate that defines our relentless pursuit of a cure.
Our work is guided by a 5-step formula to inform decisions about research and shape the future of multiple myeloma treatment.
1. Strive to discover multiple highly effective therapies that work through different mechanisms
Each patient with cancer presents a case that is complex, unique, dynamic and generated against each individual’s genetic background.
Because each patient and cancer is unique and evolves with each subsequent treatment, multiple myeloma must be attacked at multiple targets with powerful therapies, through new combinations and approaches to managing the disease. A cure will undoubtedly involve multiple therapies that focus on different mechanisms of multiple myeloma development, growth, and proliferation.
2. Combine therapies to treat a complex, heterogeneous disease
As multiple myeloma research and development has progressed, our understanding of the science has unlocked the need to develop therapies that build on each other synergistically. The challenge is to determine the intricate details of combinations and the corresponding clinical protocols, such as what to combine, at which doses, in what order, and with what duration between them to maximize outcomes as well as safety and tolerability of the regimen for patients.
This perspective drives our approach at Janssen, building on our more than 20-year history of innovation in this disease and a unique position with our portfolio of assets representing distinct and complementary mechanisms, which we are progressing in combinations and sequences as we aim to deliver curative regimens. As the science continues to change and advance, our commitment and expertise deepens.
3. Measure the effects of therapies on multiple myeloma to define cure
Evaluating the impacts of our therapies requires that we are able to reliably measure disease burden. Take viruses, for example, which are foreign to the body and can be readily identified. Undetectable viral load is accepted as cure for many diseases, such as hepatitis C, and eradication, or “cure” can be seen in a blood test within a matter of months. Unfortunately, because it takes years to confirm that an individual is cured of cancer, we currently must rely on other endpoints to inform our understanding of the efficacy of each cancer therapy.
Measuring disease is challenging in multiple myeloma because the cancer arises from normal cells. Distinguishing multiple myeloma cells with a high degree of sensitivity and specificity requires more sophisticated techniques and more advanced technologies. We need advanced and widely accessible technologies to measure minimal residual disease in multiple myeloma and truly define a cure.
4. Treat disease until it is no longer detectable
Curing multiple myeloma requires treatment until signs of the disease are undetectable. However, doing so requires consensus around an endpoint that provides meaningful insight into disease burden.
“Minimal Residual Disease” is most frequently measured after a course of treatment or in the clinical trial setting, but as we move ahead those who treat multiple myeloma will look for these inputs more often to inform therapeutic choices and prognosis in closer to real time. Key stakeholders, including regulators, academics, industry, and patient advocates, must work together to rapidly align on a therapeutic endpoint and enable patient access to potentially curative therapies.
5. And finally…the need to treat a little longer
Undetectable disease does not guarantee that cancer has been fully eliminated. If even one multiple myeloma cell remains, the cancer is likely to progress.
Once multiple myeloma can no longer be detected, additional consolidation or maintenance therapy should be considered to ensure that any remaining cancer cells are eliminated. Ideally, this process includes the use of a different agent that targets the cancer in a way that it has not yet been targeted to reduce the chance that it continues to evade previous therapies. Only after those final remaining multiple myeloma cells have been destroyed could it be feasible that a patient is cured.
Our Commitment to Future Patients
These five steps drive our approach at Janssen, building on our legacy of innovation in multiple myeloma.
Right now, patients live with the disease, and with treatment(s). The critical unmet need in multiple myeloma is a combination treatment that enables patients to undergo treatment once – and only once, and live as long as people who do not have the disease. Through our drive, commitment, and deep disease understanding, we are driving hopefully closer and closer to a day when a cure for multiple myeloma is possible.
For more information on Janssen Oncology and our commitment to discovering and delivering innovative therapies for patients, click here.
Sen Zhuang, M.D., Ph.D. is Vice President, Oncology Clinical Research, Janssen Research & Development, LLC, one of the Janssen Pharmaceutical Companies of Johnson & Johnson