Over the last decade we have seen great strides taking place in the field of multiple myeloma as the disease has moved from an acute to a more chronic one with the advent of proteasome inhibitors and IMiDs. We’re still not curing many people, however.
The good news is there is now a raft of completely different agents with varying novel targets and modalities emerging at a rapid pace in early to near-term clinical development.
This raises some important strategic questions to think about for the future way beyond which ones look most promising because the bigger question is how will new regimens evolve to challenge the standard of care in each line of treatment?
CAR-T cell therapies are certainly in the mix here, but where will they be optimally used in the future, how do we go about figuring out which people should receive which particular option?
The issues at stake are much more complex than simply asking which BCMA directed therapy is going to be the ‘winner’ because myeloma doesn’t work like this given the preponderence of doublet and triplet regimens.
A better way of exploring new opportunities will be to consider who has what synergies with whom and how might they fit together in a more cogent and coherent fashion.
In order to explore the evolving multiple myeloma landscape, we decided to take a step back and explore the new options from a more strategic perspective. To accomplish this, we interviewed two companies who are active in this niche as well as some specialist thought leaders. It’s a highly relevant time to consider the issues given the broad discussions likely to emerge at JPM21 this week.
We kick off the latest mini-series with a look at the BMS pipeline opportunities in myeloma, who will be followed by J&J tomorrow, and finally discussion with a global expert on Wednesday – so without much ado, let’s roll!
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Two of the most intriguing developments in cancer research over the last 5 years have been checkpoint blockade and CAR T cell therapies. There’s no doubt that they work – in some patients – or that toxicities can be challenging to manage at times, but what has been very interesting to me has been physician reactions to the rise of immunotherapies.
There has been much noise about biomarkers, including whether they work or not in this niche, as well as how do we go about selecting patients for therapies and combinations?
Ultimately, immunotherapies will be no different from targeted therapies in that we need to better understand the underlying biology in order to move forward beyond the low hanging fruit and figure out how we can best select appropriate therapy for each individual based on their particular characteristics.
The worry that many researchers have is that we could end up making the same mistakes with immunotherapies as targeted therapies, i.e. treat them in a broad fashion akin to throwing mud at the wall. Indeed, some companies are already doing this, much to the consternation of the research community.
So how do we go about doing things better and thinking more strategically about what needs to be done?
Up next is the first in a two-part interview series with a global thought leader who is a scientist-clinician with expertise in both immunology and oncogenic pathways. What does he have to say about where we are now and importantly, what does the future hold?
This is the penultimate article in our coverage from the Triple meeting in Munich, held in November 2016.
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