Dr Brid Seoighe, Medical Director, Commercial Business at Janssen Sciences Ireland UC, looks at the critical role that collaboration and research have played in the delivery of new therapeutics, improving the prognosis for multiple myeloma patients in Ireland
Advances in medicine have paved the way to revolutionised treatments in oncology. For previous generations of oncology patients, radiation or surgery were the only options available and if these didn’t work, ultimately the cancer couldn’t be treated. For blood cancers, including multiple myeloma, the treatments were even more limited.
September marks Blood Cancer Awareness Month. Despite being the second most common type of blood cancer in Europe, multiple myeloma is not well known outside of the medical community. In Ireland, approximately 2,200 people are living with multiple myeloma and around 350 people are diagnosed with it annually. A condition that manifests in diverse and nonspecific manners, commencing subtly within the bone marrow, it is characterised by an excessive proliferation of plasma cells.
The journey so far
In the past two decades, survival rates have soared due to a combination of advances in technology, a wave of innovative research, and heightened public awareness of all cancer types. Significantly, Irish data shows that the five-year net survival for someone diagnosed with multiple myeloma has increased from 27 per cent to 64 per cent in the period from 1994-2018.
Irish clinicians and patients along with pharmaceutical companies, have been at the forefront of research into multiple myeloma, and we are united by a shared goal to cure this disease.
Collaborative efforts across the wider medical community have highlighted the need to make new medicines available through clinical trials, which may accelerate access to therapeutics.
Educational resources for professionals and the public have contributed to increased awareness of this condition, and critically, the symptoms.
Some patients may undergo a variety of treatments, requiring expert clinical supervision to delicately balance the various regimes of therapeutics, and their respective timings, in order to optimise the clinical benefit while minimising adverse effects.
Despite the progress in treatment options, we have a long way to go in curing this disease. While treatment can result in remission for some, many patients will relapse and, in others, their multiple myeloma will prove resistant to treatment.
The outlook remains poor for this cohort of patients with relapsed and refractory disease, which presents an ongoing challenge in treating multiple myeloma.
Following the introduction of the first-in-class proteasome inhibitor, VELCADE® (bortezomib) 18 years ago, which works by inhibiting many of the molecular events that lead to multiple myeloma and mantle cell lymphoma, Janssen’s evolving portfolio of products has enabled us to provide haematologists with multiple tailored therapeutic options for each patient.
Since then, we have produced a broad body of evidence to support our multiple myeloma therapeutics including daratumumab, with data across many patient types and treatment lines.
Darzalex® (daratumumab) works by targeting CD38, a surface protein that is present in high numbers on multiple myeloma cells, regardless of the stage of the disease. Since 2015, Darzalex (daratumumab) has been manufactured at our biopharmaceutical manufacturing site in Ringaskiddy, Co Cork, ensuring the safe and uninterrupted supply of the medication to patients in over 100 countries worldwide, including Ireland.
In a continued effort to address the unmet needs of patients, Janssen Oncology developed Teclistamab®▼, a bispecific T-cell redirecting engager antibody for patients who relapse and become refractory to prior lines of treatment.
Teclistamab redirects CD3-positive T-cells to BCMA expressing myeloma cells to induce the killing of tumour cells. Teclistamab received marketing authorisation from the European Commission in August 2022 and our hope is that patients in Ireland will be able to access it in 2024.
We continue to deliver important innovations and first in class treatments for what remains an incurable disease.
Celebrating a major milestone
The development of immunotherapies represents a major milestone with the potential to change the treatment paradigm for all types of multiple myeloma patients regardless of their age or whether they are newly diagnosed or relapsed.
These therapies represent pioneering science at its best — attacking cancer cells in several different ways, working alongside a patient’s immune system. In short, they mean we’re no longer approaching blood cancer ‘one therapy at a time’ and this opens the door to more effective treatment plans for patients, including those experiencing resistant disease or who have failed to respond to multiple previous options.
The combination of anti-cancer monoclonal antibodies with immunomodulatory drugs and proteasome inhibitors effectively remodelled how standards of care are developed for treating multiple myeloma, including transplantation support.
Determined to tackle this challenge, we continue to work alongside stakeholders in the multiple myeloma community to best address the unmet needs of patients diagnosed with this incurable disease.
Holistic multiple myeloma management addressing patient needs
People with multiple myeloma require holistic care that is tailored to their individual needs – something 97 per cent of diagnosed patients rely on their caregivers to provide. The physical, emotional and social burden of both the disease and its treatment often goes under-addressed. Ensuring patients have access to multidisciplinary care teams and prioritising shared decision-making throughout their treatment journey, can help meet patients’ needs.
Multiple Myeloma Ireland is the only charitable organisation in Ireland focused on multiple myeloma, which provides invaluable support to patients, carers and healthcare professionals dealing with myeloma through education, advocacy and research.
Irish collaborative efforts driving research
New clinical trials for Irish patients with multiple myeloma, novel treatment combinations and innovative therapies, are the key to ensuring that people with multiple myeloma live long and healthy lives. Janssen Sciences Ireland has supported numerous Investigator Initiated Studies (IIS), including preclinical and clinical research and trials, led by Irish physicians, with the purpose of advancing scientific knowledge and investigating novel treatment options for multiple myeloma.
For instance, the lead investigator for a recent international multiple myeloma trial, MAIA, was based in Galway. In partnership with Blood Cancer Network Ireland (BCNI) scientists, the trial represented an approach where scientific insights from the laboratory were applied to developing new and improved treatment options.
Results from the MAIA trial showed that anti-cancer monoclonal antibodies have a role to play in treating patients ineligible for traditional therapeutic protocols such as autologous stem cell transplant.
In January this year, the first ever clinical study in Ireland of CAR-T cell therapy for treating multiple myeloma opened at St James’s Hospital Dublin, supported by Janssen.
The trial, CARTITUDE-5, is a multicentre global study which seeks to evaluate the efficacy and safety of CAR-T as a frontline therapy in people newly diagnosed with multiple myeloma.
True collaboration between industry leaders, policymakers, healthcare professionals and patients will help pave the way to find a cure. We will never settle until we can get in front of cancer, deliver cures, and eliminate multiple myeloma.
References available upon request.