I recently had the chance to meet with Jane Griffiths, Ph.D., Company Group Chairman, Europe, Middle East and Africa, for Janssen Pharmaceutical Companies of Johnson & Johnson, for a discussion on the current state of affairs in oncology. She shared her thoughts on the importance of innovative clinical breakthroughs in oncology, the justification for renewed optimism among patients, and the need for the pharma industry and payers to work together to address serious affordability issues.
“A cancer cure is within sight.” These are the prophetic words of Jane Griffiths, Company Group Chairman for Janssen Pharmaceutical Companies of Johnson & Johnson. With a Ph.D. in Biochemistry and more than three decades at Janssen, the trailblazing executive is the first female Company Group Chairman at the company, and currently is in charge of the entire commercial group for the markets in Europe Middle East and Africa. Griffiths is also member of the Janssen’s Pharmaceuticals Group Operating Committee.
Throughout oncology, the long-held assumption is that a cancer diagnosis means certain death. But today, “our fundamental understanding of the mechanisms that cause various cancers are better characterized than ever before, and the mechanism of action of today’s newest oncology medicines are much more targeted,” says Griffiths. Such advances are helping to replace despair with optimism, and uncertain outcomes with predictable results.
“Traditional medicines used during the treatment of cancer have been fairly blunt instruments in the way the mechanism of action worked, and they have caused a lot of toxicity in patients. With today’s more-targeted medicines, toxicities are far lower, and because of that, we are able to target the tumor better and are more likely to have a positive impact.”
Historically, the toxicities associated with many forms of chemotherapy and radiation treatments are responsible for the many painful and both unpleasant adverse events and side effects (such as pain, nausea, hair loss, fatigue, mouth sores, neuropathy and more) and long-term peripheral damage. Sadly, actual and anticipated chemo- and radiation-related side effects are often to blame for patients avoiding life-saving treatments, so the ability to reduce such toxicities not only gives hope to many cancer patients but allows them to remain more adherent to therapy.
When it comes to treating cancer, Griffiths has loftier ambitions than simply securing a temporary remission for patients. Rather, the visionary Brit firmly believes it’s only a matter of time before cancer can be truly eradicated in a growing number of patients. “We’re seeing some very, very good results coming through with medicines we’re launching, and with other companies, as well,” she says.
“There’s been such a fast pace of change — with both incremental and transformational innovations leading to more-targeted treatments that are more well-tolerated,” says Griffiths. “This gives me real hope that at some point we can actually cure cancer forever — not just put it into remission for a few years while the patient is waiting anxiously for it to return. Maybe I’m just one of life’s hopeful people, but from what I see, I think a cure is within sight.”
Focus on ‘blood cancers’
One particularly challenging area within oncology are the so-called ‘blood cancers’ — an umbrella term that refers to a variety of hematologic cancers (more than 140 have been identified to date), including various forms of leukemia, lymphoma, Hodgkin’s lymphoma, Non-Hodgkin’s lymphoma, multiple myeloma and others.
“There are many different types, and the symptoms are often vague, non-specific and not well-characterized. If we can help people to better understand what the symptoms might be, and improve the diagnosis around certain blood cancers, we can provide more effective treatments and give hope to more people battling hematologic cancers, as well,” says Griffiths.
Janssen has put a particular focus on developing innovative therapies for areas of high unmet medical need. The objective is to develop “medicines that are significantly better than what already exists, in order to make some real inroads into the treatment of blood cancers,” says Griffiths. “Janssen recently launched something in multiple myeloma, which is providing more options for people who have run out of them, and there are new indications in chronic lymphocytic leukemia, areas where there is serious unmet need.”, says Griffiths.
She refers to a second breakthrough therapy designation the FDA granted Janssen in July for the immunotherapy daratumumab (DARZALEX®) in combination with lenalidomide (an immunomodulatory agent) and dexamethasone, or bortezomib, for the treatment of patients with multiple myeloma who have received at least one prior therapy. DARZALEX® was approved by the FDA in November 2015 for the treatment of patients with multiple myeloma who have received at least three prior lines of therapy, including a PI and an immunomodulatory agent, or who are double-refractory to a PI and an immunomodulatory agent.
In September, the company showcased some of the research and the dedication to patients as part of Blood Cancer Awareness Month– a multimedia information and advocacy campaign that happens every year since its launch in 2010. Griffiths also highlighted their “Victories Over Cancer” campaign which provides a valuable resource for those facing the diagnosis.
Cause for optimism
Despite feelings to the contrary — particularly among newly diagnosed patients and their families — there is a lot of cause for hope in oncology today, says Griffiths.
As a society, we need a different perspective on staying well, carrying out routine screenings and earlier diagnosis, and intervening early. “If insurers don’t cover patients for early screening and intervention, then pharma must play a stronger role to change the environment on that,” says Griffiths. “Of course it can be costly to do this early on, but deferring cancer treatment until later is always more costly – in so many ways.”
One particularly exciting breakthrough that is being widely pursued by many in the biopharmaceutical industry involves genetic testing methods that aim to characterize different tumor types in terms of their genetic makeup, and thus guide the development of more-targeted treatment options. “We’re trying to develop diagnostic kits that go very early with certain diseases and tumor types, so that we can better identify diseases earlier, characterize tumors and blood cancers more effectively, and target the treatment options better,” says Griffiths.
“It’s important that we get to a point where medical screenings could routinely seek to identify, for example, issues around diseases that don’t fully manifest themselves in any physical symptoms, but may be detected through a comprehensive blood screening,” says Griffiths. “Such early detection could help to stop the disease in its tracks.”
“One area that we’re looking right now is smoldering myeloma,” she adds. “It is almost always a precursor to multiple myeloma yet it is typically only found serendipitously, if an anomaly shows up on a blood test.”
Managing high costs, ensuring patient access
Clearly, we recognize the challenges around affordability in the healthcare system,” says Griffiths. But it’s important to recognize the value that today’s innovative therapies bring in terms of improved longevity and quality of life, and in terms of the ability of today’s most innovative treatments to offset longer-term costs related to additional surgical or medical interventions, repeat hospitalization and so on.
“We’re continually looking at how we can identify and develop new medicines while keeping the cost of development as low as we possibly can, and finding more efficient ways to run clinical trials, and concurrently, we’re exploring different models for ensuring that patients have access to lifesaving therapies,” says Griffiths. “There are many examples of how we can get different medicines onto the market now and improve access for patients with different payment models.”
"The pharmaceutical industry cannot fix this issue alone, and pharma must work closely with payers and clinicians, There can’t just be a perennial complaint that ‘today’s medicines are too expensive.’ There must be more honest dialogue among all parties."
“All sides must recognize that yes, affordability is an enormous challenge (particularly with aging and expanding populations),” but researching and developing innovative medications is “an extremely costly undertaking and there needs to be a reward for innovation,” says Griffiths. “When you think how much healthcare and medications have been improved in the last century, we owe it to the next generation to make sure that that continues.”
“Of course, as an industry, we are having a lot of dialogue with payers about how this is going to move forward in terms of oncology pricing, and how that will work with combinations, and so on, and we have lots of work streams going on at the moment in the industry body with our peers and various governments.”
Helping people redefine their cancer journey
The idea that you can take a cancer diagnosis and turn it into a manageable condition —and even envision a cure — is a bold objective that the self-proclaimed “eternal optimist” heartily endorses.
There are two aspects to this. In addition to aggressively pursuing innovative new oncology therapies and working to ensure that patients have access to them, “we must continue changing the dialogue around what a cancer diagnosis means for people,” says Griffiths. Today, “it’s a cultural and society thing — that a cancer diagnosis is always very bleak, with long faces, and a lack of an optimistic outlook about survival. But these days, a cancer diagnosis doesn’t need to be a death sentence.”
“With sequencing of oncology medicines, with early diagnosis, with people understanding what symptoms to look for, we are already making huge inroads into moving from a death sentence to something that’s actually manageable and curable. With all of these advances, you can actually die with cancer — not die of cancer, and hopefully, many will actually be cured,” says Griffiths.
Look at patients with breast cancer — “2 out of 3 survive now, rather than 1 out of 3 twenty years ago, so there’s some significant innovation,” says Griffiths.
And there are encouraging parallels in hepatitis C and HIV, as well. “Hepatitis C could eventually be virtually eradicated, thanks to the new medications that have been approved in recent years,” says Griffiths. Similarly, she adds “if we go back 30 years to look at how people felt about HIV, nobody knew how to address it; It came upon us very quickly, people were totally confused about what was causing it. And in just 30 years, people now die with HIV and not because of it.” Griffiths believes that can be the same with cancer.
There’s an understanding of what symptoms to look for, say in breast cancer, testicular cancer, even with bowel cancer. “But with many cancers we still don’t know, and blood cancers are one of those, where the symptoms might be ill-defined.”, says Griffiths.
Meanwhile, it’s also important for people to take care of themselves (through diet, exercise, smoking cessation and more), understanding hereditary and other factors that might cause cancer, seeking routine screenings, and in the not-too-distant future, using genetic profiling — and these factors can work together to help people avoid their risk of cancer, catch it early, seek a diagnosis if they’re worried, and hopefully get great treatment early,” says Griffiths.
“The point is — what’s the average age expectancy now? Well into the 80s,” says Griffiths. “Everybody wants to get there so let’s see how we can make that happen.”