Integrated treatments may defeat cancer

cancer

Johnson & Johnson’s Dr. Craig Tendler talks about the latest developments in oncology and the close ties with Israel.

The $260 billion market cap giant Johnson & Johnson, active across the pharmaceutical and medical device sectors, has registered a number of major milestones in the development of cancer treatments says Dr. Craig Tendler, vice president of the oncology department at J&J subsidiary Janssen Research and Development.

In his role, he supervises cancer treatments in the late-stage development and after, when they have been approved to market. It is a unique position, which provides Tendler with a wide perspective on the spell-binding developments which have characterized oncology in recent years.

“Unlike other companies, Johnson decided to focus on only three parts of the oncology world: hematology, prostate, and lungs,” Tendler said in an interview with “Globes”.

“We understand these diseases much better than in the past. Because of our focus we have become the natural partner for companies younger than us that are developing products in this area,” he explained.

G: The medical establishment has been coming around to the realization that cancer is actually a collection of diseases, but it is still rare to find such a narrow focus on subfields. You assume that treatments for prostate cancer, for example, won’t suit other cancers?

“So far we have not seen cases in which it was easy to expand a new treatment we developed for once cancer to another cancer from another source. It’s been quite the opposite; we have seen that the new specialized approaches to cancer treatment are extremely focused. Immunotherapy, the newest generation of cancer medication, is highly specialized; there are types of cancer for which it is far more effective than others.

“It’s true, for example, that a protein we are attacking for leukemia has also been discovered in intestinal cancer. And yet, our medication is less effective for that cancer than for leukemia; despite the appearance of that protein in both, a new, specialized medication for the intestines is required. There are feasible scenarios in which we will have treatment that will be effective across types, and then we might expand to subfields which are not part of the three I mentioned before, but it is highly unlikely.”

What are your newest approaches to cancer treatment?

“Today, we talk a lot about immunotherapy, using the immune system to fight a cancerous growth. However, even when we strengthen the immune system, freeing it up from limitations that the cancer has imposed on it, and equip it with an effective ‘weapon’ for fighting a growth, like all the breakthrough immunotherapy methods discovered in recent years it still may fail to locate the malignant tumor, as often happens with prostate cancer.

“That’s why we combine this technology with methods that cause the growth to stick out to the immune system. We do that by stirring up the antigens, molecules that the immune system identifies as a threat. That’s under our partnership with Aduro.”

Aduro’s product is Listeria bacteria, genetically engineered so that they will no longer express the genes that enable it to multiply and become a danger to humans, which are loaded with antigens that are unique to malignant growths. This approach lets the tumor absorb the bacteria, thereby excreting more antigens, leading the immune system (whether naturally or “reinforced” by immunotherapy medication) to identify and attack it more easily. Janssen holds the rights for the use of Aduro’s product for prostate cancer treatment.

“Another approach is to bring the T cells, one of the killer cells of the immune system, closer to the growth. We do that using an antibody that identifies and connects to the growth on one side and attaches to T cells on another side and leads them to the malignant tumor. We can use both of these methods together, and we can integrate them with other treatments.”

“Vaccine for cancer”

Your product has been heralded as a “vaccine” for cancer; these types of products haven’t particularly succeeded in the past.

“True, but now we can combine a vaccine like ours that improves identification with approaches that reinforce the immune system and relieve it of certain constraints. It is possible that the combined treatment could beat the growth.

“When does it not work? Unexpectedly, when the growth is in the early stages and hasn’t developed many mutations to differentiate itself from ordinary tissue, and there are specific types of cancer which express fewer mutations. There are also patients who respond well but develop a tolerance to the medication over time. We don’t always know the reason, but we are getting better at figuring out which patients will not benefit from the treatment or become resistant and switching out their treatment before we see negative developments in the growth. It’s not market ready yet, but it’s in development.”

You have a unique role for pharmaceutical firms, overseeing both late-stage oncology developments and global medical affairs. Where do these fields intersect?

“It is rather rare but the idea was that part of the activity conducted only during the product launch should actually begin even before the treatments are approved. What do I mean? The massive effort of introducing the medication to doctors and understanding the best way to market it and integrate it into the medical establishment, such as adding it to the list of treatments covered by various insurance providers, used to only begin after regulatory approval. It then took a long time to figure out what was actually relevant for the market.

“Now we patch in that department much earlier, each medical affairs unit for its relevant country, and they report back to us in the development division what information interests the doctors and the insurance coampnies in their specific country. That way we can already start gathering information and launching new trials before we receive approval, and we can answer doctors’ questions immediately at launch. The bottom line is that we have been makingg successful product launches right after regulatory approval, a process that used to require much more time.”

You would conduct a study just because it was required in a specific country or for a certain demographic?

“That does happen. Just recently we launched a leukemia treatment that had to be tested on older, sicker patients in order to receive regulatory permission. That’s how we conduct cancer trials ethically: first you test the medication on the people who don’t have much better choices. However, we knew that doctors were more interested in the treatment’s effects on a younger population - maybe the effect would be better if we catch it at an earlier stage or when the cancer has developed fewer mutations.”

But what if the product isn’t approved? You conducted an expensive study and even involved patients in an unnecessary clinical trial.

“That doesn’t really happen to us because we only undergo such a series of additional trials when we are perfectly confident in the preliminary results of the main group that is part of the trial up for approval. When you note improvements in severe patients then it is quite clear that the product could work with easier patients, but the doctors want to know the exact results. So it hasn’t happened to us yet that we expanded our trials and did not receive the required approval.”

Close ties

Tendler and his team have close ties to Israel. “When my family left Europe, some went to the United States and some went to Israel; some of those who went to the US actually made aliyah a few years ago. When I started working in oncology at Johnson, the first product I was responsible for was Velcade, which was developed based on a mechanism that was discovered by the Nobel Prize winners Avram Hersko and Aaron Ciechanover from the Technion.

“The company has always worked with Israeli doctors, and at least in once case that I know an innovative new treatment was approved in Israel right after it was approved in the US; the connection to Israel is very close and positive. Janssen works closely with Israeli companies.”

One of the company’s leading treatments for prostate cancer, ZITYGA, was developed by Cougar Biotechnology, founded by Israeli-born American Prof. Arie Belldegrun.

Published by Globes [online], Israel business news - www.globes-online.com - on September 6, 2015

© Copyright of Globes Publisher Itonut (1983) Ltd. 2015

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