In recent years, however, he’s noticed something else. Some patients with an incurable disease—cancer that has spread to multiple organs was a death sentence just a few years ago—are not only still alive, but they’re thriving, thanks to transformational new treatments. “I get cards and texts from these patients, and my jaw still drops when I think about how well those novel treatments worked,” says Dr. Infante, who has spent the last 20 years working in oncology innovation.
Today, such cancer treatments and the pace at which they’re being discovered are prompting many to share Dr. Infante’s awe and excitement. Although “there are still a lot of pockets in oncology where the innovation has been slower and there’s a lot of unmet need,” he says, cancer treatments have come so far that some patients feel more like they’re living with a chronic disease that can be managed with medication rather than a life-threatening illness.
Johnson & Johnson, driven by a vision to eliminate cancer, is playing a major role in transforming what it means to be diagnosed with the disease, most notably, hematologic malignancies (including multiple myeloma, B-cell lymphoma and leukemia), lung cancer, prostate and bladder cancer.
For National Cancer Survivors Month, we sat down with Dr. Infante to learn more about Johnson & Johnson’s work developing novel cancer treatments and to get his perspective on what it now means when a patient is told, “You’ve got cancer.”
Q:
Have the advancements in cancer research and the pace at which they’re happening surprised you?
A:
Yes and no. There are areas where there’s been tremendous impact on new therapies that directly affect patients—not only their overall ability to live, but their quality of life. Many patients who once would’ve been told, “There’s no chance for a cure,” now have the chance of a curative approach—or at least a very long-term remission.
There is nothing that makes me happier than hearing from patients who had no hope, but then went on a clinical trial and had dramatic results.
Q:
Is there anything you’re working on now that would’ve seemed implausible 20 years ago?
A:
I was in medical school from 1995 to 1999, and some of the treatments that we had then almost feel barbaric compared to what we’re doing today. One example is CAR-T cell therapy. Twenty years ago, I would never have imagined we would have the ability to remove a patient’s infection-fighting cells, manipulate those cells and then reinfuse them back into the patient so that they can selectively target their cancer. That type of innovative technology seemed so far-fetched when I was in medical school.
As someone who’s spent their career looking for new ways of finding paradigm-changing therapies, it’s an exciting time.
Multiple myeloma treatment is a great example of just how far we’ve come. When I was in training, all we had was standard chemotherapy—and it worked. But while the high-dose chemo typically would work for a while, the cancer usually found a way around it very quickly. Then the field moved toward stem cell transplants, where a patient’s bone marrow is removed (harvested) prior to receiving extremely high-intensity chemotherapy that would not normally be tolerable.
The harvested cells would then be reinfused back into the patient, where the normal bone marrow would recover over time. The whole process of harvesting cells, extensive chemotherapy, the re-infusion of normal cells and waiting for blood count recovery often required multiple weeks in the hospital while the patient remained neutropenic with very high risk of infection. Though these types of procedures often provided longer-term responses and remissions and are still a main part of today’s treatment paradigm, unfortunately they are not usually curative.
What I love about medicine is that innovation keeps coming up with new and creative ways of going after this disease. A plethora of new medicines have been approved in the last 15 years, bringing a variety of treatment options to patients, including multi-drug regimens that can help control a patient’s disease and preserve quality of life. Today, we don’t know all the benefits of these novel treatments but many patients are living with multiple myeloma for well over a decade. We have medications to keep the cancer under control—and even better, many of the medications are more tolerable. These patients don’t necessarily have to be hospitalized or at their doctor’s office all the time, and they can live relatively normal lives for many, many years. That’s a big deal.
Q:
When it comes to cancer treatment, we’re increasingly hearing about immunotherapy. Can you talk about how these therapies work?
A:
Some of the biggest changes I’ve seen in oncology have been advances in immune therapies. CAR-T is a good example. A few others include:
Immune checkpoint inhibitors, which reverse cancer’s suppression of the immune system and unleash it to attack cancer cells. The newer checkpoint inhibitors that are now used in melanoma and kidney cancer have completely changed the treatment paradigm, even in patients who have metastatic lesions in multiple parts of the body. We’re seeing remarkable remissions with these drugs; patients are 10 years or more past their initial diagnosis. We’re also seeing checkpoint inhibitors working in some other tumor types that haven’t traditionally been quite as sensitive to immune therapies, such as in certain lung cancers, gynecologic cancers, head and neck cancer and other skin cancers, which has had a dramatic impact on how we treat these diseases.
CD3+ bispecific T-cell engagers (TCE) involve redirecting and activating a patient’s infection-fighting cells to target the cancer. Though this sounds similar to CAR-T, CAR-T requires an individualized approach that takes many weeks, with harvesting a patient’s infection-fighting cells, a manufacturing process and a preparative chemotherapy regimen followed by reinfusion. Bispecific T-cell redirectors are like normal antibodies that have two arms: one that is designed to target the cancer and one that is designed to bind and activate a patient’s infection-fighting cells. How it works sounds almost unbelievable: These molecules target the cancer and activate your body’s own infection-fighting cells right at the site of the cancer.
Q:
If we were talking 10 years from now, what would you be most excited to share with me?
A:
I hope we see exponential innovation. I feel like we’ve been doing incrementally better, but I’d love to accelerate our pace even more—that we get twice as good, then three times as good, then four times as good at finding new treatments. And I hope it extends into more disease areas because unmet need remains in a lot of different tumor types.
For instance, the Cancer Moonshot initiative, which aims to cut the cancer death rate by 50% in the next 25 years, is a pretty lofty goal. But all the progress we’ve made—things I could never have imagined when I was in med school—makes me think the Moonshot is possible. Whether we reach the goal or not, the aim is great. You have to set your expectations high or you’re never going to get there.
As someone who’s spent their career looking for new ways of finding paradigm-changing therapies, it’s an exciting time. But progress is still not happening fast enough.
Q:
How does your experience as a medical oncologist treating patients inform and inspire your work?
A:
Every decision I make is grounded in my experience at the bedside. I vividly remember everything these patients and their families are going through when they see their doctors and participate in our studies with novel treatments. There is no doubt that experience guides us in our search for the next generation of treatments and helps us design the best clinical trials to test them.
Some of my most memorable moments are of patients who were told there was no hope in treating their cancer and they enrolled in a clinical trial and had dramatic and long-lasting results. But I’ve also held the hand of many more patients and said, “I’m sorry, we have nothing else to help you.” Those are painful moments, but they’re part of what fuels all of us to keep pushing until we find a cure for all types of cancer.
