Revelations in oncology: Reflecting on the past and charting the future in cancer research

Over the past several decades, we have seen tremendous progress across the oncology landscape, with advances that have transformed our understanding of cancer and ushered in new hope for people facing the disease. Among these critical advances was the introduction of immuno-oncology, which revolutionized how cancer is treated. Recently, Adam Lenkowsky, executive vice president, chief commercialization officer, and Tania Small, senior vice president, head of medical affairs, sat down to reflect on Bristol Myers Squibb’s (BMS) contributions to pioneering the field of checkpoint inhibition. 

That work is far from done: with an ever-evolving oncology pipeline that focuses on specific targets of disease and solving complex biologic problems in a precise way, our team at BMS remains committed to reimagining drug development and addressing the complexities of cancer through multiple research approaches.

Q: While we have come a long way in cancer care, in many ways it seems we’re only just beginning. Can you tell us more about how the cancer treatment paradigm has evolved in recent years?   

Tania: I started my career in clinical practice, specializing in pediatric hematology/oncology in the early 2000s. Back then, the treatment paradigm for many cancers was more simplistic, and survival rates were lower. What I observed during my years treating patients strengthened my resolve to contribute to our collective understanding of the disease and radically improve the treatment paradigm. 

We’ve made incredible progress since then. We recognize cancer as a diverse collection of diseases and understand the equally diverse set of needs our patients face. And we are applying that knowledge and experience to the development of future therapeutic approaches.

This sort of patient-driven science has led to some true revelations for our team at BMS. Take the pervasive issue of disease recurrence: we recognized a little over a decade ago that single agents may only get us so far in confronting the biological complexities of solid tumors and delaying—or preventing—progression or recurrence. We asked ourselves: what more could we do to overcome these challenges? We recognized that more needed to be done and we formulated and tested a hypothesis around a double immunotherapeutic approach that became the backbone of what is today an industry-leading development program.

Adam: We’re in an exciting new era of innovation in oncology. For decades, breakthroughs in radiation, chemotherapy and immunotherapy have changed the game and people are living longer. This progress has motivated our team to continue to push and expand our research into new modalities and mechanisms. 

But we’re not stopping there. As Tania said, we understand the relentless grasp that cancer can have, and recognize the role that access to life-changing medicines can play in improving the lives of patients and their loved ones. We do everything we can to get our medicines in the hands of the patients who need them, including taking tailored approaches to ensuring access for those living in low- and middle-income countries. These actions represent just a few of the ways we are working to eliminate barriers, achieve equitable outcomes and positively impact the treatment paradigm for all.

Q: We are still working to find a cure for cancer. With this, what are the challenges BMS is hoping to tackle to improve current standards of cancer care?

Adam: Our team has always been defined by curiosity, collaboration and innovation. Dr. Jim Allison and Dr. Tasuku Honjo undisputedly sparked a revolution with their discovery that the immune system could be activated to attack and destroy cancer cells. Discoveries like that inspire us and remind us of the importance of working together. We take every opportunity to engage more closely across the scientific community to consider what new technology means for current standards of care and how we can approach science in new ways. We need open dialogue to understand what physicians are seeing in clinical practice, and what more they need as they work to make the best decisions for their patients.

Tania: I agree. It takes what I like to call a “whole treatment team,” inclusive of physicians and other healthcare providers, advocates, researchers, regulators and more, to help meet the needs of patients. Every day, these individuals work tirelessly to solve the challenges of cancer treatment, and we are grateful for their efforts.

At the same time, our goal is to be a partner to patients and families. For too long, drug development was devoid of the patient voice and didn’t reflect patient needs! We needed to fix that as a collective community. I’m proud of our company’s efforts to change the course. Our Patient Expert Engagement Resource (PEER) program ensures the patient voice is embedded into every stage of the process. The program functions in a number of ways: for example, requiring all pivotal trial protocols include expert patient advocacy engagement prior to internal sign-off. These perspectives are critical as we continue to translate big ideas into tangible scientific advances.

Q: You mentioned the “revelation about recurrence” the BMS team had more than a decade ago. As we think about the time period since, what would you consider is the team’s biggest achievement? 

Tania: While we’ve seen marked improvements across many cancers, a core focus related to the issue of disease recurrence has been on the cancers that are among the hardest to treat. This is an area we have always believed we can make a broad impact, and an area where we are seeing proof of progress. Not long ago, available treatments for advanced melanoma offered patients little hope, with only one in four surviving a year after diagnosis. Today, more than 49% of patients are living 6.5 years after diagnosis.^* It’s clear how scientific progress is translating to tangible impact for patients. I would say our greatest achievements from the past 10+ years are seen in the patients themselves, who have more treatment options than ever before and the potential for more time. The ultimate metric we strive to reach every day is transforming as many lives as possible through our science.

Q: What opportunities lie ahead? 

Adam: Having worked at BMS for over 27 years, including leading our U.S. and global oncology business, I’ve seen firsthand our company’s remarkable evolution in oncology. The growth of our oncology portfolio has created some incredibly meaningful milestones in my own career and for our organization – and the continued impact on patients is a steady source of excitement and pride. As we continue to expand our oncology pipeline through diversified research strategies, we see countless opportunities to push the boundaries of science, target novel disease mechanisms and tackle even more complex biological challenges. But equally important is the opportunity we see to have a direct, positive impact on people living with cancer and their loved ones. It’s an exciting time, not only for BMS, but for our entire industry, as science and technology around the world are moving at a rapid pace and helping us better understand and address patient needs. We’re leveraging these advancements to speed up the discovery and development process across our pipeline with the goal of making immunotherapy and other breakthrough modalities, like protein degradation, targeted therapies, cell therapy, antibody-drug conjugates and radioligands, a reality for more patients.

Tania: Our team is made up of scientific innovators who are actively pursuing new breakthroughs to tackle some of the biggest challenges we face in cancer. Our dedication to drive discovery in immuno-oncology and throughout our growing oncology portfolio is tied to a greater purpose, which is supporting the lives of patients and their families.

In my time as a hematologist/oncologist, I connected deeply with the families I served, and profoundly felt their desperation for more time. When I think about the last decade-plus of progress and the promise of what’s to come, I think very specifically about our opportunity to help patients and their loved ones at scale. I believe the next decade of innovation will enable us to drive more inclusive research and the types of durable treatment responses that can make more time a reality for more patients. And who knows? There is likely to be another scientific revelation or two ahead of us, too!

^{*Korn et al. 2008 meta-analysis for the introduction of immunotherapy and targeted therapy: 25% of patients still alive after 1 year – median life expectancy 6 months/IPI alonge: 20% (Schadendorf et al. JCO 2015)/Hodi et al. presented at ASCO 2020 (abstract 9522).}

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