Page 73 - Binder2

Instead of addressing the underlying immunologic drivers
of therapy resistance—such as antigen escape, T cell
exhaustion, or antibody neutralization—J&J built a
stepwise treatment model where each new therapy slots in
as the previous one fails. From daratumumab to
talquetamab, the goal isn’t to keep patients on one durable
drug. It’s to own every rung of the ladder.

And the ladder is long. Most patients with myeloma will
cycle through 3–5 different biologics in their lifetime.
That’s not a bug. That’s the business model. Each loss of
response becomes an opportunity—for the next branded
infusion, the next bispecific rescue, the next CAR-T reset.

To be clear: these drugs save lives. They extend survival.
They buy time.
But they don’t fix the problem at the root.

Tolerization, immune escape, and biologic attrition are
accepted as inevitable—not because they have to be, but
because the system has never demanded otherwise. In fact,
it’s structured to benefit from patient turnover. When a
drug stops working, it doesn’t end the relationship—it just
hands the baton to the next revenue stream.

In multiple myeloma, Johnson & Johnson isn’t just treating
a disease.
They’ve built a business on managing failure—carefully,
sequentially, and profitably

71