Dr Mikhael on the State of Myeloma Research Funding in 2025

Cancer research and drug development are undergoing a time of uncertainty, and the realm of multiple myeloma is no exception. Although groundbreaking approvals in the newly diagnosed and relapsed settings have propelled the myeloma field forward in recent years, researchers and clinicians fear this progress will be stalled by potential funding cuts to the FDA, National Institutes of Health (NIH), and other organizations.

In an interview with Targeted Oncology, Joseph Mikhael, MD, MEd, chief medical officer at the International Myeloma Foundation, discussed the challenges the myeloma research community is facing and expressed his resilient optimism about the current pace of progress in myeloma, which is being driven by unprecedented collaboration.

Myeloma research requires a comprehensive approach, encompassing basic science, translational research, clinical trials, and daily clinical practice. As Mikhael put it, “Myeloma research is a village.” The ultimate goal remains the cure of myeloma, necessitating continued advocacy for funding and patient engagement.

Targeted Oncology: How do you see potential federal funding cuts for the field of myeloma research?

Joseph Mikhael, MD, MEd: Myeloma research is a village. It is a multifaceted approach to bringing better therapies and quality and quantity of life to patients. That involves everything from basic science to clinical trials to what is done daily in the clinics.

I am very concerned about the cuts. But I also recognize that is one piece of a greater puzzle. There are a lot of threats of cuts, but not a lot of things have immediately happened. These things always take time, and there's a downstream effect. We're worried about the downstream effect. I strongly believe that the NIH should be a leader in research across all of health, and obviously, particularly myeloma, my area of focus.

But I do want to step back and look at the big picture. The way I would look at it is, yes, this is a significant threat to individuals and organizations who conduct research at all of those levels. I'm also concerned that it becomes a disincentive for people to pursue careers in research. One of the reasons why the US has been such a world leader in research has been that this incentivized approach, not just financially, but by having an infrastructure, mentors, areas to study, and an incredible diversity of the kinds of organizations and institutions across the country that do research. I’m very concerned that there's the [financial] cut, but then there's also the psychological impact of that.

I am concerned, but I don't immediately see that myeloma research is not going to be able to continue. NIH funding accounts for a portion of myeloma research if we look at it nationally, let alone internationally.

Do you see these cuts as another hurdle in the development of myeloma research?

Yes. I also think the US is a little bit unique in the creation of the NIH. I was trained initially in the medical system in Canada, and there was sort of an NIH equivalent, but its proportion of funding and research was dramatically smaller. If we go to our colleagues in Europe, there are government-funded organizations and efforts that support the research, but a lot of it is done through philanthropy, academic institutions, and other foundations.

I think it is a bit of a signal to us, too, that we can't entirely depend on one source—not that we've ever been entirely dependent on one source—but we have to recognize the diversity of research sources because we can't expect the NIH or the government to always be as prominent a funder as they have been.

Do you see this changing how research is conducted or prioritized?

There's such a beautiful diversity of institutions that obtain NIH funding. Historically, there had been this view that the large institutions had the lion’s share of funding, but there has really been a strong push to ensure that we do real-world studies and work in other institutions that have historically not been included. I think every institution will approach it differently, but I think the reality of it will be that there will have to be cuts and that prioritization will have to be reflected individually in each of those institutions as to their contributions to the scientific community. I do have a concern about that, because I think that if you always have the same 5 or 6 major centers that cover breast cancer or myeloma or whichever [disease], there is a strength in diversifying that to other institutions. And I do worry that when the prioritization process works, everybody will just focus on their own [specialty]. The opportunity for other institutions that have not, historically, done a lot of research in one area or another is now going to be even more excluded.

On the other hand, I also think it will cause those institutions to look at their sources of funding and [assess] what other opportunities [there are]. Whether it be through philanthropy, granting agencies, other foundations, or other approaches. I think that has always been an important theme as a researcher: You want to diversify your funding. I think it's causing the scientific community to think that way.

Do you worry about a chilling effect that cuts to NIH funding may have on the progress of myeloma research, especially considering the significant progress that has been made in the past several years with new agents and moving therapies into earlier lines of treatment?

Absolutely. When I think of the outstanding progress we've seen in multiple myeloma—and I've had the privilege of being a little piece of that over 25 years as a myeloma physician—when I started, most patients lived for 1 year. Now, most of our patients are going to live over 15 years. When I look at what has led to that success, NIH funding has been critical.

We could argue that [NIH funding] incentivizes people to go into research. The NIH wasn't the funder of all that research, but it triggered someone's career. It incentivized them. It gave them role models. This is, as I mentioned before, what scares me the most about the funding: not the absolute dollar amount, but what it might have downstream, the effect of psychologically and pragmatically impacting the infrastructure of research. When I think of all my colleagues who are NIH-funded, most of them are not only NIH-funded, but their NIH funding also allows them to get other funding.

The NIH is not only numerically a massive player in the whole sphere of research, but its influence is greater than finances—it provides an infrastructure to sustain careers. That incentivization can be lost with these cuts. We don't want to scare people out of a career in research.

That being said, when I look at all this great progress we've had, a lot of it is also done on the industry side, initially in developing these agents, and then bringing them to the institutions as we do clinical trials and cooperative group trials, in particular, in these larger studies that have led to these massive advances.

Despite these challenges, what are the areas in myeloma research that you are most excited about?

I've been in myeloma for over 20 years, and I've never seen a time like the time we're in. Perhaps what strikes me most is the genuine spectrum of that work. If I look over the past 25 years, there were incremental steps where we would work on very heavily relapsed myeloma, and then there were a few small breakthroughs in frontline therapy, and then we found some supportive care areas that really [helped] patients. It just seemed like at any given time, there were different steps forward. But right now, what excites me the most is that we're seeing steps forward in all areas at the same time. We're doing so much better with understanding whether we should screen and intercept earlier. Can we intervene at the level of smoldering myeloma? Frontline therapy has exploded in myeloma with all these new therapies. We’re seeing the longest survivals we've ever seen in myeloma.

More than ever, we are focused on patient-centered, patient-engaged research. One way to look at it is like an orchestra. We were strong in the violins for a while, and then we were strong in the trumpets for a while, and then the bass was playing. But now the whole orchestra is playing at the top of its game. [All levels of research] are intimately connected. When everyone's working together, it really has a greater impact. Better frontline therapies affect relapse therapies later.

The other area that I like to focus on is that I have never seen greater collaboration than right now, especially in the form of the International Myeloma Working Group [IMWG]. I think this is unique to myeloma, and I think a lot of my colleagues in other disease states wish they had an international working group [like the IMWG]. What it’s allowed us to do is to work in a way that we otherwise couldn't work individually. We have to be creative in the way we work together. We bring everybody together so that we can collaborate, share data, share information, create registries, create an open forum for discussion, and do the kinds of research that industry may not be interested in, so we can advance the field. We’ve always done collaborative research. But the degree of it, the technology, the connectivity—I think all these things have contributed to tremendous success in myeloma.

Despite the fact that we've made this huge progress, the vast majority of patients are still not cured. Whether we can advocate for greater NIH funding or find other models of funding is so critically important. But it's also not just funding. It is about the degree of engagement. It's ensuring that we engage our patients from day one in the design of our studies and in the work that we do. My work at the IMF has really uniquely positioned me. I was an investigator at Mayo Clinic for 10 years, and I loved it. I didn't fully appreciate how much more can be accomplished when more players are brought together.

I’ve sometimes said that the IMF is like the host country of the Olympics. Individual countries have outstanding athletes who perform extremely well. But why are so many world records broken at the Olympics? Because we set the stage to allow people to perform at their highest level. I can work in my lab or in my clinic in an individual center. Yes, science is based on reproducing one thing that someone else has reproduced. But at the same time, let's not all reinvent the wheel. Let's work together to accelerate the speed of research. And I think that's happening.