『Oncology Unscripted With John Marshall』のカバーアート

Oncology Unscripted With John Marshall

Oncology Unscripted With John Marshall

著者： John Marshall
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 Oncology Unscripted with John Marshall, MD brings you a unique take on the latest oncology news including business news, gossip, science, and a special in-depth segment relevant to clinical practice.
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  • Oncology Unscripted With John Marshall: Episode 19: Who Really Benefits From Cancer Innovation—and How Can We Do Better?

    Oncology Unscripted With John Marshall: Episode 19: Who Really Benefits From Cancer Innovation—and How Can We Do Better?
    2025/07/15
    ACCESS THROUGH INNOVATION: THE POWER OF SMARTER CANCER CARE STRATEGIES[00:00:05] John Marshall, MD: John Marshall for Oncology Unscripted. Really no script at all, but we are post-ASCO here in Washington, DC, trying to take all of those major innovations that we all get so excited about—curves with big deltas that we saw in all sorts of different cancers, including the humblest of them all: GI cancers.So, now the question is: how do you take those innovations and those changes—some of them are added to NCCN, some of them may be FDA-approved, some of them in The New England Journal of Medicine, some not—and apply them to our patients? Many of them are novel tests, maybe not covered by insurance.Many of them are new drugs that don't have a label and may not yet be approved by healthcare coverage. Many of them, as we will talk about, are not available to most of the world. In fact, they're only available to us here in the wealthy corners of our planet. And so, how do we go from that innovation to the patient to realize those benefits?I want to highlight two papers because, thematically, they go along with what we are talking about this cycle. So, you've probably seen this journal before—it's called The New England Journal of Medicine—but I want you to make sure and look at this paper by Andrea Cercek. You know about it. This is using IO therapy in MSI-high positive primary cancers, and of course the rectal cancer data. This bar plot right here: 100% of patients with rectal cancer, MSI-high, had a positive clinical response and didn't need surgery. It's not quite 100% in some of these other cancers, but it's dramatically positive, and we here in the United States have access to those therapies for patients with these dramatically positive benefits. But, as you will hear, not everybody has that access and, therefore, they don't even really want to know what their MSI-high status is, because they can't do anything about it.A second paper, also from a journal you've probably seen before—recent cover change; I kinda like the old cover better myself—Journal of Clinical Oncology. This is also a GI cancer paper. This is from a European consortium group, and there are also some US folks here. They took samples from adjuvant clinical trials in colon cancer and developed a sort of digital path–generated signal of risk, and were able to sort patients into their risk categories so that we could know who needs chemotherapy and who doesn't—who's going to benefit from chemotherapy and who doesn't. Similar to what we are seeing with the MRD ctDNA testing.This is pretty damn cool because everyone's getting surgery, or most of the world who has healthcare is getting surgery. The analysis that this requires is actually relatively inexpensive compared to some of the fancier tests that are out there. It enables a sorting of patients into risk factors—so much, importantly, for whom needs treatment. Because, right now, we're treating everybody. But more importantly, who doesn't need treatment? How much value can we find with these tests that actually identify the patient who's already cured or who will be upfront resistant to the treatment, therefore not needing it?This is really where AI is going. And both of these papers speak to this concept of access and value. When something's a 100% benefit rate, the whole world should have access to that—and that's where you can have MSI for rectal cancer with IO therapy. When, on the other hand, an inexpensive test—a series of tests—can show you who needs treatment and who doesn't, there's incredible value. The whole world saves money if we can apply that kind of metric to decision-making going forward.So, I think these two papers are really good examples of how the progress we are making improves the value and our efficiency going forward, so that as we approach the next generation of cancer care and cancer interventions, we can do it better, more effectively, less expensively—so that one day we can say, yeah, that was worth it.John Marshall for Oncology Unscripted.MEDBUZZ: WHAT IF THE BEST CANCER DRUG IS THE ONE YOU CAN’T GET?John Marshall, MD: We've been talking a lot and thinking a lot about access to cancer care. And let's start hometown—let's start here in the good old US of A—and talk about unequal access to cancer care. Here, we all know that what color you are, what your race is, what your gender is, who your parents were, what type of insurance you have, urban versus rural—we all know about those differences in access to cancer care. A new one that's emerging is specialization of the team that you're seeing. So, general oncology teams versus disease-specific oncology teams tend to produce different outcomes, simply because everything is moving so fast, the subtleties are something that the specialized team can keep up with, that a generalist would struggle with. And this is an important issue that we need to figure out, as a nation, how to ...
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    55 分
  • Oncology Unscripted With John Marshall: Episode 18: “Badge-up” with Dr Marshall at ASCO 2025

    Oncology Unscripted With John Marshall: Episode 18: “Badge-up” with Dr Marshall at ASCO 2025
    2025/06/10
    “Badge-up” with Dr Marshall at ASCO 2025John Marshall, MD: John Marshall coming to you live Oncology Unscripted, not from my office back in Georgetown, but from beautiful downtown Chicago, Illinois at ASCO 2025. Look at this amazing place. 40,000 of our closest friends.To get in, you need to have one of these. So, I'm gonna go ahead and badge up. I got a fancy red collar thing here, boy, that makes me stand out even that much more.But what we're gonna talk about today first is the social aspect. You remember in anticipation of coming, we were a little worried about would people from outside the US come to the meeting, and, yep, they've come, but not to the same extent that they have in years past. So very clearly international travel being affected by the world today, and, therefore, our community, which is so important to get together on a regular basis, probably being a little bit affected by this. But it is an incredible time to get together, to share thoughts, to give a hug or two, to shake a hand or two, and connect with those of us in our community who are dedicated to trying to cure cancer to find positive outcome for our patients for Monday morning, for Tuesday morning, in the week ahead.So, let's start with some high-level reviews of the most important science. Later today, we will have the plenary session where five abstracts will be presented, each one of which has significant impact on our patients going forward. Let's start, in my world of GI cancer, where immuno-oncology, again, doubling down in the microsatellite unstable patient adjuvant IO in MSI patients with chemotherapy proving to be better than chemotherapy alone. Not tested against IO alone, which will clearly be the next question, but for now, starting next week, MSI-high, IO plus chemotherapy in the adjuvant setting in colon cancer.What about gastric cancer? Same thing, IO, and this is not an MSI-high, added to chemotherapy showing survival benefit for our patients with gastric cancer. So, as of today, new standards where IO will be added to adjuvant perioperative therapy for patients with gastric cancer.And the third area where IO has been shown to be a benefit in this plenary session is adding it to radiation and chemotherapy in head and neck cancer, something we've long been needing. Improved novel therapies for head and neck cancer. IO has just entered that field too in the curative intent combo chemo RT setting. So, three major places where IO is gonna have an impact starting today.Now I'm not even gonna try to talk about polycythemia vera. I'm not even sure I can spell it, so I'm gonna make you look that one up yourself.But I wanna finish from a plenary perspective on this breast cancer study. Of course, it's always breast cancer. They are the smartest, they have the most money, they have the highest survival of all of our solid tumors, and, yep, they did it again. They actually show that if you monitor patients who are getting therapy and you can use circulating tumor DNA, so a blood test that can demonstrate the emergence of resistance before there's a change in the clinical scenario. And if you add in, in this case, an androgen hormone degrader, that in fact you can intervene and actually extend survival and progression-free survival significantly. So, this is real time monitoring, using novel blood tests for resistance and changing your therapy in advance of any other clinical signal. Clearly, this is the way things are gonna be going more and more as we define therapies for our patients. Not so much using CT scans and waiting on progression, but blood tests that demonstrate resistance at a much earlier time point.Two other important GI papers. Not part of the plenary. There wasn't room for everything in the plenary, and this is, guess what? It's now good to be BRAF colon cancer. Do you remember when it used to be bad to be HER2-positive breast cancer? Do you remember when it used to be bad to be MSI-high? Well, it's not bad anymore for those two because the therapies work. It used to be bad to be BRAF V600E-mutated colon cancer. Just a bad prognostic sign. Nothing you can do about it. Study just presented showed that the addition of BRAF-targeted therapies and frontline metastatic colon patients with a 30-month median survival. So, that took a bad marker, we can now deal with it. What does that mean for your clinic? I'm gonna be strong here. It now means that it is malpractice, you are not practicing the standard of care, if you're not doing frontline molecular testing in colorectal cancer. You are obligated to find Ras mutations, BRAF mutations, MSI, and HER2 before you initiate treatment. So, this positive BRAF study affects standard of care in your practice today, so you have to do that going forward.There was a study looking at the novel, local therapy for pancreas cancer called tumor treating fields. That showed some positive data, finally, in pancreas cancer, so that's exciting. Tomorrow morning ...
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    11 分
  • Oncology Unscripted With John Marshall: Episode 17: Badges, Booths, and Buses: Welcome to ASCO 2025

    Oncology Unscripted With John Marshall: Episode 17: Badges, Booths, and Buses: Welcome to ASCO 2025
    2025/05/28
    Badges, Booths, and Buses: Welcome to ASCO 2025John Marshall, MD: John Marshall Oncology Unscripted. You know what this is? Yeah. You know what this is. This is my ASCO badge. It is that time of year again where I. I don't know, 40, 50, 60,000 of us and our closest friends all fly up to Chicago, stay in hotels that are overpriced, get bused around downtown Chicago, even on Saturday and Sunday. We get in nice clothes. We go to the convention center. We probably share a virus or two, but we mostly share important new information around the world of cancer. Maybe the most important cancer meeting there is on an annual basis, both from a social but also professional level do we gather to really exchange ideas and hear what's happening out there in the world Now. I also in my badge, got this, a 30-year member, God. know what that means? I got one also called ASCO Ambassador. I'm not even really sure what that means. Maybe I owe 'em money. I don't, I don't know what that's all about. I got my thing that I'm gonna submit to win whatever it is they're giving out, this year at ASCO. So, I've got all my equipment, I'm ready to go.Titles of the abstracts have been released, and there's a lot of really cool information. I know we've been kind of having a sub-theme around pancreatic cancer, last few episodes and during the oral presentations, there are three very important, probably practice changing abstracts around pancreatic cancer, around perioperative treatment for resectable pancreas, cancers, novel therapies that are being brought to the table for pancreas cancer. So, whether you're going or not, you need to know what happened at ASCO. And so, stay tuned because we're also going to be broadcasting from the meeting, and we'll of course follow up with some of the key data post ASCO. Now, most of us, when we think about ASCO, we start with what are the plenary papers this year? And there are five. Two of the five happen to be GI. That's, that's a record. I think for us. Normally it's all breast and then maybe something else. But two of these five are in fact, GI cancers. One is around immunotherapy in the perioperative setting of gastric cancer. Gotta be positive. It's why it's in the plenary session. The other is not news in some way, but, God, if it had been negative, we would really need to rethink things. It's using IO therapy in the adjuvant setting for MSI, high mismatch repair deficient colon cancer. Important study around head and neck and immunotherapy. So, big, continued theme around immunotherapy, incorporation, some targeted therapy in breast cancer. Again, positive. Yet another positive breast cancer study, and the last is around polycythemia vera. Have to kind of throw something to the heme team there. So, it looks like a very interesting year for new data and new research.But if you are thinking about ASCO, I mean. Will people be going? The United States is not the favorite place to be, particularly if you're from another country right now, a huge number of people usually come from around the world. I'll be interested to see do they decide to come, or do they decide to stay home because they're concerned about being in the US and feeling vulnerable at a time when nobody wants to feel vulnerable.Have you ever been to ASCO? It's a zoo. It's a huge convention center, like I say, 40, 50,000 people that are there. But you keep crossing people that like, you know, we did fellowship together, or I know you, you're a friend of mine. Let's stop and talk for a second. Or let's just wave at each other and remember that each other still exists. It's a wonderful experience and if you've never been. You should absolutely go. If you've been every year for the last 30 years like me, then you're eager to go back and see all of your friends and show off your new comfortable shoes and your new tie.ASCO has become more commercial. If you've ever been in the big area, the booth area where all the displays are, they're just remarkable and they have to be divided by US and EX-US because of the different rules. Although still, I've never seen one as quite as good as one I saw early on in my career where they actually had a flowing fountain of water through the entire exhibit. because it was a medicine to help dry mouth and so this water was going to improve your overall feeling, this water in the desert, if you will. I don't even think that drug actually ever really stuck around. But, anyway, they had the best booth, the most remarkable booth that I have ever seen, but it's still pretty commercial, pretty crowded. A lot of people crosstalk on the academic side as well as on the corporate side.I was talking to a company the other day and they were saying that a very high percentage of their business actually gets transacted while in Chicago. Not just ideas exchanged in a follow up email or a call later, but they actually do the discussion and sign on the dotted line while they're in Chicago. So, a lot more closure at ...
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    32 分

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