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From Science to Survival: Dr Marshall Sounds the Alarm on the Dangerous Freeze on Cancer Research
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Released: February 14, 2025

John Marshall
John Marshall, MD
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From Science to Survival: Dr Marshall Sounds the Alarm on the Dangerous Freeze on Cancer Research

 

[00:00:05] John Marshall, MD

 

Hello, everybody. John Marshall from Oncology Unscripted. Do you know where I was this past weekend? I was in San Francisco. It's actually pretty nice weather there in San Francisco. I go pretty much every year. In fact, I have gone to every GI ASCO.

 

Skipping This Test in Frontline Metastatic Colon Cancer? That’s Malpractice Now.

 

[00:00:24] It's really usually my first business trip of the year. Usually, the weather out in San Francisco is kind of rainy and gloomy in the fifties, but it was pretty sunny compared to here out east where it was cold and snowy. So it was kind of good to get away, but that's not really why I go. It's also not a meeting you go to learn a lot of new science. That's usually ASCO and ESMO and other places. Occasionally there's some data, and I'll talk about some of that in just a minute. The reason most of us go to GI ASCO, and I with my perfect attendance at GI ASCO, is to see the people. The GI cancer community is very, very close. Some of us argue that that may be why we haven't made more success, but we are a very, very close community. And this gives us an opportunity to get together, share meals, share ideas, compare notes, and become better at what we do through our camaraderie and our collaboration.

But I do want to make sure and give you the highlights of what happened at GI ASCO. Now the first, and this has really been true for many, many years there is I've been very discouraged, as you know, in the progress that we're making in GI cancers. For example, colon cancer, I have been giving essentially the same adjuvant therapy for colon cancer for 20 years. There is no other cancer where we have failed to make some advances in adjuvant therapy over the last two decades. Essentially, until a paper that was presented in San Francisco, I had been giving the same frontline treatment for metastatic colon cancer until now. Yes, we had MSI, but that's kind of its own different disease. But now what we have is a 9 percent wedge of colon cancer that has BRAF V600E mutations. I remember, because I'm this old, when it used to be bad to be HER2-positive for breast cancer. Now, you want to be HER2-positive for breast cancer because we know how to control that pathway, right? It's a good thing when you're HER2-positive.

 

BRAF, for a long, long time, was just bad news. We had nothing we could do for it, and it was just a bad prognostic marker. So why would you care about knowing? Now you have to know because now we have frontline therapy, proven combination BRAF, EGFR therapy with chemo, big increase in response rate, big increase in Overall survival, new FDA approval that you have to know about for BRAF patients. So no longer can you wait till later to do your RAS and BRAF testing in colon. You have to, or it is malpractice if you don't- yes, sir, yes, ma'am. You need to do it frontline so you can incorporate your frontline treatment of your patients because now that BRAF has some drugs to target to it, we can, in fact, improve the outcome for those patients. So, for me, that was the biggest data set that was out there.

Let me share two other high-level observations. And that is one that we were part of, but others have also shown a similar data set, is that does specialized care is only seeing GI and not knowing anything about breast cancer and lung cancer, et cetera. Does that make me a better doctor? Does it make our team have a better product than if you're a general practitioner who's having to see all of the new treatments and understand all of the nuances all at once? And there's a couple of different beliefs in this. One is that as long as you're practicing the guidelines, as long as you're following the rule book, you in fact do just as well as those who are writing the guidelines and writing the rule book. But some new data we presented and others also presented there suggested that if you are a specialist, things like proper molecular profiling, time to treatment, those kinds of things, can overcome even social determinants of health, which, by the way, with our new administration, there are no imbalances in social determinants of health. That's all gone. it's just wiped away. But those of us who know they still exist; specialization might allow you to prioritize that. So then the question becomes, how do we connect our specialists, those who live one disease day in and day out, to our community docs who are doing most of the work of treating most of our patients in this country and doing a fabulous job. How do we help them? How do we help them to do even better out there with making sure our patients get the best care? And that's our next step of going forward. And that was a theme that came out of the ASCO GI meeting.

 

But the last piece I want to really emphasize, and this is again back to that frustration of lack of success. Is that there are a lot of new drugs coming for GI cancers. One is that there are some very successful RAS targeted agents that are on the way, with very good response rates in pancreas cancer, colon cancer, and other diseases. The problem this has created is that patients know about them, doctors know about them, but there aren't enough slots for all the patients that are out there. So, I was actually engaged in a bunch of discussions with folks about how do we as a cancer community get access to these agents before their eventual FDA approval that doesn't hurt their eventual FDA approval. Essentially that phase four kinds of study, but before so it doesn't spend all the money of the company doesn't hurt their ultimate package. And this is a really important issue. If you thought about it, it would be true with immunotherapy before. But now with the RAS targeting agents, there's more of it there. But it's not just that there are a lot of people nibbling at the edges of different signaling pathways, improved immunotherapy outcomes, in microsatellite stable GI cancer. So, this is going to get better and it's going to get better fast if we can keep the machine going.

 

NCI Silenced, Grants Frozen—What This Means for Cancer Care

 

[00:06:43] And what we really talked about at GI ASCO was the new administration. On Wednesday, the meeting started on Thursday, a good friend of ours, was on a review committee. He's on a normal NCI grant review committee. And during the Zoom, 20 minutes into this review, they'd all done their work. They were presenting their grades, if you will. somebody interrupted the meeting from the grants group and said, this meeting's over. There are no more grant reviews going to happen because of the freeze that a certain president put in place. So, they stopped. Think about if you're a researcher or what not, that grant renewal, that grant application is your career, it's your salary, it's everything, right? And you've spent your whole life to try and achieve that, and now you are uncertain whether it's going to happen at all. so, this was just devastating.

Then I ran into somebody at the airport, a very good friend in the airport, she was saying that their institution interpreted the freeze as there would be no more indirect. So, you know, you get a grant for 100 grand, you get some extra percentage to keep the lights on and the heat on and running water so that you can actually do the science. And that's always the way it's been. But there was some suggestion based on their interpretation that the indirects were going to go away, right? All of that.

Then we got to the meeting, landed, had the airport discussion. We're all anxious. We get to the meeting, and I ran into one of my NCI friends, and the only reason he was there was that he left on Wednesday, because if he had left on Thursday, he would have been shut down, not able to travel, So there was no NCI representation at GI ASCO, and they do a lot of great science there, right? And they were shut down and said, You can't come at all. And in fact, you can't communicate with anybody. You can't share information. You can't put out your bulletins or the information that is your job basically to do. And that person had to go back. They couldn't even stay at the meeting because they only were there for the day. And then they had to go back because of the freeze. Right?

 

So, this has created this wave of uncertainty, fear of panic among many of us out there. So, is there going to be ongoing research funding for us in the cancer world? At a time when we've never known more! At the time we were about to cure this set of diseases, we run into this administration that doesn't believe that science is real or that progress is something that we can have. But it does cost money, but they don't want to spend it on us.

 

Then think about the DEI piece of all of this. Every NCI designated comprehensive cancer center is required currently to have a DEI section in it and everybody's like I talked to actually a few cancer center directors in the last week. They're all saying that's gone. They're just going to take that out and we'll just don't worry. We'll keep doing it. We'll fold it into other things. Yeah, right. You know, there are people who are hired at cancer centers in order to meet that grant requirement in order to play out what we need in terms of DEI support for folks out there.

 

If you offer institution, any sort of gender affirming care. Right. What touch words those are gender affirming care. Then we're going to cut you off. We're not going to give you any support, which would go to education, medical school, research, other things, right? Progress and science. So, if you do that, you're no longer eligible for this. And so, you talk about dictating and governing. And it's not just gender affirming grants, it's all grants that go to your institution, right? And we all know that the government helps support.

 

Now, where's that money come from, from the government? Guess what? It comes from us. I just got my tax form for last year. Just paid the government a whole lot of money to spend. I'm thinking it is on our behalf, right? Not on certain people's behalf, on all of our behalf. So indeed, we have to make sure that everyone knows how disruptive it will be.

 

Now, another piece is that communications have been cut off. So you believe what you see on your feed, right? You do from certain sources. You don't from others. Sometimes you're not sure. Well, if communications out of the NCI and the government are cut off, then you have the right not only to invade the Capitol. It's a new right that you have, apparently, but you have the right to die of bird flu. That's a new right you have. And of course, you have the right to die from cancer because we're not going to communicate any new data about cancer and the cures for it. So, let's face it, this was disruptive.

 

The last story I want to tell you Is this came from my daughter. My daughter is in school becoming a social worker and a minister, and she spends after school time with preteens and kids helping to mentor, helping to guide. And of course, when this all came out, around immigration, these children at school were given a pamphlet on what happens if ICE comes to your door. You all have kids out there. What if your kids came home with a pamphlet that says what are you going to do if ICE comes and knocks at your door? I just want us all to think about that a little bit, what we have done in just one week.

 

Now, it is the next Wednesday after GI ASCO. This will air a little later. So, who knows what will have happened by the time this airs. But just today I saw on the Washington Post, also owned by a billionaire who was on the podium during the inauguration, so you got to wonder in the Washington Post, it's been rescinded. For all the confusion it has caused. it's confusing because they didn't know what they were doing. They just think all of this is the right thing to do.

 

So they're just blowing up stuff and then figuring it out later. we're uncertain here. We are trying to keep our heads down. We are trying to take care of the patients. I'm on service right now. So I'm trying to make sure we manage keeping our eye on the ball of taking care of people who need us in the medical translational research community. but it is very hard not to be distracted by what our world is becoming, what's happening to it, how it's being nibbled around the edges and how it's being exploded only to say, Oh, no. We were kidding. We didn't really mean it, but we could mean it in the future.

 

I don't know what to tell you. But I encourage all of you who out there are listening is to throw some comments in shoot me a note, put it in the chat, if you will, but let's get this conversation going and get it noisy so that those people not too far from here on the other end of Pennsylvania Avenue for me, hear it loud and clear and understand that their whims have major impact on our future. What is it to be a great nation? It is to take the success that you have and share it with others. That is really what we have lost. I think with this election is this concept of sharing it with others. It is what we do in the healthcare world. We take the gifts that we have we share them with others. I really hope that you have a chance to share your gifts with others. John Marshall for Oncology Unscripted. Until next time.   [00:14:39]