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We Funded the Cure—Now We're Pulling the Plug?
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Released: April 16, 2025

John Marshall
John Marshall, MD
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We Funded the Cure—Now We're Pulling the Plug?

 

John Marshall: Welcome to Washington DC. My name is John Marshall. This is Oncology Unscripted. There is a whole lot of stuff going on out there, seemingly unscripted, seemingly without much in the way of a sense of motivation, really a plan. It's just blow it up. Let's see what'll happen after the fact.

 

But let's stop for just a second and think about what science, federally funded science, has accomplished over the last many decades here. Because a lot of us, including a lot of the population as well as the government, feels like, it was really business that did everything, not the government. So, we should shift all of this money over to business and take it away from the government. So, they're firing all sorts of people here in Washington and around the country with the science community.

 

But let's start by acknowledging what science has done for our health. So first, we know that cancer mortality has fallen dramatically. If you think about when I first started as a fellow a thousand years ago, really the only investment in clinical translational research was through the National Cancer Institute, occasional company here and there, and all of this improvement that we're seeing today comes really from that beginning, and so we've had a clear, positive influence. But let's look at some of the details here. The concept of, I don't know, rituximab, immunotherapy, and multi chemotherapy treatments, and the cures for lymphomas comes out of government invested research, bone marrow transplant comes out of government investment research.

 

How about understanding HPV and using vaccines? I know. Vaccines are crazy things that we shouldn't be giving because they're terrible things, right? According to the current government. But let's talk about the discovery of HPV and vaccines, which is going to get rid of HPV-mediated tumors.

 

What about imatinib? Remember that drug that was really out of the beginnings, of government research? But you know what? One of the ones that's my favorite is actually HER2. HER2 was discovered with government funded research, the therapies for treating HER2-targeting, transforming it from just a bad target, prognostically bad target, to something that actually is good news nowadays because we know how to treat it well. That was all done with government research, right? And so then here comes swooping in a pharmaceutical company under the name of Genentech that took it and made it into a billion-dollar profit that helped to fund other research.

 

And so, we have failed to value the innovation that comes from the government world, and there's just so much of it out there. And over the last month or so, there's been this dramatic downsizing of grants, grant applications, payment for grants that are funded, downsizing the number of people who are at the National Cancer Institute and other places around the world where there is federal funding for these with the, with the idea being that that's just wasteful, I guess that's the thought.

 

We know that the NIH investment has fueled a great deal of economy in all of the places that it's ongoing. So, not only is it producing science and our understanding of the biology of cancer and other diseases, it is also helping the local economy. Then what really got me going on, this was an ad. I'm pretty sure you're probably seeing them too, at your home for our new president and our new, folks that have taken over, ruling our country in a completely different way. And in fact, this team had the boldness to put out an advertisement that in four years they will cure cancer. You should watch it. It's just unbelievable. If they're going to fire all of these people who are the brains and the brain trust and the innovators and they're not going to fund the science that's teaching us what we need to know in order to actually cure cancer. We're going to get rid of all of those people and somehow through some other mechanism, they are going to have cured cancer in four years. So, what have we got to worry about? Right? This is going to be all fine because don't you worry our boss is going to cure cancer.

 

Speaking of cancer that we need to cure. We've been talking a lot lately about pancreatic cancer and what a difficult disease it is, and despite great deal of investment and positive input around it, we've made some strides, but not the kind of strides we need to make. But I do want to reinforce the progress that we have made. I've been thinking a lot about pancreas cancer comparing to colon cancer. I'm still giving the same adjuvant therapy I've been giving in colon cancer for 21 years. That's an embarrassing statement. On pancreas cancer, we have made progress. We know the drugs that are working there better. We are curing more people with pancreas cancer. One of those innovations is liposomal irinotecan, and the idea that you could take existing drugs and improve their performance by modifying their delivery and the formulation, and that's what liposomal irinotecan is all about. So, we now have pretty clean data that frontline incorporation of liposomal irinotecan in a FOLFIRINOX recipe is in fact better than other options in frontline.

 

And so, it really begins to fall on us more and more to make individual decisions about which drugs we're going to use and when. And so, this pushes down onto each of us. A sort of plan or a strategy of what regimen do you give in frontline? What do you give in second line? Which of the drugs do you combine? I think the best data we have is with NALIRIFOX, if you will, in frontline.

 

How much of this is going to be under our control? We are all feeling the pressure. How many peer-to-peer reviews are you having to do every week for what is essentially standard of care? I'm doing too many of them I have to tell you. So, we are clearly feeling an outside pressure in healthcare today about incorporating what we see as best of care for our patients, and so I want us to make sure that we are connecting, that the experts in your area and the generalists in your area are talking. And that we're sharing advice and optimizing individual patient care for all patients throughout our communities, because we know that if you do that, you get better outcomes. It's not necessarily about being more aggressive. That's often the term we use. It's honestly about being more effective.

 

As you know, we've been interviewing some of the leaders in the world of pancreatic cancer and we thought it would be appropriate to reshow some of these key comments that leaders have made, such as Julie Fleshman, who started and runs the biggest advocacy group for pancreas cancer, PanCan.