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Global Realities of ASCO Innovation: Perspectives From Eastern Europe
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Released: August 07, 2025

John Marshall
John Marshall, MD
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Interview With Dr Stefan Pörsök

 

John Marshall, MD: Hey everybody, John Marshall for Oncology Unscripted, and I am so excited to be joined today by a very, very good friend and colleague who had spent some time here in Washington, DC, with me. We got to know each other very well. He graciously invited me to his hometown, which he'll tell you about in a minute. So, I've gotten to spend time in his hospital, in his hometown, and we just got back having run into each other in Chicago at ASCO. And part of what we started talking about while we were there was differences in access to cancer care. ASCO's all about new treatments, new fancy this or that—expensive drugs, new tests, standards of care—but standards of care for rich countries that can just not care that they have a balanced budget like the United States. But he provides cancer care to people in a world where you can't get an MRI every week if you want one. And so, I am so gracious and grateful to him for having joined us today to talk a little bit about his hometown and the cancer care he is delivering. So, Stefan, introduce yourself to our great audience and we'll get into the discussion.

 

Stefan Pörsök, MD, PhD: My name is Stefan Pörsök. I'm a medical oncologist in Bratislava, Slovakia, in Europe. I am the head physician of the gastrointestinal and neuroendocrine cancer unit. As a GI oncologist, I've been working approximately 20 years in this very interesting and very hard patient population with GI cancer. As we see, the treatment approach has developed very correctly, and now we have new data, new biomarkers, new treatment approaches, and tumor-agnostic treatment approaches. And, I don't know this problem in other countries, but in our country, we have difficulties with accessibility to targeted drugs.

 

In colorectal cancer, mainly, we have a problem with IO—with MSI-high colon cancer or colorectal cancer. We are speaking or talking about just in metastatic cancer. Neoadjuvant treatment approaches are not possible currently. Sometimes in young patients, we do a good job with reimbursement, and we have the drug for the patient—but that's not for everyone. BRAF-mutated colorectal cancer: serious problem with combination therapy in second line. We have now good and practice-changing data in first line. I don't know what will be the situation in our country. This practice-changing data—nivo, ipi, and other treatment—practice-changing data, because reimbursement is much higher than in monotherapy.

 

We don't have accessibility in later lines, maybe for regorafenib, maybe fruquintinib. We don't have this drug yet in routine reimbursement in our country. We don't have routine reimbursement in metastatic gastric cancer when CPS is high. Gastric cancer patient—new, practice-changing data for durvalumab as a first line—currently, we don't have accessibility. Cholangiocarcinoma line and biomarker-driven treatment: FGFR treatment, we don't have IO in first line with gemcitabine in combination.

 

John Marshall, MD: Let me ask you something. So, the IO for MSI, for example—to me, it's shocking because those treatments are so effective compared to standard of care and other chemos. You would think that would tip the balance on the cost side. Can I ask a different angle though—one, really two follow-ups. One is: are patients aware that there are these drugs out there that they don't have access to?

 

Stefan Pörsök, MD, PhD: No, the patients aren't aware of these drugs. We have some experiences with these drugs. Currently, in our republic, routine accessibility for IO is available in metastatic malignant melanoma, non–small cell lung cancer, triple-negative breast cancer, renal cell cancer in second line, and for MSI-high metastatic colorectal cancer. We are waiting now for the discussion and final decision of our government and policymakers.

 

John Marshall, MD: You could argue that MSI-high colon cancer works better than in all the other cancers you listed. So, it is—it’s crazy, isn’t it?

 

Stefan Pörsök, MD, PhD: Crazy because—

 

John Marshall, MD: Let me ask you a second question. You go to ASCO, you’re always there—and you're learning and you're sharing your experiences with others. How frustrating is that meeting for you?

 

Stefan Pörsök, MD, PhD: I'm very frustrated from this ASCO. We have 10-year follow-up data on IO therapy, colorectal and non–colorectal cancer. We have data—47 patients alive 10 years after treatment. And it's cured, this patient. And this is very frustrating, and it’s terrible for the patient.

 

John Marshall, MD: If you were Donald Trump and ruled the world like he thinks he does, what would be your thought about how to even access global cancer care? Yes, it's very expensive—

 

Stefan Pörsök, MD, PhD: Yeah.

 

John Marshall, MD: Because of development costs and things like that. But some of it is because in America we're paying more than everybody else. It's expensive. So, what would you recommend to the world to make it better?

 

Stefan Pörsök, MD, PhD: It's a very hard question. The tailored therapy—not as prior therapy with prior therapies—but a tumor-agnostic tailored therapy. This therapy has a very high percent of curability or prolonged survival for these patients and a very acceptable toxicity profile.

 

John Marshall, MD: I was thinking the same thing. We do so many things that are wasteful—using standard medicines that don’t work. Or like in adjuvant therapy, most patients don’t really benefit from it or don’t really need it, but we give it to everybody, and that's covered. And yet, we're holding back on these—yes, expensive, but much more effective—medicines. If we had to trade off, I think I probably would, to your point.

 

Stefan Pörsök, MD, PhD: I don't know how it will improve for our patients. We have groups; we are trying to find our patients, try to discuss with our policymakers and people in health policy, and try to argue that this is—we have success with this communication with the government. But it is very hard work, very long, and we have a lot of patients that could have a good impact from this therapy. We are good in the field of locally advanced, or—we have really nice surgery, interventional radiologists, radiation oncologists, but we have a problem with the targeted drugs. And I guess we are not alone in the world with this problem.

 

John Marshall, MD: Yeah, it’s a problem we have to solve because there are a lot of people out there who could be cured of their cancer—or certainly have a major impact on overall outcome. And I actually think, on the backside, it would help lower the cost of drug development and the return on investment for these companies that are discovering new drugs.

 

Dr. Stefan Pörsök, a good friend of mine—a little bit on the other side of the world—but he was gracious enough to spend some of his busy time with us on Oncology Unscripted. Thanks very much, Stefan.

 

These are three really smart folks who care so much about not only the science of cancer care but applying that technology to their populations and their patients. And you've heard the struggles that they have going forward. You've heard some of the ideas they are putting forward about how, if we were to work together, we could, in fact, solve some of these problems—and probably at a bargain rate. So, I'm hoping that this series on access to cancer care post-ASCO has been useful to you and effective in getting you thinking about how you can contribute to improving the outcome for not only the patients you're going to see tomorrow, but those around the world who are facing these diagnoses.

 

John Marshall For Oncology Unscripted.