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On the Ground at ASCO GI: People, Pipelines, and Precision
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Released: January 28, 2026

John Marshall
John Marshall, MD
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Oncology Unscripted at ASCO GI: People, Pipelines, and Precision

 

John Marshall, MD:
Hello, everybody, from San Francisco, California. My name is Dr. John Marshall, and you are on—maybe unwisely—Oncology Unscripted. But thanks for joining me. I love this meeting, but let's first talk about the news of 2026.

 

Top of the line is: we're out to get new countries. Now, I'm sort of running for mayor of Havana. I don't know if it's important that I, in fact, speak Spanish—because I don't. I speak a little bit of French. My Spanish is terrible. But maybe it won't matter, because I am who I am, and they're looking for just my kind of person to go be mayor of Havana. So, if you see that and you get a chance to vote, vote me in. I love the whole country of Cuba—it's beautiful.

 

Second, in today's newspaper—I couldn't believe it—this guy named Dr. Oz, you know him, he's an actual cardiologist, believe it or not. Then he became the talk show host. And then, for some reason, he's the head of CMS at this point—one of the head overseers of healthcare here in the country. And he said his position was that alcohol is good. This couldn’t have made me happier. This couldn’t have been a better holiday present, because I'm a big alcohol fan myself, and now I can feel less guilty about it. His rationale is that if you drink more, you'll be with people more, you'll be more relaxed, and the camaraderie will pay off in terms of lessening your anxiety and stress—and the world will be a happier place.

 

So, don’t be smart. We don't want people in our country to be intelligent or educated. Drink more. Be less educated. You'll be happier in the long run. That's the official position of our government today.

 

Probably the most important new news from a healthcare perspective is that the House approved an extension on the Affordable Care Act. This has been an incredible threat and uncertainty for so many of our patients. The people who depend on that health insurance could never afford cancer care without it. Having the extension of the Affordable Care Act—for them—talk about lowering your stress. Maybe better than alcohol is actually being insured.

 

I don’t know if you go to many meetings out there, but this one is called GI ASCO. It's always in San Francisco. It's always in this building that I'm standing in now. I have perfect attendance. I’ve been to every one since they started. You should get a special ribbon for that. I think there’s probably one down there for that.

 

They are a little bit more environmentally conscious—no plastic covering to this. Just a piece of paper. Totally recyclable old name badge. Way to go, ASCO, on that.

 

Do you go to meetings or don’t you? I come to this one for a very, very important reason. I come to this one for the people. It’s a small meeting. It’s just the GI gang, both from the industry side and the academic side. It’s a very heavy global presence that comes. I know almost everybody here, and there are only like 3,000 people here. There’s time to stop and say hello to almost everybody you know—give them a hug, share a little COVID, maybe flu, with each other—but then know that you are connected again. And this is something Zoom doesn’t do. This is something you can’t check on—somebody’s kids—over a meeting. But that’s one of the main reasons I come.

 

I love these people. These are people that share in our values and our motivation to try and cure cancer. We all take care of the group of cancers—GI cancers—which are the most common, most fatal cancers on our planet. We are inspired to do this. We know it’s a steep climb, and we do it together. I’m so very pleased to be a part of this community, and it’s the main reason I come.

 

Main reason—people. Second reason—pipelines. There’s a lot of data out there, and there are a lot of companies here that finally have new products for GI cancers. We’ll talk a little bit about that in more specific detail, but if you just look at the number of groups that are here—the number of people who’ve got innovative, new approaches—whether it’s novel immunotherapy, targeted agents, combinations of those, targeted antibodies that are delivering toxic payloads—we’re seeing waterfall plots that we haven’t seen in decades.

 

So, response rates, survivals, progression-free survivals that really compare favorably to our traditional chemotherapy approaches. We are on the cusp of a true revolution in the world of GI cancer.

 

And, surprisingly, one more—led by the world of pancreatic cancer. So, let’s talk a little bit about precision in GI oncology. The biggest breakthroughs that we are seeing at this meeting have to do with RAS targeting.

 

There are a bunch of RAS drugs out there now. There are some that are more out in front than others. There are some that are degraders that break down the RAS. There are some that block pan-RAS, so they hit a bunch of RAS targets. There are some that are very specific for one particular kind of RAS mutation—and they’re working.

 

Now, they’re not curing everybody. But we’re seeing great waterfall plots, even with single agents, in a disease that we haven’t cracked in a long, long time—and that is pancreatic cancer.

 

So, we are all incredibly optimistic about what we are seeing. We are anticipating approvals this year for some—maybe one or more—of these agents. We’re excited about the possibility of combining these RAS-targeted agents with things like immunotherapy or others. We are already starting to try and think about: is the pan-RAS better than an isolated targeted RAS? What are the toxicities? How are we going to manage it? Because we’re fully expecting these drugs to get approval and to get rapidly incorporated into our day-to-day management.

 

First, pancreas cancer. We’re seeing it in biliary cancers. We’re seeing it in stomach cancers. Where we’re not seeing it just yet is in colorectal cancer. And I would’ve predicted a long time ago that colon was going to be the easiest nut to crack. And yet, we’ve made progress. But in fact, what we’re going to see now—biliary, hepatocellular, pancreas cancer, stomach cancers—we’re going to see a lot of evolution over the next several years.

 

A good friend, and really a fabulous speaker, Dr. Andrew Ko from here in San Francisco—UCSF—was the discussant just an hour ago in this building, where he did a great job of setting the stage of both the excitement for the future, but also a healthy respect for what we are going to need to understand to march forward quickly but effectively for all of those patients we’re sitting across the exam room from—that need our help.

 

So, precision medicine is finally making its way to GI cancers—led by the RAS wave that we are seeing. So, stay tuned. You’re going to have new drugs out there. There’s going to be competition. A lot of people talking about it.

 

As we talked a lot about pipelines and the new drugs that were coming out, one of the common questions we get is: what's missing? What have we not been studying well enough? And I have a pretty consistent answer—and that is the microbiome.

 

We don’t understand the impact of those bacteria on us, on our health, on the effectiveness of drugs, etc. And until we really start digging into that science, I don’t think we’ll see that next wave of innovation. So, the answer is microbiome.

 

So, why do I come to GI ASCO every year? Well, you already know the number one reason—that’s people. I love them. They’re my family, and I love to catch up with them just like you do with your family around the holidays. This is my family visit for the holidays.

 

Second—pipelines. Understanding what’s out there today, what’s coming, and how we are going to cure patients with GI cancer. It’s going to be through these pipelines.

 

And then last—the latest data. And that’s around precision medicine. We are about to embark on a wave of therapies that target RAS, and you’re going to start to see cancer shrink as these new drugs come into play.

 

Our job, then, over the next couple of years, is to take this new understanding, this new ability to control precision medicine, and apply it to our patients—to cure more patients with GI cancers.

 

Thanks for joining me from San Francisco. Totally unscripted. John Marshall, Oncology Unscripted.