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Are We Watching a Global Evolution in Cancer Care Leadership?
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Released: March 25, 2026

John Marshall
John Marshall, MD

         

 
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Are We Watching a Global Evolution in Cancer Care Leadership?

John Marshall, MD: John Marshall, Oncology Unscripted. You know, I still get journals. I think I’ve mentioned that before. I still get the actual paper copy. And this one came into my inbox, into my mailbox, just yesterday, and I was scanning down and I found a paper that actually, in my field, it’s in cholangiocarcinoma, that was looking at perioperative, preoperative, neoadjuvant treatment for cholangio, and it’s in the New England Journal.

And you would’ve thought I would’ve already known the result, and maybe I’m just not paying attention. So I went to page 983, and I saw that neoadjuvant chemotherapy along with lenvatinib and, by the way, a PD-1 inhibitor preoperatively had a major positive impact on overall outcome in cholangio.

And I’m like, how did I not know about this? And I looked at the authors, and I looked at where this study was done, and I realized the paper was done in China. And we’ve talked on this program before about the impact of research that’s being done in China on all of us. First, we were skeptical of Chinese data. Now it’s in the New England Journal. It is an important article and probably practice-changing for us in bile duct cancers.

We talk about competition and new science and who’s discovering what and being somewhat envious of the Chinese product that’s coming out. But let’s also remember that the Chinese are doubling down on their investment. Their patient population is participating in this innovative science, whereas here in the United States, new budget numbers say we’re going to decrease the investment in science and science research, cancer, and everything else as well.

So how can we compete when they’re increasing their investment and we are devaluing the science and investment that we’re putting in there? So we’ve got to come to terms with this in order to move forward.

I think about our acceptance of this. We’ve been fighting it, but now we’re accepting it.Even our current administration is embracing the idea that we’re going to have to figure out energy. Maybe it’s solar energy to keep up with the Chinese, not just to beat the Chinese, if you will, but to keep up with the Chinese.

So I’ve been reflecting a lot not only on this paper and the rapid evolution that we are seeing in novel therapies as new drugs, targeted agents, and immunotherapies are moving into every corner of cancer care and other diseases as well, but also our sort of relationship with others around us on this planet and how we, instead of competing—healthy competition’s okay—but instead of competing economically and medically and scientifically, how we work more and more together as a group. And I don’t think the current environment is sustaining that or supporting that.

Hopefully it’ll evolve over time to where it improves. Fingers crossed. I would like to see it in my lifetime. Not holding my breath, however. But I do think it’s the way we should be going. John Marshall, Oncology Unscripted.

This transcript has been generated by AI and edited for clarity.