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Oncology Unscripted With John Marshall

Oncology Unscripted With John Marshall

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Oncology Unscripted with John Marshall, MD brings you a unique take on the latest oncology news including business news, gossip, science, and a special in-depth segment relevant to clinical practice. Aprendizaje de Idiomas
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  • Oncology Unscripted With John Marshall: Episode 23: The Molecular Space Race: Will It Bring Earlier Detection and Better Treatment?

    Oncology Unscripted With John Marshall: Episode 23: The Molecular Space Race: Will It Bring Earlier Detection and Better Treatment?
    Nov 18 2025
    MEDBUZZ [0:00:05]When the Sources of Trusted Information Change—Who Do We Believe?John Marshall, MD:Happy whatever day it is today when you're watching this. John Marshall for Oncology Unscripted. A little bit of a rainy day here in Washington, DC. It's been a little bit of a weird time here in Washington, DC—even weirder than it normally has been.Let's start with a little of the business of our world today—the business of oncology. You may have seen that we have a new National Cancer Institute director: Dr Anthony. Professor of medicine, he's kind of a basic science guy, but he's also a medical oncologist from Dana-Farber. Would you take that job if it was offered to you? I knew some of the candidates who were in line for it—or the finalists—and you'd really have to want that job to take it right now, because of all the unsettledness at the NIH in general, et cetera. So, I'm grateful that this very smart person has said yes to the job. Now, what he does—one of his areas of expertise—is programmed cell death, which is sort of a subtle way of getting a cancer cell to kill itself, right? So maybe, just maybe, he'll use some of that expertise to help in the shifting of government. A little programmed cell death around here might go a long way. So, fingers crossed that he succeeds in maintaining and growing the research that we are doing in cancer, much of which is sponsored through the National Cancer Institute. So, fingers crossed.But as soon as he gets the job, what happens? Well, we shut down the government.We've done this before. It is weird in Washington when the government shuts down. Whether it's patients who now don't have a job for the moment and who risk not having health insurance to receive their ongoing cancer care—in my case—or care in general out there.We're clearly seeing an impact on patients. We're clearly seeing an impact on government operations. I'm supposed to fly to Florida to get measles, maybe, this coming weekend, and I'm not sure we will do it because—who knows if there'll be air traffic controllers available? Would you go to work if you weren't getting paid?I had a recent call with an NCI colleague who is going to work, who is seeing patients, and is trying to manage things—but is uncertain about whether they will be paid.I also happened to come across recently somebody in the medical center who works up in McLean. If you know what offices are in McLean, I'll let you figure that out—sort of secret spy stuff. Normally, they're incredibly busy, but because there aren't any other government activities going on, they're kind of sitting there saying, "Well, we can't do what we normally do because we're dependent on the rest of the government to do what we do." So even those who are going to work are kind of stalled.So, there's a whole lot going on. The one positive—and it's not really a positive to make up for the negatives—is that the traffic's a lot lighter here in Washington. But still, not enough to make up for it.Now, I do want to talk a bit about another big topic that’s come forward. You know that RFK Jr. fired 17 members of the Advisory Committee on Immunization Practices. This is the group that gathers to make recommendations around vaccines and immunizations in general. He fired a lot of them. He put some replacements in—many of whom have been featured in other articles—I won’t drill down into the weeds on some of this, but many of them are more than just anti-vaxxers. They’re suggesting that we’ve mismanaged this as a medical community, and that we’ve not been telling the true scientific story.The new people who’ve been put in place haven’t made any formal recommendations yet. But the most recent one that came out is that there’s even some debate about whether newborns should be given hepatitis vaccines. And that data is very, very tight about how many lives are saved because of vaccines—as they all have been shown. But we’ve forgotten data, and we’re going to have to relearn the lesson going forward.Do you read the front page of the paper or don’t you? In my family, it’s split. My wife only reads the sports section. I read the front section—or at least read the headlines.In the Washington Post editorial page was an article written by the last six Surgeon Generals—right and left—appointed by different presidents over time. And this was a very thoughtful piece that basically summarized that RFK Jr.—he’s perfectly entitled to have his own opinions about things—but he’s not entitled (this was their conclusion) to put other people’s health at risk.And they collaboratively, collectively, emphatically said that that is what is going on with this new ACIP committee—with RFK Jr. at the helm. That we are putting a lot of people at risk, and it’s what’s making us all very, very anxious in the medical community today.Now, I want to talk in closing on this about a book that I am reading. Don’t worry, it...
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    33 m
  • Oncology Unscripted With John Marshall: Episode 22: ESMO, Efficiency, and Evidence: A Look Ahead at New Data and Important Updates

    Oncology Unscripted With John Marshall: Episode 22: ESMO, Efficiency, and Evidence: A Look Ahead at New Data and Important Updates
    Oct 14 2025
    [00:00:05] Main Topic ESMO, Efficiency, and Evidence: New Data, China’s Science Leap, and Leucovorin and Autism John Marshall, MD: Hey everybody, John Marshall from Oncology Unscripted. There is so much going on right now that we're gonna need a full hour-long show, but we're not gonna do that to you. We still promise short bites here and there of the stuff that's going on, just to make sure you're in the loop. I'm sure you are.But let's start with a little science. And the science we wanna focus on is the upcoming ESMO meeting. We've looked at the leading abstracts that are gonna be presented there, and there's not gonna be a lot of surprises about the content. There's a lot of innovation in precision medicine and immunotherapy and different diseases, and positive randomized trials, and some exciting early-phase clinical trials. But what I think is worth noting is that a pretty high percentage of the science that's being presented at ESMO actually comes from China—Chinese pharmaceutical companies sponsoring it, China's institutions running the clinical trials. And there's been a lot of discussion about the quality of Chinese data.Just recently, on September 23rd, Scott Gottlieb—who used to be, of course, the head of the FDA—did a very nice opinion piece in The Washington Post about the impact of Chinese drug development. The quality wasn't actually that bad—it was just less expensive. They were able to do clinical research much less expensively than we can here in Western society, if you will.So, it's not so much intellectual innovation—it's efficiency in getting answers out. His whole editorial is about: how do we reshape and reprioritize our own clinical research infrastructure? How does the opportunity of a, I don't know, a world turned upside down in terms of regulatory oversight, et cetera, give us a chance to maybe improve the process, to lower the cost of drug development, so that our innovation—which we really still remain the hub for—can actually be brought forward and not create some sort of global intellectual property war, which he refers to, but more: how do we keep up with the pricing structure and the innovations that are out there?So, I encourage you to not only look through the abstracts from ESMO—because there are some very important positive results from that—but also think a little bit about how we, in different parts of the world, even the playing field around the cost of new drug development. I encourage you to read that Scott Gottlieb Washington Post editorial.One of the big abstracts that will be presented is around MRD ctDNA testing and using that technology as a way to define who should receive adjuvant therapy and who should not. Of course, we are interviewing the lead author on that paper, so stick around for that interview. But we clearly can see that genetic testing may, in fact, have a major impact on making us more efficient on who should get adjuvant therapy and who should not.So, I do clearly think that's the evolution that's going forward. You wanna make sure to keep your finger on the pulse of MRD ctDNA testing in the decision-making process for adjuvant therapy and subsequent treatment.I'm lucky enough to be running a protocol here in the United States looking at MRD positivity in patients with colorectal cancer, and others are doing it in other diseases.One of the ways that could, in fact, make that much less expensive is digital pathology. Because it turns out that a digital image of an H&E slide—and there's some fascinating data around this—can actually predict risk almost as well as genetic testing. So, that's very inexpensive. It takes 20 minutes to scan it in, send it off to the computer, AI reads it back, and gives you a risk factor.So, I do want you to also keep a nose out for digital pathology as an impact.But maybe the most unsettled science that I saw in the last week actually was also in The Washington Post. Now, The Washington Post, in one issue, reported on vaccines killing children, our administration down the street is going to be talking about how evil vaccines are—continuing that discussion that their rising costs are gonna break us in the U.S. Our economy is so built around healthcare that the rising costs are eventually gonna break it. And the risk is that what I'm saying right now might land me in the same boat as Jimmy Kimmel—of getting fired. But you know, last night he was back on again. So maybe that will only be temporary. But the science I wanna talk about is this whole connection between, say, Tylenol—acetaminophen—and autism. And the only reason it says “Tylenol” is that Donald Trump can't say the word “acetaminophen.” And so many people out there are affected with autism over many, many decades—even well before Tylenol/acetaminophen was invented. But what really caught my eye is these smaller studies that have suggested that leucovorin—which is folinic acid, okay? It’s reduced folic ...
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    33 m
  • Oncology Unscripted With John Marshall: Episode 21: Watching Vaccine Access Collapse in Real Time

    Oncology Unscripted With John Marshall: Episode 21: Watching Vaccine Access Collapse in Real Time
    Sep 16 2025
    [00:00:05] MedBuzz: Back to Being ‘Just a Doctor’John Marshall, MD: John Marshall for Oncology Unscripted, coming to you live from this big office. This is the biggest office because, you know, I've been the Chief of the Division here at Georgetown for 20 years. I didn't want the job when I was first offered it a long time ago. I ended up saying yes. Of course, that's a dramatic change in one's academic career—taking on administrative roles like this. You do get the big office, which is nice, but you also get a lot of other stuff. You know too much. You know who's mad at whom, you know who you need to recruit, and who you need to un-recruit—all of those things. You have the business side of a cancer business going on, and you're a doctor, and you're doing clinical research, and you're trying to educate everybody around you.About a year or so ago, I decided in my own head that 20 years is enough. And so, as of this summer, I have officially stepped down as the Chief of the Division here at Georgetown. My colleague and much smarter friend, Dr. Steven Liu—lung cancer expert, world expert—is stepping in to be the Chief of our Division, and he's already hit the ground running. The fresh voice is honestly already a positive. You can just hear the freshness of his voice and his attitude and his energy. You know, the Mayo Clinic actually has a structure where you can only be in a leadership position for so many years, and it has to turn over. And I really like that. It's sort of like what we hope our presidential terms will be. But who knows—that may change. But there's a limit: you do the job for a certain period of time, and then someone else steps in and gives you that fresh voice and fresh perspective. But that's not the traditional way of doing it. Most of the time, people hold on to their position as long as they can hold on to it, until they can't do it anymore or they decide to go to some other institution.But the reason I'm sharing this is that I'm now in this sort of weird new place. I'm an ordinary staff physician. All of a sudden—yep. I have my patients, I'm doing my thing, I'm putting people on clinical trials, I'm educating the brand-new fellows who just showed up here about a month ago. Great fun having brand-new fellows 'cause they don't even know how to spell 5-FU, much less how well it works, how it works, and the side effects, etc. So, I love the first few months 'cause you're teaching people a lot of new things that they need to know. But anyway, that part's very exciting. So, I'm still doing all of that.But what I'm gonna have to get used to is not knowing everything—also not feeling responsible for everything. And that's gonna be a change for me. So, any of you out there who've either been through that transition or who maybe wanna offer me some therapy—I'm in line for some therapy as I transition, as I begin to slow down my academic career, withdrawing as the Chief of the Division, but still doing my day-to-day job and still trying to cure cancer.Take care of each other out there. Take care of your bosses and those leaders. It's not a great, fun job. But also, remember: those of us who are now back in the trenches—we need to take care of each other as well. John Marshall for Oncology Unscripted.[00:03:35] Editorial: Watching Vaccine Access Collapse In Real TimeJohn Marshall, MD: John Marshall Oncology Unscripted. First piece of advice: don’t read the newspaper. Second piece of advice: don’t watch C-SPAN, for sure. Just yesterday on C-SPAN was the big congressional hearings. I did read the summary of it in The Washington Post, where RFK Jr. was interviewed—cross-examined for three hours by both sides of the aisle—about what he has been doing with the CDC. And I think we all, as medical professionals, need to take a big step back and a pause and sort of ask: what the hell is going on?You know, the specifics first. He fired everybody at the CDC. He has hired new people at the CDC. They have not come forward with any formal vaccine recommendations. This is all about vaccines and the like.Yesterday in clinic, a patient of mine—who would be a candidate for both flu and COVID vaccines, who could have, a month ago, walked into CVS and gotten both of those injections—now, in the state of Virginia (and I think there are about 14 other states where this is true), has to have a prescription. This came out from CVS and Walgreens—that you have to write a prescription. Physicians have to write a prescription so that patients can take it to the CVS and Walgreens to get their vaccines. Some states are not providing them at all. Some states have gone the other way, where they’ve formed collaborations—and this is those cool West Coast states: Washington, Oregon, Hawaii, California. They’ve formed a consortium to say, “We are gonna set our own policy,” because the government’s policy right now is up in the air about whether you can get access to them, whether...
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    20 m
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