Main Topic: Reporting live from ASCO 2025 in Chicago, Dr. John Marshall reminds us why being there matters—for both data and dialogue. Beyond the packed sessions and headline-making practice changes, this year’s meeting underscored the power of community, connection, and real-time exchange, where the science is both personal and practice-changing. MedBuzz: Reporting live from ASCO 2025, Dr. Marshall goes off-script to spotlight what’s not on the slides. From proposed NIH budget cuts and the ongoing absence of an NCI Director to AI-generated references in national policy documents. This MedBuzz is a wake-up call about truth, leadership, and what’s at stake for cancer care.
“Badge-up” with Dr Marshall at ASCO 2025
John Marshall, MD: John Marshall coming to you live Oncology Unscripted, not from my office back in Georgetown, but from beautiful downtown Chicago, Illinois at ASCO 2025. Look at this amazing place. 40,000 of our closest friends.
To get in, you need to have one of these. So, I'm gonna go ahead and badge up. I got a fancy red collar thing here, boy, that makes me stand out even that much more.
But what we're gonna talk about today first is the social aspect. You remember in anticipation of coming, we were a little worried about would people from outside the US come to the meeting, and, yep, they've come, but not to the same extent that they have in years past. So very clearly international travel being affected by the world today, and, therefore, our community, which is so important to get together on a regular basis, probably being a little bit affected by this. But it is an incredible time to get together, to share thoughts, to give a hug or two, to shake a hand or two, and connect with those of us in our community who are dedicated to trying to cure cancer to find positive outcome for our patients for Monday morning, for Tuesday morning, in the week ahead.
So, let's start with some high-level reviews of the most important science. Later today, we will have the plenary session where five abstracts will be presented, each one of which has significant impact on our patients going forward. Let's start, in my world of GI cancer, where immuno-oncology, again, doubling down in the microsatellite unstable patient adjuvant IO in MSI patients with chemotherapy proving to be better than chemotherapy alone. Not tested against IO alone, which will clearly be the next question, but for now, starting next week, MSI-high, IO plus chemotherapy in the adjuvant setting in colon cancer.
What about gastric cancer? Same thing, IO, and this is not an MSI-high, added to chemotherapy showing survival benefit for our patients with gastric cancer. So, as of today, new standards where IO will be added to adjuvant perioperative therapy for patients with gastric cancer.
And the third area where IO has been shown to be a benefit in this plenary session is adding it to radiation and chemotherapy in head and neck cancer, something we've long been needing. Improved novel therapies for head and neck cancer. IO has just entered that field too in the curative intent combo chemo RT setting. So, three major places where IO is gonna have an impact starting today.
Now I'm not even gonna try to talk about polycythemia vera. I'm not even sure I can spell it, so I'm gonna make you look that one up yourself.
But I wanna finish from a plenary perspective on this breast cancer study. Of course, it's always breast cancer. They are the smartest, they have the most money, they have the highest survival of all of our solid tumors, and, yep, they did it again. They actually show that if you monitor patients who are getting therapy and you can use circulating tumor DNA, so a blood test that can demonstrate the emergence of resistance before there's a change in the clinical scenario. And if you add in, in this case, an androgen hormone degrader, that in fact you can intervene and actually extend survival and progression-free survival significantly. So, this is real time monitoring, using novel blood tests for resistance and changing your therapy in advance of any other clinical signal. Clearly, this is the way things are gonna be going more and more as we define therapies for our patients. Not so much using CT scans and waiting on progression, but blood tests that demonstrate resistance at a much earlier time point.
Two other important GI papers. Not part of the plenary. There wasn't room for everything in the plenary, and this is, guess what? It's now good to be BRAF colon cancer. Do you remember when it used to be bad to be HER2-positive breast cancer? Do you remember when it used to be bad to be MSI-high? Well, it's not bad anymore for those two because the therapies work. It used to be bad to be BRAF V600E-mutated colon cancer. Just a bad prognostic sign. Nothing you can do about it. Study just presented showed that the addition of BRAF-targeted therapies and frontline metastatic colon patients with a 30-month median survival. So, that took a bad marker, we can now deal with it. What does that mean for your clinic? I'm gonna be strong here. It now means that it is malpractice, you are not practicing the standard of care, if you're not doing frontline molecular testing in colorectal cancer. You are obligated to find Ras mutations, BRAF mutations, MSI, and HER2 before you initiate treatment. So, this positive BRAF study affects standard of care in your practice today, so you have to do that going forward.
There was a study looking at the novel, local therapy for pancreas cancer called tumor treating fields. That showed some positive data, finally, in pancreas cancer, so that's exciting. Tomorrow morning frontline trastuzumab deruxtecan data will be presented for patients with HER2-positive breast cancer, showing dramatic deltas and PFS and OS when you initiate treatment within trastuzumab deruxtecan instead of the traditional therapies there.
Practice changing common cancers. Precision medicine driven, IO-driven. It's a dramatic year for new data; new standards of care being presented here in Chicago. ASCO 2025.
John Marshall, Oncology Unscripted.
Live from ASCO: What the Slides Don’t Show
John Marshall, Oncology Unscripted ASCO 2025.
You know what this is? It's called the ASCO Daily News. They hand you one of those as you enter the building here every morning. And yeah, there's a lot of good science here, a lot of cool things, and pictures of prominent presenters. Even old oncologists get their picture here as well. But there's a whole bunch of stuff that's not in the oncology news that's really important to our future.
On Friday, Trump unfolded his budget. His budget includes a 40% reduction in the NIH budget. It is a huge delta in what will happen at the National Cancer Institute, if indeed this happens. 15% indirect rate officially now on the table. The Cancer Center Directors, NCI Cancer Center Directors, visited Capitol Hill last week hosted by Georgetown’s Lou Weiner, my boss, and they all went up to the hill to talk to various congressional folks about what the heck's going on. If you cut this budget, we will lose ground in terms of America's ability to contribute to cancer research at a time when we know more than we ever did.
Our European colleagues have put out advertisements to attract some of our major thought leaders to go to Europe, granting visas so that they can in fact do their own brain drain of us now that our budgets are being cut. So, we really have to figure it out. What we are doing and the impact this is gonna have day to day, not only on our research, but on our cancer care delivery, for our patients here in the United States. And I don't think folks have really thought that through very well.
Secondly, we of course have no NCI director right now. They're sort of an interim. And one of my friends, a guy named Wafik El-Deiry, who's at Brown, has put his hat in the ring. He had said some pro-Trump stuff coming into this year thinking that shaking up clinical research was gonna be a good idea, but he's sort of like, what are we talking about now? And he said, I'll do it. I'll do the job if you give me $50 billion for cancer research. Well, that's more than the current budget is. And of course, I just told you they're cutting the budget. So, I don't see any way that angle, that argument, is gonna take any traction with our current administration. So Wafik, I hope you get what's on your Christmas list, but my guess is you will not. And my guess is we will continue to go without an NCI Director, and an unclear future about the role the NCI is going to play, in global cancer drug discovery and drug development and looking for cures.
The other major theme that we're hearing here at this cancer meeting is that artificial intelligence is gonna be important. That if you're not doing it, if you're not embracing it on the education level, on the research level, any level you wanna look at, then you're gonna fall behind. And I think most of us probably agree that it's gonna be a very, very important tool.
But you that little thing called Make America Healthy again, that just came out from somebody named Kennedy. Well, that actually includes seven papers that were hallucinating. References in our national policy proposal that never were written that AI wrote instead. So, where's truth? How are we gonna know what's real? How are we gonna know what's a hallucination when we do our Google searches? How deeply does a journal need to review a paper to know whether AI wrote it or in fact, some fellow who wants to get a paper on their CV wrote it, right? How are we gonna prove truth going forward when a government policy paper has seven references that never existed, supporting what we're proposing. How are we as a major cancer community gonna keep track of what's real and what's not real? So, I'm very anxious about AI and how we're gonna manage that going forward. We know we need it. We don't know how to control it. Figure this out. Everybody.
John Marshall
Oncology Unscripted.