Main Topic: Dr Marshall kicks off this episode with a whirlwind preview of ASCO 2025. What plenary sessions are practice-changing? What’s the buzz around pancreatic cancer? And what’s the real value of showing up—beyond the data? Whether it’s your first or 30th ASCO, this is your unscripted guide to oncology’s biggest week. Candid Conversations: Dr. Marshall sits down with three Georgetown fellows as they prepare for their first-ever ASCO. From what to pack to what they hope to learn, this panel captures the anticipation and curiosity of oncology’s next generation. It’s a reminder that for every seasoned badge-holder, there’s a newcomer seeing ASCO—and cancer care—through fresh eyes. MedBuzz: In this MedBuzz, Dr Marshall dives into the federal government’s escalating attacks on academic freedom, including a letter threatening Harvard’s funding, visa retaliation against graduate researchers, and pressure on journals like The New England Journal of Medicine. What does it mean when the U.S. begins dismantling its own scientific foundation? For patients, it’s not just political—it’s personal. Without funding, the cures don’t come.
Badges, Booths, and Buses: Welcome to ASCO 2025
John Marshall, MD: John Marshall Oncology Unscripted. You know what this is? Yeah. You know what this is. This is my ASCO badge. It is that time of year again where I. I don't know, 40, 50, 60,000 of us and our closest friends all fly up to Chicago, stay in hotels that are overpriced, get bused around downtown Chicago, even on Saturday and Sunday. We get in nice clothes. We go to the convention center. We probably share a virus or two, but we mostly share important new information around the world of cancer. Maybe the most important cancer meeting there is on an annual basis, both from a social but also professional level do we gather to really exchange ideas and hear what's happening out there in the world Now. I also in my badge, got this, a 30-year member, God. know what that means? I got one also called ASCO Ambassador. I'm not even really sure what that means. Maybe I owe 'em money. I don't, I don't know what that's all about. I got my thing that I'm gonna submit to win whatever it is they're giving out, this year at ASCO. So, I've got all my equipment, I'm ready to go.
Titles of the abstracts have been released, and there's a lot of really cool information. I know we've been kind of having a sub-theme around pancreatic cancer, last few episodes and during the oral presentations, there are three very important, probably practice changing abstracts around pancreatic cancer, around perioperative treatment for resectable pancreas, cancers, novel therapies that are being brought to the table for pancreas cancer. So, whether you're going or not, you need to know what happened at ASCO. And so, stay tuned because we're also going to be broadcasting from the meeting, and we'll of course follow up with some of the key data post ASCO.
Now, most of us, when we think about ASCO, we start with what are the plenary papers this year? And there are five. Two of the five happen to be GI. That's, that's a record. I think for us. Normally it's all breast and then maybe something else. But two of these five are in fact, GI cancers. One is around immunotherapy in the perioperative setting of gastric cancer. Gotta be positive. It's why it's in the plenary session. The other is not news in some way, but, God, if it had been negative, we would really need to rethink things. It's using IO therapy in the adjuvant setting for MSI, high mismatch repair deficient colon cancer. Important study around head and neck and immunotherapy. So, big, continued theme around immunotherapy, incorporation, some targeted therapy in breast cancer. Again, positive. Yet another positive breast cancer study, and the last is around polycythemia vera. Have to kind of throw something to the heme team there. So, it looks like a very interesting year for new data and new research.
But if you are thinking about ASCO, I mean. Will people be going? The United States is not the favorite place to be, particularly if you're from another country right now, a huge number of people usually come from around the world. I'll be interested to see do they decide to come, or do they decide to stay home because they're concerned about being in the US and feeling vulnerable at a time when nobody wants to feel vulnerable.
Have you ever been to ASCO? It's a zoo. It's a huge convention center, like I say, 40, 50,000 people that are there. But you keep crossing people that like, you know, we did fellowship together, or I know you, you're a friend of mine. Let's stop and talk for a second. Or let's just wave at each other and remember that each other still exists. It's a wonderful experience and if you've never been. You should absolutely go. If you've been every year for the last 30 years like me, then you're eager to go back and see all of your friends and show off your new comfortable shoes and your new tie.
ASCO has become more commercial. If you've ever been in the big area, the booth area where all the displays are, they're just remarkable and they have to be divided by US and EX-US because of the different rules. Although still, I've never seen one as quite as good as one I saw early on in my career where they actually had a flowing fountain of water through the entire exhibit. because it was a medicine to help dry mouth and so this water was going to improve your overall feeling, this water in the desert, if you will. I don't even think that drug actually ever really stuck around. But, anyway, they had the best booth, the most remarkable booth that I have ever seen, but it's still pretty commercial, pretty crowded. A lot of people crosstalk on the academic side as well as on the corporate side.
I was talking to a company the other day and they were saying that a very high percentage of their business actually gets transacted while in Chicago. Not just ideas exchanged in a follow up email or a call later, but they actually do the discussion and sign on the dotted line while they're in Chicago. So, a lot more closure at ASCO than I thought. I thought it was mostly openings, if you will.
In one word, what does ASCO mean to me, it's community. reminds us that we are part of a huge, invested, caring global community that's focused on curing cancer, and we get together to remind ourselves every year, recharge ourselves and take that energy back so that we can make it another year doing the hard job that we do. Community.
After ASCO, you definitely wanna tune back into Oncology Unscripted. We might have a couple of interviews that'll be interesting to you, but mostly we're gonna focus on the new data, the practice, transforming data that's out there that we're gonna want to, know about for everyday practice for you and your patients.
So, if you are a busy clinician. Maybe a generalist. Almost always the answer is 'no, I don't have time to go to ASCO.' It's not an efficient use of your time. Right. So, you would rather go on a Saturday to the best of ASCO and hear the best of, in one afternoon, one day. So, that, that's the practice changing stuff you need to take back with you. And I don't blame you one bit. I think it is the responsibility of us specialists to go to ASCO. like that and pull out all that we can pull out in our area. So, I'm not gonna go to the breast meeting and I'm not going to the lung meeting. I'm gonna focus on the GI meetings So, I can learn every little bit I can to help me be a smarter parson So, that I can help develop the next study and help those around me provide the best GI cancer care we can.
ASCO's a really, really special time for many of us. Usually, the weather in Chicago is pretty nice. We get a chance to meet new people that do what we do. We get a chance to check up with old people to know that, hey, you're still out there and you're doing okay, and you're making progress in the world of cancer care.
So, it's really an incredibly busy time. Sleep is out of the question. You just don't do it. You work all day long. You party until the wee hours, and then you get up and do it all over again, usually four days in a row. some of the busiest and hardest days of the year. But also, I would say some of the best days of the year. I can't wait to see many of you in Chicago at ASCO.
Crumbling Crown: The Collapse of America’s Research Backbone
John Marshall, MD: How's your week been this week? What's the federal government done to you in your world this week? I've been doing a little bit of math and I've been tracking my patients coming through clinic, and yes, I'm in Washington DC, So, my numbers are going to be higher than yours are in this regard. But right now, about one out of every five patients I'm seeing has been directly affected by changes in employment due to the changes that the government's putting into place. One in five. Either they've lost their job, they chose the fork in the road, or they're feeling eminently threatened by their current job status. Their current job status is vulnerable, if you will.
I sit in section 309 at the Nats Park. I have a half season. I'm there a lot. I drink an occasional beer while I am there. Baseball is my escape. The nice woman who sits right behind me, who's been sitting there for years as well. She, every time I go to a game, is there, and I said, did it happen? And so, last night I was at the game, and she said, no, not yet, but she thinks this week. So, it's everywhere around us, this dramatic downsizing that's just sort of sweeping the country, and we don't really know how it's going to have an impact on any of us going forward.
Now we, in the academic world, we in the cancer world are feeling this in a dramatic way. So, we have discussions every week at the leadership level of will grants continue to exist? Will funded grants be paid? We have examples where they have been withdrawn, right? I happen to know if somebody who was offered a cancer job at a prominent, stable, large, old academic institution withdrew the offer because they were uncertain about future budgetary issues because of the changes in grants. I've never seen that happen in my 35 years of being a faculty member. So, clearly a change in the world. you start thinking about the job that we have, this drug development and new discoveries. How will we go forward? Let's say I'm industry. How can I reliably continue to invest in this front? When I'm not sure how things are gonna go. If I'm an investigator based at an academic institution, how do I decide that that's a logical career path forward for my brain and my intellect if I don't know that there'll be this source of funding to do the research, to set the standard, to change the standard of care?
In many ways, what we're hearing is that the United States is becoming increasingly irrelevant and untrustworthy for sure. The whole point of what we established in establishing the National Institutes of Health and the National Cancer Institute was to be the gold standard, to be the rock that was always going to be there, to be the constant stream of new data and new resources that will the actual improvements in many diseases, not just cancer. We know that that's why people would come and want to train here. So, the best brains on the planet would wanna come and train and be trained by us here in the United States because of this resource. And, of course, all of this is going away.
The Georgetown University faculty, my daughter, who is my sage. Yesterday, that our faculty, I somehow missed the memo, is now gonna hold a weekly vigil for one of our graduate students who was deported because according to the federal government, his visa status was not right. But really, we know it was because the research he was doing was not in line with what the current administration feels is important.
I don't know if you saw this, but the New England Journal editor in chief received what was perceived to be kind of a threatening letter basically accusing them of not publishing "competing viewpoints." A randomized clinical trial. Patient got treatment A versus treatment B, and the accusation is that the authors may be misleading the readers. So, is this an assumption that the science was fraud? Is it an assumption that there's a counterpoint to their hypothesis that was not listed in the science? I don't know. I don't even know where it comes from. So, this is where we are, is that the federal government is trying to undermine the veracity, the solidness, stableness of the data being presented by the New England Journal of Medicine, one of the journals that we have in highest regard, and it is their strategy, of course, right, is to doubt, to cause doubt, in things that we hold, to be the solid base and the truth, if you will.
Now, you all know that, talked about before on Oncology Unscripted this, this concept that the federal government sent Harvard a letter, which we talked about already, that basically said, we're freezing your funding. So, $2.2 billion of funding to Harvard has been frozen with an additional billion dollars in grants. And basically, threatening the education of international students. They're talking about removing Harvard's tax status.
And, of course, Harvard is the one group that has quite publicly stood up and essentially said, look, you don't have the rights to do this. And their president, Harvard's president, wrote this response, and I do wanna read it to you in specific.
It says the consequences of the government's overreach will be severe and long lasting. Research that the government has put in jeopardy includes efforts to improve the prospects of children who survive cancer, to understand at the molecular level how cancer spreads throughout the body, to predict the spread of infectious disease outbreaks and to ease the pain of soldiers wounded on the battlefield. Opportunities to reduce the risk of multiple sclerosis, Alzheimer's disease and Parkinson's disease are on the horizon. The government's saying, "no, we don't wanna know that." And the victims, will be the future patients, so writes their president. And their loved ones who will suffer with a heartbreak of illness that might have been prevented or treated more effectively.
So, this indiscriminate slashing of science, medical technology research is essentially undermined our role and our ability to help, not just Americans, but people around the world. The accusation, again said by Alan Garber, who's the president of Harvard is that this was the government's reaction to the university, Harvard being antisemitic Alan Garber is Jewish and American, and he basically says, look, we understand our role in all of this. They take their work very seriously, and they'll continue to fight hate with an urgency that it demands. And they will comply with all their obligations under the law they say, he says, it's not only their legal responsibility, it's their moral imperative. Such a strong pushback counter statement to that.
But then, you know, our Secretary of Education? No, you don't know who that is, but She's become famous really for a couple of things. One, she was at an AI meeting. She kept referring to it, because she can't read the teleprompter as A-one. Which of course the reason you know this is that every steak sauce joke in America comes from this statement, statement, this lack of understanding of even where she was.
But then she also was, in theory, the signatory or author of a response to Dr. Garber at Harvard for his letter that he had just sent, that I quoted there. And if you haven't seen this, this has been getting a lot of social media press just because of the quality of writing. You would think that our Secretary of Education could write a letter, particularly if you're writing it to somebody at Harvard that at least is grammatically correct, if not at least readable and understandable. But as you can see, and as I'm sure you have seen on social media, the people in charge aren't up to the game.
And that's how they're doing this. They're undermining education. They're undermining those sources that are our foundation of knowledge of truth, So, that we can get on with curing cancer or whatever it is that our cause is. But by undermining us, causing doubt on us, they can then bring their agenda forward.
And I want to restate what I've shown you before is that there is an ad out there. claiming that the current administration under the President's leadership will cure cancer by 2029. why does it matter what we do? Why does it matter where truth resides? Because the real truth is gonna come forward over the next four years, and we will no longer have to worry about cancer.
In the meantime, I hope to see you at ASCO in Chicago, and I hope you continue to do the right thing, to build truth, to build for the future because we know it's gonna be back on our shoulders soon, and in fact, the load will be heavier when it's back on our shoulders. So, be in shape, get ready because it is gonna come back to us to solve the problems.
John Marshall, Oncology Unscripted.
The Fellows’ Forecast: What First-Timers Expect at ASCO
John Marshall, MD: Hey everybody, John Marshall for Oncology Unscripted. We are getting all ready to go to ASCO and we thought it would be really interesting to talk to some people who are going to ASCO who have never been. I was thinking back, my first ASCO was in a year that started with 19, just to give you an idea, and it used to rotate around different cities. Been at Chicago, same place, same bat channel every year for many, many years at this point.
I was actually able to coerce some of our fellows who are making their first trip ever to ASCO to come on and for a quick interview, introduce themselves, give us some thoughts about what they're anticipating, and then if they're nice enough, maybe we'll grab 'em after ASCO to see what they learned and what was different than what they were expecting. So, listen in folks for what, you might reflect back as to what you thought before you went to your first ASCO.
Tina, introduce yourself and maybe give us one word of what's ringing around your head about what you're anticipating for ASCO.
Tina Roy, MD: Hi, I am Tina. I'm one of the second-year fellows at Georgetown, second year hematology oncology fellow. I did med school back in Scranton, Pennsylvania at Geisinger, and I did residency and now fellowship here. The one word that, I think of is, overwhelming because of how packed it is.
John Marshall, MD: That one's gonna come true. That one's gonna come true. Christian, introduce yourself. Give us your thoughts.
Christian Agbisit, MD: I went to med school in the Philippines, but then my residency in Illinois, and then ended up in Georgetown for fellowship. And my word is something big is at ASCO.
John Marshall, MD: Good. I think big, it will feel that way for sure. And last, but not least, Nikita.
Nikita Chintapally, MD: Hi everyone. My name's Nikita. I went to medical school in India at Kasturba Medical College, did my residency here in DC, and happy to be at Georgetown. I'm a first-year heme/onc fellow. My word for ASCO, as I'm a baby fellow, I still like to think of, is just ready to get inspired, I guess.
John Marshall, MD: That's awesome. And, let me tell all of you out there listening, and these are three of the smartest people. It's such an honor to work with these folks who have dedicated their entire lives and they know so much more than old people know, and I'm dependent upon them. And they're great partners for us, and they're nice enough to spend time with us. Actually, I snuck them out of somebody else's clinic right now to do this, so, I'm in trouble with their current clinic mentors. But anyway, let's get right into it.
Tina, let me pick on you first. When I first went to ASCO, I thought it was all about fun. I wanted a hotel with a good pool, in the, in the range of fun versus work. Where do you think this is gonna be? What's your impression of what it's gonna be?
Tina Roy, MD: I think it's going to be in the middle. Work because there's so many different events to go to. I've tried to make my schedule multiple times already and I can't decide for some of the sessions which ones to even go to. So, I think I'm going to even have to watch some, like on demand after. And then fun, there's a bunch of dinners planned already. I am planning on getting deep dish pizza, So, I think there'll be, it'll be fun too.
John Marshall, MD: There is a lot of fun. There is booze involved at ASCO. Sleep is not one of the big things. Christian, work-fun. Where are you in this balance? Here?
Christian Agbisit, MD: Yeah, I think it's gonna be both. Basically, because I'm graduating and going into a community practice, I wanted to kind of soak in all the new stuff.
John Marshall, MD: I wanna come back to you maybe afterwards about the community practice piece because you'll notice just that there aren't many community practitioners who go to ASCO but do get a feel for that when you're there. As you look at that, because it becomes not worth it to community docs to go to ASCO, which is always one of—and they go to best of ASCOs on a Saturday somewhere, later. So, I'd be interested in your feedback on that of the value that you see, as a rising community practitioner, in the future.
Nikita, where are you? Work fun.
Nikita Chintapally, MD: I am hoping it's more on the spectrum of fun for me. I'm hoping to, you know, do maybe meet some people, meet other fellows, happy to just branch out, network in any way possible. I'm really excited to see more people do like oral presentations. I think it'll be really inspiring, and it'll be a good way to get a sense of how people present their work in an effective way. So, I think that's what I'm looking forward to the most.
John Marshall, MD: One of my partners and good friends, and one of your mentors, Dr. Isaacs, is giving a. Big oral presentation, you gotta show up for that and see what it's like. Because it is, it does make you nervous when you get up there in front of, what is the largest room you will ever be in for a medical meeting. So, just so get ready for that is one piece of it.
Christian, let me pick on you. Have you thought about packing yet? Carry on. Are you gonna check? I mean, it's what, three, four days, right? So, what are you gonna do?
Christian Agbisit, MD: Well, basically just gonna pack like some shirts, and shoes, comfortable shoes for walking.
John Marshall, MD: That is such a boy answer, isn't it? Mm-hmm. let's talk, I, you know, I'm a married man. I know about packing that it's different by gender, although some boys are more about their packing than others, but ladies, have you thought about it?
Tina Roy, MD: Comfortable shoes.
John Marshall, MD: Heels? Let's start there.
Nikita Chintapally, MD: I'm doing sneakers.
John Marshall, MD: Sneakers.
Tina Roy, MD: Definitely practical shoes.
John Marshall, MD: Okay.
Tina Roy, MD: I also am going for a day extra because I have a lung cancer event to go to beforehand, so I actually have thought about how many outfits, and I think I might need to go shopping this weekend.
John Marshall, MD: So, it's remarkable. I will wait to see what is going on this year, which is how dressed up people are. This is just a warning. particularly when we see people from other countries, they tend to, there's a lot of heels when you and to Christian's point you, you know, you, you put a lot of steps on, right? I mean, you, you, one meeting to the next could be a quarter mile, in terms of just distances. So, practical shoes is a good piece of advice. Nikita, do you have a particular, have you already put it out on the bed? Know what you're gonna take?
Nikita Chintapally, MD: I'm probably just gonna need to pack maybe like a blazer or some layers, because I know conference centers can get super cold.
John Marshall, MD: Cold. It's totally true. It's totally true. And you don't sleep by the way, just so you know. So, you, you party until late and then. You get up early because the next session that you really feel like you should go to is at 7:30 AM. And by the way, you're gonna be taking a bus with a bunch of other nerdy oncologists from downtown Chicago to the convention center sipping coffee. Don't spill it on yourself because you had to be careful with your pack, right? This is just advice, To go out there. it is a contact sport ASCO. So, you're also gonna see for the first time, Nikita, I'll start with you. It's like we've all been to meetings where pharmaceutical companies display stuff, right? So, I don't know if you've been to a big meeting before, but they have these halls where they have their booths and their maps, their actual maps. And so, any idea about what that's gonna be like?
Nikita Chintapally, MD: I have absolutely zero clue what that's gonna be like. I'll probably see the, you know, drug names that we use in clinic, and that'll be the extent of my excitement, but maybe I'll be, it'll be different.
John Marshall, MD: Have you all had, have you been to one of these meetings where you've seen this kind of huge booth?
Tina Roy, MD: I haven't seen huge pharmaceutical booths, but even some small ones can be pretty exciting. I'm expecting a, because I've heard about it, I'm expecting a lot, I think.
John Marshall, MD: Well, one thing you'll notice, this is it'll freak you out—and you'll go, Dr. Marshall? The carpet is thicker, so they make fancier carpet to slow you down when you're on the booth. So that's one thing you'll notice. There are two sides, US and not US because there are different rules around regulatory, they hire people who are not real reps to stand on the corners to welcome you.
So, there's this big thing, the wildest booth I have ever seen. I'd be interesting if our listeners might chime in. many years ago, and it was a medicine for dry mouth, and they literally had a fountain flowing through a sand desert in the middle of this booth. So, when you all go, we always try to pick our favorite or maybe, worst booth that you, you went to go see. So maybe when we follow up later, you take a, share something with like, you were just like, whoa, that, that was, that was something.
Let's do something more important while we're really going. am, and maybe I'm back to Tina. So, what do you wanna learn? What are you expecting to learn?
Tina Roy, MD: I'm really excited about the trainee and early career lounge because of meeting other mentors, meeting other fellows. So, I’m hoping to learn a little bit more about the job application process. See different people in different practices. I am also really excited to see what interaction is between pharmaceutical companies, oncologists, what kind of atmosphere there is.
So, I think I'm kind of, of course, those big like plenary sessions, oral abstracts. I'm excited about learning the nitty gritty about what's happening, but also just like that atmosphere and interaction between the different groups that are there.
John Marshall, MD: That's great answer. Christian?
Christian Agbisit, MD: Kind of same thing as Tina. How I can treat my patients, plenaries and which are the, well, the new stuff that comes out in.
John Marshall, MD: You know, if it's in the plenary, it's positive. So that's one of the things you can pretty much bank on, going forward. Nikita, what are you hoping to learn from all of this? That you really wanted to be a surgeon? No, no, no. Something different.
Nikita Chintapally, MD: Never, yeah, definitely similar to what Tina said about the early career and mentorship, as I'm going into second year, we have more research time, so hopefully trying to see, you know, you know, what could be feasible from my standpoint. Get some ideas and just again, big, big picture. Get really inspired, hopefully.
John Marshall, MD: I think you'll be surprised. By the number of people that you actually recognize. You'll, you'll cross paths, maybe, you know, through your training at other institutions or just you'll see people you recognize. And of course, it is when you're as old as I am. You recognize lots of people. I think. So that's one thing that is fun too, is that you connect to people that you don't see often or regularly.
It is time to connect, the internationalness of it is quite striking. So, you'll see people from all over the world. are certain countries that do not allow, or we don't let them in. To be blunt. And so, they will go to ESMO or other meetings so that you will notice the absence of certain people, maybe, you know, over time because their countries don't allow, or we don't allow their immigration in.
But very much of an international feel to it. It's both exhilarating, I think. But it's exhausting too because you are learning. There's a lot of new stuff you're drinking in. There is a lot of business that's transacted during the meeting, and a lot of new data that's unloaded on us.
And so, what we then try to do is take this information as say just a GI specialist and try to integrate it into how does it affect treatment on the Wednesday, when we get back on June 4th. So, from there. So, any last thoughts? Christian, you got a plane ticket,
Christian Agbisit, MD: Yeah.
John Marshall, MD: okay, you got a hotel? Okay, then those are the two most important things, Nikita, any thoughts?
Nikita Chintapally, MD: What are you most looking forward to, Dr. Marshall?
John Marshall, MD: Well, so my problem is, is that I'm overbooked and so, I, I, you know, which meeting will I actually go to, and will I actually go and see any data being presented? So, I'm at a place where I almost never go into the posters or to the presentations because I got too much other stupid stuff going on in my world.
It’s an enjoyable event because so much, it is our community. It is a celebration of our community. It's, it's an excitement. You all talked about being inspired and, you know, reaffirming what you do so you leave, you leave charged and ready to, to move on to cure cancer.
Thank you, guys, very, very much. I know you gotta keep running. We'll get back together in a couple of weeks and see what you learned when you went to the 2025 ASCO.
John Marshall for
Oncology Unscripted
Talk to you all soon.
Badges, Booths, and Buses: Welcome to ASCO 2025
John Marshall, MD: John Marshall Oncology Unscripted. You know what this is? Yeah. You know what this is. This is my ASCO badge. It is that time of year again where I. I don't know, 40, 50, 60,000 of us and our closest friends all fly up to Chicago, stay in hotels that are overpriced, get bused around downtown Chicago, even on Saturday and Sunday. We get in nice clothes. We go to the convention center. We probably share a virus or two, but we mostly share important new information around the world of cancer. Maybe the most important cancer meeting there is on an annual basis, both from a social but also professional level do we gather to really exchange ideas and hear what's happening out there in the world Now. I also in my badge, got this, a 30-year member, God. know what that means? I got one also called ASCO Ambassador. I'm not even really sure what that means. Maybe I owe 'em money. I don't, I don't know what that's all about. I got my thing that I'm gonna submit to win whatever it is they're giving out, this year at ASCO. So, I've got all my equipment, I'm ready to go.
Titles of the abstracts have been released, and there's a lot of really cool information. I know we've been kind of having a sub-theme around pancreatic cancer, last few episodes and during the oral presentations, there are three very important, probably practice changing abstracts around pancreatic cancer, around perioperative treatment for resectable pancreas, cancers, novel therapies that are being brought to the table for pancreas cancer. So, whether you're going or not, you need to know what happened at ASCO. And so, stay tuned because we're also going to be broadcasting from the meeting, and we'll of course follow up with some of the key data post ASCO.
Now, most of us, when we think about ASCO, we start with what are the plenary papers this year? And there are five. Two of the five happen to be GI. That's, that's a record. I think for us. Normally it's all breast and then maybe something else. But two of these five are in fact, GI cancers. One is around immunotherapy in the perioperative setting of gastric cancer. Gotta be positive. It's why it's in the plenary session. The other is not news in some way, but, God, if it had been negative, we would really need to rethink things. It's using IO therapy in the adjuvant setting for MSI, high mismatch repair deficient colon cancer. Important study around head and neck and immunotherapy. So, big, continued theme around immunotherapy, incorporation, some targeted therapy in breast cancer. Again, positive. Yet another positive breast cancer study, and the last is around polycythemia vera. Have to kind of throw something to the heme team there. So, it looks like a very interesting year for new data and new research.
But if you are thinking about ASCO, I mean. Will people be going? The United States is not the favorite place to be, particularly if you're from another country right now, a huge number of people usually come from around the world. I'll be interested to see do they decide to come, or do they decide to stay home because they're concerned about being in the US and feeling vulnerable at a time when nobody wants to feel vulnerable.
Have you ever been to ASCO? It's a zoo. It's a huge convention center, like I say, 40, 50,000 people that are there. But you keep crossing people that like, you know, we did fellowship together, or I know you, you're a friend of mine. Let's stop and talk for a second. Or let's just wave at each other and remember that each other still exists. It's a wonderful experience and if you've never been. You should absolutely go. If you've been every year for the last 30 years like me, then you're eager to go back and see all of your friends and show off your new comfortable shoes and your new tie.
ASCO has become more commercial. If you've ever been in the big area, the booth area where all the displays are, they're just remarkable and they have to be divided by US and EX-US because of the different rules. Although still, I've never seen one as quite as good as one I saw early on in my career where they actually had a flowing fountain of water through the entire exhibit. because it was a medicine to help dry mouth and so this water was going to improve your overall feeling, this water in the desert, if you will. I don't even think that drug actually ever really stuck around. But, anyway, they had the best booth, the most remarkable booth that I have ever seen, but it's still pretty commercial, pretty crowded. A lot of people crosstalk on the academic side as well as on the corporate side.
I was talking to a company the other day and they were saying that a very high percentage of their business actually gets transacted while in Chicago. Not just ideas exchanged in a follow up email or a call later, but they actually do the discussion and sign on the dotted line while they're in Chicago. So, a lot more closure at ASCO than I thought. I thought it was mostly openings, if you will.
In one word, what does ASCO mean to me, it's community. reminds us that we are part of a huge, invested, caring global community that's focused on curing cancer, and we get together to remind ourselves every year, recharge ourselves and take that energy back so that we can make it another year doing the hard job that we do. Community.
After ASCO, you definitely wanna tune back into Oncology Unscripted. We might have a couple of interviews that'll be interesting to you, but mostly we're gonna focus on the new data, the practice, transforming data that's out there that we're gonna want to, know about for everyday practice for you and your patients.
So, if you are a busy clinician. Maybe a generalist. Almost always the answer is 'no, I don't have time to go to ASCO.' It's not an efficient use of your time. Right. So, you would rather go on a Saturday to the best of ASCO and hear the best of, in one afternoon, one day. So, that, that's the practice changing stuff you need to take back with you. And I don't blame you one bit. I think it is the responsibility of us specialists to go to ASCO. like that and pull out all that we can pull out in our area. So, I'm not gonna go to the breast meeting and I'm not going to the lung meeting. I'm gonna focus on the GI meetings So, I can learn every little bit I can to help me be a smarter parson So, that I can help develop the next study and help those around me provide the best GI cancer care we can.
ASCO's a really, really special time for many of us. Usually, the weather in Chicago is pretty nice. We get a chance to meet new people that do what we do. We get a chance to check up with old people to know that, hey, you're still out there and you're doing okay, and you're making progress in the world of cancer care.
So, it's really an incredibly busy time. Sleep is out of the question. You just don't do it. You work all day long. You party until the wee hours, and then you get up and do it all over again, usually four days in a row. some of the busiest and hardest days of the year. But also, I would say some of the best days of the year. I can't wait to see many of you in Chicago at ASCO.
Crumbling Crown: The Collapse of America’s Research Backbone
John Marshall, MD: How's your week been this week? What's the federal government done to you in your world this week? I've been doing a little bit of math and I've been tracking my patients coming through clinic, and yes, I'm in Washington DC, So, my numbers are going to be higher than yours are in this regard. But right now, about one out of every five patients I'm seeing has been directly affected by changes in employment due to the changes that the government's putting into place. One in five. Either they've lost their job, they chose the fork in the road, or they're feeling eminently threatened by their current job status. Their current job status is vulnerable, if you will.
I sit in section 309 at the Nats Park. I have a half season. I'm there a lot. I drink an occasional beer while I am there. Baseball is my escape. The nice woman who sits right behind me, who's been sitting there for years as well. She, every time I go to a game, is there, and I said, did it happen? And so, last night I was at the game, and she said, no, not yet, but she thinks this week. So, it's everywhere around us, this dramatic downsizing that's just sort of sweeping the country, and we don't really know how it's going to have an impact on any of us going forward.
Now we, in the academic world, we in the cancer world are feeling this in a dramatic way. So, we have discussions every week at the leadership level of will grants continue to exist? Will funded grants be paid? We have examples where they have been withdrawn, right? I happen to know if somebody who was offered a cancer job at a prominent, stable, large, old academic institution withdrew the offer because they were uncertain about future budgetary issues because of the changes in grants. I've never seen that happen in my 35 years of being a faculty member. So, clearly a change in the world. you start thinking about the job that we have, this drug development and new discoveries. How will we go forward? Let's say I'm industry. How can I reliably continue to invest in this front? When I'm not sure how things are gonna go. If I'm an investigator based at an academic institution, how do I decide that that's a logical career path forward for my brain and my intellect if I don't know that there'll be this source of funding to do the research, to set the standard, to change the standard of care?
In many ways, what we're hearing is that the United States is becoming increasingly irrelevant and untrustworthy for sure. The whole point of what we established in establishing the National Institutes of Health and the National Cancer Institute was to be the gold standard, to be the rock that was always going to be there, to be the constant stream of new data and new resources that will the actual improvements in many diseases, not just cancer. We know that that's why people would come and want to train here. So, the best brains on the planet would wanna come and train and be trained by us here in the United States because of this resource. And, of course, all of this is going away.
The Georgetown University faculty, my daughter, who is my sage. Yesterday, that our faculty, I somehow missed the memo, is now gonna hold a weekly vigil for one of our graduate students who was deported because according to the federal government, his visa status was not right. But really, we know it was because the research he was doing was not in line with what the current administration feels is important.
I don't know if you saw this, but the New England Journal editor in chief received what was perceived to be kind of a threatening letter basically accusing them of not publishing "competing viewpoints." A randomized clinical trial. Patient got treatment A versus treatment B, and the accusation is that the authors may be misleading the readers. So, is this an assumption that the science was fraud? Is it an assumption that there's a counterpoint to their hypothesis that was not listed in the science? I don't know. I don't even know where it comes from. So, this is where we are, is that the federal government is trying to undermine the veracity, the solidness, stableness of the data being presented by the New England Journal of Medicine, one of the journals that we have in highest regard, and it is their strategy, of course, right, is to doubt, to cause doubt, in things that we hold, to be the solid base and the truth, if you will.
Now, you all know that, talked about before on Oncology Unscripted this, this concept that the federal government sent Harvard a letter, which we talked about already, that basically said, we're freezing your funding. So, $2.2 billion of funding to Harvard has been frozen with an additional billion dollars in grants. And basically, threatening the education of international students. They're talking about removing Harvard's tax status.
And, of course, Harvard is the one group that has quite publicly stood up and essentially said, look, you don't have the rights to do this. And their president, Harvard's president, wrote this response, and I do wanna read it to you in specific.
It says the consequences of the government's overreach will be severe and long lasting. Research that the government has put in jeopardy includes efforts to improve the prospects of children who survive cancer, to understand at the molecular level how cancer spreads throughout the body, to predict the spread of infectious disease outbreaks and to ease the pain of soldiers wounded on the battlefield. Opportunities to reduce the risk of multiple sclerosis, Alzheimer's disease and Parkinson's disease are on the horizon. The government's saying, "no, we don't wanna know that." And the victims, will be the future patients, so writes their president. And their loved ones who will suffer with a heartbreak of illness that might have been prevented or treated more effectively.
So, this indiscriminate slashing of science, medical technology research is essentially undermined our role and our ability to help, not just Americans, but people around the world. The accusation, again said by Alan Garber, who's the president of Harvard is that this was the government's reaction to the university, Harvard being antisemitic Alan Garber is Jewish and American, and he basically says, look, we understand our role in all of this. They take their work very seriously, and they'll continue to fight hate with an urgency that it demands. And they will comply with all their obligations under the law they say, he says, it's not only their legal responsibility, it's their moral imperative. Such a strong pushback counter statement to that.
But then, you know, our Secretary of Education? No, you don't know who that is, but She's become famous really for a couple of things. One, she was at an AI meeting. She kept referring to it, because she can't read the teleprompter as A-one. Which of course the reason you know this is that every steak sauce joke in America comes from this statement, statement, this lack of understanding of even where she was.
But then she also was, in theory, the signatory or author of a response to Dr. Garber at Harvard for his letter that he had just sent, that I quoted there. And if you haven't seen this, this has been getting a lot of social media press just because of the quality of writing. You would think that our Secretary of Education could write a letter, particularly if you're writing it to somebody at Harvard that at least is grammatically correct, if not at least readable and understandable. But as you can see, and as I'm sure you have seen on social media, the people in charge aren't up to the game.
And that's how they're doing this. They're undermining education. They're undermining those sources that are our foundation of knowledge of truth, So, that we can get on with curing cancer or whatever it is that our cause is. But by undermining us, causing doubt on us, they can then bring their agenda forward.
And I want to restate what I've shown you before is that there is an ad out there. claiming that the current administration under the President's leadership will cure cancer by 2029. why does it matter what we do? Why does it matter where truth resides? Because the real truth is gonna come forward over the next four years, and we will no longer have to worry about cancer.
In the meantime, I hope to see you at ASCO in Chicago, and I hope you continue to do the right thing, to build truth, to build for the future because we know it's gonna be back on our shoulders soon, and in fact, the load will be heavier when it's back on our shoulders. So, be in shape, get ready because it is gonna come back to us to solve the problems.
John Marshall, Oncology Unscripted.
The Fellows’ Forecast: What First-Timers Expect at ASCO
John Marshall, MD: Hey everybody, John Marshall for Oncology Unscripted. We are getting all ready to go to ASCO and we thought it would be really interesting to talk to some people who are going to ASCO who have never been. I was thinking back, my first ASCO was in a year that started with 19, just to give you an idea, and it used to rotate around different cities. Been at Chicago, same place, same bat channel every year for many, many years at this point.
I was actually able to coerce some of our fellows who are making their first trip ever to ASCO to come on and for a quick interview, introduce themselves, give us some thoughts about what they're anticipating, and then if they're nice enough, maybe we'll grab 'em after ASCO to see what they learned and what was different than what they were expecting. So, listen in folks for what, you might reflect back as to what you thought before you went to your first ASCO.
Tina, introduce yourself and maybe give us one word of what's ringing around your head about what you're anticipating for ASCO.
Tina Roy, MD: Hi, I am Tina. I'm one of the second-year fellows at Georgetown, second year hematology oncology fellow. I did med school back in Scranton, Pennsylvania at Geisinger, and I did residency and now fellowship here. The one word that, I think of is, overwhelming because of how packed it is.
John Marshall, MD: That one's gonna come true. That one's gonna come true. Christian, introduce yourself. Give us your thoughts.
Christian Agbisit, MD: I went to med school in the Philippines, but then my residency in Illinois, and then ended up in Georgetown for fellowship. And my word is something big is at ASCO.
John Marshall, MD: Good. I think big, it will feel that way for sure. And last, but not least, Nikita.
Nikita Chintapally, MD: Hi everyone. My name's Nikita. I went to medical school in India at Kasturba Medical College, did my residency here in DC, and happy to be at Georgetown. I'm a first-year heme/onc fellow. My word for ASCO, as I'm a baby fellow, I still like to think of, is just ready to get inspired, I guess.
John Marshall, MD: That's awesome. And, let me tell all of you out there listening, and these are three of the smartest people. It's such an honor to work with these folks who have dedicated their entire lives and they know so much more than old people know, and I'm dependent upon them. And they're great partners for us, and they're nice enough to spend time with us. Actually, I snuck them out of somebody else's clinic right now to do this, so, I'm in trouble with their current clinic mentors. But anyway, let's get right into it.
Tina, let me pick on you first. When I first went to ASCO, I thought it was all about fun. I wanted a hotel with a good pool, in the, in the range of fun versus work. Where do you think this is gonna be? What's your impression of what it's gonna be?
Tina Roy, MD: I think it's going to be in the middle. Work because there's so many different events to go to. I've tried to make my schedule multiple times already and I can't decide for some of the sessions which ones to even go to. So, I think I'm going to even have to watch some, like on demand after. And then fun, there's a bunch of dinners planned already. I am planning on getting deep dish pizza, So, I think there'll be, it'll be fun too.
John Marshall, MD: There is a lot of fun. There is booze involved at ASCO. Sleep is not one of the big things. Christian, work-fun. Where are you in this balance? Here?
Christian Agbisit, MD: Yeah, I think it's gonna be both. Basically, because I'm graduating and going into a community practice, I wanted to kind of soak in all the new stuff.
John Marshall, MD: I wanna come back to you maybe afterwards about the community practice piece because you'll notice just that there aren't many community practitioners who go to ASCO but do get a feel for that when you're there. As you look at that, because it becomes not worth it to community docs to go to ASCO, which is always one of—and they go to best of ASCOs on a Saturday somewhere, later. So, I'd be interested in your feedback on that of the value that you see, as a rising community practitioner, in the future.
Nikita, where are you? Work fun.
Nikita Chintapally, MD: I am hoping it's more on the spectrum of fun for me. I'm hoping to, you know, do maybe meet some people, meet other fellows, happy to just branch out, network in any way possible. I'm really excited to see more people do like oral presentations. I think it'll be really inspiring, and it'll be a good way to get a sense of how people present their work in an effective way. So, I think that's what I'm looking forward to the most.
John Marshall, MD: One of my partners and good friends, and one of your mentors, Dr. Isaacs, is giving a. Big oral presentation, you gotta show up for that and see what it's like. Because it is, it does make you nervous when you get up there in front of, what is the largest room you will ever be in for a medical meeting. So, just so get ready for that is one piece of it.
Christian, let me pick on you. Have you thought about packing yet? Carry on. Are you gonna check? I mean, it's what, three, four days, right? So, what are you gonna do?
Christian Agbisit, MD: Well, basically just gonna pack like some shirts, and shoes, comfortable shoes for walking.
John Marshall, MD: That is such a boy answer, isn't it? Mm-hmm. let's talk, I, you know, I'm a married man. I know about packing that it's different by gender, although some boys are more about their packing than others, but ladies, have you thought about it?
Tina Roy, MD: Comfortable shoes.
John Marshall, MD: Heels? Let's start there.
Nikita Chintapally, MD: I'm doing sneakers.
John Marshall, MD: Sneakers.
Tina Roy, MD: Definitely practical shoes.
John Marshall, MD: Okay.
Tina Roy, MD: I also am going for a day extra because I have a lung cancer event to go to beforehand, so I actually have thought about how many outfits, and I think I might need to go shopping this weekend.
John Marshall, MD: So, it's remarkable. I will wait to see what is going on this year, which is how dressed up people are. This is just a warning. particularly when we see people from other countries, they tend to, there's a lot of heels when you and to Christian's point you, you know, you, you put a lot of steps on, right? I mean, you, you, one meeting to the next could be a quarter mile, in terms of just distances. So, practical shoes is a good piece of advice. Nikita, do you have a particular, have you already put it out on the bed? Know what you're gonna take?
Nikita Chintapally, MD: I'm probably just gonna need to pack maybe like a blazer or some layers, because I know conference centers can get super cold.
John Marshall, MD: Cold. It's totally true. It's totally true. And you don't sleep by the way, just so you know. So, you, you party until late and then. You get up early because the next session that you really feel like you should go to is at 7:30 AM. And by the way, you're gonna be taking a bus with a bunch of other nerdy oncologists from downtown Chicago to the convention center sipping coffee. Don't spill it on yourself because you had to be careful with your pack, right? This is just advice, To go out there. it is a contact sport ASCO. So, you're also gonna see for the first time, Nikita, I'll start with you. It's like we've all been to meetings where pharmaceutical companies display stuff, right? So, I don't know if you've been to a big meeting before, but they have these halls where they have their booths and their maps, their actual maps. And so, any idea about what that's gonna be like?
Nikita Chintapally, MD: I have absolutely zero clue what that's gonna be like. I'll probably see the, you know, drug names that we use in clinic, and that'll be the extent of my excitement, but maybe I'll be, it'll be different.
John Marshall, MD: Have you all had, have you been to one of these meetings where you've seen this kind of huge booth?
Tina Roy, MD: I haven't seen huge pharmaceutical booths, but even some small ones can be pretty exciting. I'm expecting a, because I've heard about it, I'm expecting a lot, I think.
John Marshall, MD: Well, one thing you'll notice, this is it'll freak you out—and you'll go, Dr. Marshall? The carpet is thicker, so they make fancier carpet to slow you down when you're on the booth. So that's one thing you'll notice. There are two sides, US and not US because there are different rules around regulatory, they hire people who are not real reps to stand on the corners to welcome you.
So, there's this big thing, the wildest booth I have ever seen. I'd be interesting if our listeners might chime in. many years ago, and it was a medicine for dry mouth, and they literally had a fountain flowing through a sand desert in the middle of this booth. So, when you all go, we always try to pick our favorite or maybe, worst booth that you, you went to go see. So maybe when we follow up later, you take a, share something with like, you were just like, whoa, that, that was, that was something.
Let's do something more important while we're really going. am, and maybe I'm back to Tina. So, what do you wanna learn? What are you expecting to learn?
Tina Roy, MD: I'm really excited about the trainee and early career lounge because of meeting other mentors, meeting other fellows. So, I’m hoping to learn a little bit more about the job application process. See different people in different practices. I am also really excited to see what interaction is between pharmaceutical companies, oncologists, what kind of atmosphere there is.
So, I think I'm kind of, of course, those big like plenary sessions, oral abstracts. I'm excited about learning the nitty gritty about what's happening, but also just like that atmosphere and interaction between the different groups that are there.
John Marshall, MD: That's great answer. Christian?
Christian Agbisit, MD: Kind of same thing as Tina. How I can treat my patients, plenaries and which are the, well, the new stuff that comes out in.
John Marshall, MD: You know, if it's in the plenary, it's positive. So that's one of the things you can pretty much bank on, going forward. Nikita, what are you hoping to learn from all of this? That you really wanted to be a surgeon? No, no, no. Something different.
Nikita Chintapally, MD: Never, yeah, definitely similar to what Tina said about the early career and mentorship, as I'm going into second year, we have more research time, so hopefully trying to see, you know, you know, what could be feasible from my standpoint. Get some ideas and just again, big, big picture. Get really inspired, hopefully.
John Marshall, MD: I think you'll be surprised. By the number of people that you actually recognize. You'll, you'll cross paths, maybe, you know, through your training at other institutions or just you'll see people you recognize. And of course, it is when you're as old as I am. You recognize lots of people. I think. So that's one thing that is fun too, is that you connect to people that you don't see often or regularly.
It is time to connect, the internationalness of it is quite striking. So, you'll see people from all over the world. are certain countries that do not allow, or we don't let them in. To be blunt. And so, they will go to ESMO or other meetings so that you will notice the absence of certain people, maybe, you know, over time because their countries don't allow, or we don't allow their immigration in.
But very much of an international feel to it. It's both exhilarating, I think. But it's exhausting too because you are learning. There's a lot of new stuff you're drinking in. There is a lot of business that's transacted during the meeting, and a lot of new data that's unloaded on us.
And so, what we then try to do is take this information as say just a GI specialist and try to integrate it into how does it affect treatment on the Wednesday, when we get back on June 4th. So, from there. So, any last thoughts? Christian, you got a plane ticket,
Christian Agbisit, MD: Yeah.
John Marshall, MD: okay, you got a hotel? Okay, then those are the two most important things, Nikita, any thoughts?
Nikita Chintapally, MD: What are you most looking forward to, Dr. Marshall?
John Marshall, MD: Well, so my problem is, is that I'm overbooked and so, I, I, you know, which meeting will I actually go to, and will I actually go and see any data being presented? So, I'm at a place where I almost never go into the posters or to the presentations because I got too much other stupid stuff going on in my world.
It’s an enjoyable event because so much, it is our community. It is a celebration of our community. It's, it's an excitement. You all talked about being inspired and, you know, reaffirming what you do so you leave, you leave charged and ready to, to move on to cure cancer.
Thank you, guys, very, very much. I know you gotta keep running. We'll get back together in a couple of weeks and see what you learned when you went to the 2025 ASCO.
John Marshall for
Oncology Unscripted
Talk to you all soon.