MedBuzz: In this episode of Oncology Unscripted, John Marshall, MD, discusses a troubling week in health care news, including upheaval at the FDA, concerns about reduced federal support for medical education, and growing evidence that AI-generated fabricated references are appearing in published scientific literature. Main Topic: In this episode of Oncology Unscripted, Dr John Marshall previews the practice-changing data expected at ASCO 2026, highlighting advances in precision medicine. Tune in to hear which presentations could shape the next wave of cancer care.
MedBuzz:
In this episode of Oncology Unscripted, John Marshall, MD, discusses a troubling week in health care news, including upheaval at the FDA, concerns about reduced federal support for medical education, and growing evidence that AI-generated fabricated references are appearing in published scientific literature.
Main Topic:
In this episode of Oncology Unscripted, Dr John Marshall previews the practice-changing data expected at ASCO 2026, highlighting advances in precision medicine. Tune in to hear which presentations could shape the next wave of cancer care.
ASCO 2026 Preview: Precision Medicine, MRD, and the Next Wave of Care
John Marshall, MD: John Marshall, Oncology Unscripted, getting you ready for ASCO. Whether you're going or not, you're going to need to know what's being presented up there.
And one of the things that I like about ASCO is, of course, seeing everybody in person. No AI allowed up there—although there'll be a session about AI—but we're going to be really there.
I think there will be no robots. Who knows what they'll have? There probably will be some robots up there. But going to be with other people, getting to see people you haven't seen in a while, is my favorite part.
My least favorite part is this sort of waiting on the data to be presented. The late-breaking abstract kind of irritates me a little bit. They tease you with the title. They tell you it's going to be in these big sessions, which usually means that the trial is positive or the data that we're going to see are going to be impactful. But we can't tell in advance where the best data are going to be or what room we should be in until after they've been presented. That's probably the thing that irritates me the most.
But what I want to feature really quickly is some of the highest-level data that's going to be presented, which usually are preserved for what we call the plenary session Sunday afternoon. Everybody crams into these huge, tractor pull-sized arenas, and we all sit around and watch slides be presented. They have some really interesting papers being presented at the plenary this year. It is about precision medicine. It is about immunotherapy and how those two are combining nicely to improve outcomes. But it is also about the right patient and the right drug, with smaller and smaller patient subsets. Let me kind of give you a high-level overview of what we're expecting to see at ASCO during the plenary and other sessions.
So, there's the CDK4/CDK6 drug abemaciclib. It's a breast cancer drug that you know already. It looks like it's going to be positive in liposarcoma. Who's ever seen a liposarcoma plenary session paper? We are going to in Chicago in 2026.
Selpercatinib is being studied in a RET fusion-positive non–small cell lung cancer trial, and it's obviously positive; otherwise, it wouldn't be in the plenary. But let's face it: that's really a 1% positivity rate for RET fusions in non–small cell lung cancer. And so, this is actually a stage I all the way to stage IIIA clinical trial, so it must be positive as well.
Ivonescimab with chemotherapy versus tislelizumab plus chemotherapy. Who makes these names up? Non–small cell, but squamous cell lung cancer. It looks like ivonescimab will be positive, and it's the first medicine at this level that combines PD-1 and VEGF in one bispecific antibody.
Lots of those are coming, with lots of positive data being seen in that combination, so there's going to be one more. So, two of these studies are in non–small cell lung cancer.
Then, there's one in my category. This drug is called daraxonrasib. Believe it or not, I really didn't know how to say that drug, even though I've been playing with it and coaching it. So, I actually looked up the phonetic spelling and pronunciation. So, daraxonrasib. We're going to have to learn how to say it. We'll probably just call it “Durak” or something like that. This is a RAS(ON) nonselective inhibitor, a kind of drug we thought could never happen. We said this was untargetable, and not only is it positive and going to be presented at the plenary at ASCO, it's already been on the front page of most newspapers around the country for its impact on patients with pancreatic cancer.
So, in my world, every one of my patients is very aware of this. And, of course, as you know, the FDA did grant it breakthrough status, and we'll talk a little bit about the FDA through this session as well. But, how are patients going to get access to these drugs? Who's going to pay for it? So, even though it's out there and accessible, getting it to patients is always a challenge when this happens.
Now, on another level, I think one of the major themes that we will continue to see presented at ASCO this year is around MRD testing. And there are several papers. Here's a recent one from the current JCO. You know I always like print. This is in breast cancer, using a tissue-informed MRD test that really did a nice job of predicting outcomes and the like. There are a bunch of papers being presented at ASCO with MRD testing in the GI cancer space, so this is around and going to stay.
And, of course, just as I mentioned earlier, there's going to be more and more talk about the use of AI, good and bad. And I do want us to refer to some papers that are being presented and actually published that suggest that AI in health care may not be all that good, but we'll talk about that more later.
So, if you can't go to ASCO, at least keep in touch with what's going on out there. See these papers. They're going to be clinically impactful, as will many others. So, the standard of care will be different by the middle of June based on the data presented at ASCO.
So, stay tuned. More to come on Oncology Unscripted.
MedBuzz: FDA Shake-Ups, Medical Debt, and AI Hallucinations
John Marshall, MD: John Marshall, Oncology Unscripted. I really wanna thank the folks at Decera for helping to support the work that we are doing, and all of our team behind the scenes who make this possible, so special shout-out to them. But there is a lot of news out there. Let’s start at the highest level.
The front page of The Washington Post this morning says that the FDA is gonna get a new leader. Marty Makary, a surgeon from Johns Hopkins, a GI surgeon who’s been filling in that spot at the head of the FDA, resigned officially this morning. And it’s just a big shake-up that’s going on in terms of staffing, in terms of leadership, in terms of priority there. And there’s really been a tension. Marty was one of those guys who was actually doing a pretty good job of balancing the pressures from the current administration and trying to do the job of the regulatory agency, of approving things that are good for people and not approving things that aren’t good for people.
But they keep relaxing the rules and changing, and basically, I think the two sides couldn’t meet. So, he’s like, “Enough. I’m outta here,” even though our president gave him a good review walking out of the door.
But, you know, there was a recent article—an approval, actually—of flavored vapes, right? We’re trying to get fewer and fewer people to smoke and not wanting young people to start these habits, but flavored vapes probably are gonna drive young people to this even more. And Marty originally didn’t want this, but ultimately caved, and they did grant approval for that through the regulatory agency. So, we’ll see what happens without the backstop of somebody like Marty in that position. That was one thing that happened this week in the news.
Another: there’s been a lot of talk about the financing of education, and there have been some recent data that the current administration wants to pull back on supporting education. And this is gonna lead to more and more student debt. And this is nowhere more obvious than in the training of physicians and other health care providers because it’s expensive, and there’s a lot of delayed gratification.
Then again, this morning in The Washington Post, there’s a paper—an article—in the finance section of The Washington Post about, you know, not only are we really good at delayed gratification when we go into health care because we have to keep putting off really making any decent money, but if you pile up a bunch of debt, you also have to put off saving money for your future because you’re paying off this big debt burden. So, it’s almost like having a second mortgage going forward.
When the government says, basically, “We’re gonna stop funding or supporting trainees in this way,” what they’re not really thinking about is the downstream impact. And we already know we have a shortage of medical and health care providers out there in this country, so increasing brain drain is gonna happen there, which is gonna have its impact 10 to 20 years from now, something that the current administration can’t see forward enough. So, financing medical school and access to support is a big deal in our world.
I promised you that there’s going to be a lot of AI talk. Even in our last episode of Oncology Unscripted, I came out and talked about how, at least in health care and science, I was increasingly comfortable with using AI to do searches. But then Maxim Topaz came out with a paper that was just recently published in The Lancet that’s been incredibly referenced all over, and he has been tracking—he and his team have been tracking—how many hallucinated references are actually then published out there in the literature.
And he showed this alarming trend where, year after year, it went from, like, 1 in 2,800 papers having one fabricated reference to now 1 in 277. So, it’s just skyrocketing, the number of papers that are published where at least one or more of the references cited is actually not a real reference.
And so, we’re going to have to be increasingly careful. Unlike what I just said a couple of weeks ago, where maybe we should be more comfortable in science, his paper suggests that maybe that was wrong, and I need to backpedal, and we need to be very careful.
Now, when you were in medical school and you were taught how to take a history and how to interpret that history, it always came to the awkwardness of: do you smoke? Do you drink? And if so, how much? And so, I don’t know if your training was like my training, but I was told and taught that whatever answer you give—how many drinks a week or a day that you have—we’re supposed to sort of secretly, in our own heads, double that, right?
That’s what you were told. Now, I tell my primary care doctor exactly the right number. Now, whether she—she’s a friend—doubles my number or not, I don’t know. But I’m actually giving the correct number that I think is in the medical record. I don’t check her work to see if she writes the number I give her or if she writes a double number.
I was also thinking about a recent story about this guy named Kash Patel. You probably know about Kash Patel. He’s leading the FBI right now, and there’s been a lot of talk within these congressional meetings lately about how much he’s been drinking.
He was filmed in a celebration in a locker room after one of the recent teams won a championship. When he was confronted with this “you drink too much” kind of thing in public, of course, he’s suing everybody for that statement. What’s ringing true to me is: do I double what he’s saying? But he’s protesting so much, it made me flash back to Hamlet.
It’s actually Act 3, Scene 2, where the line is, “The lady doth protest too much, methinks,” right? We all know the line. And when somebody’s fussing that much about something, it makes you wonder if it’s indeed maybe possibly true. So, do we double what he says? Do we cut and... I don’t know what to do with all of this.
But there’s a lot out there this week in our news that’s gonna affect us in health care today. Most of it is unsettling; most of it is troubling. But you can ask me whether you think this is true: am I protesting too much, or am I on target?
Oncology Unscripted, John Marshall. Thanks for joining me.
This transcript has been generated by AI.