Dr. John Marshall: Outspoken advocate and expert

On this National Doctors’ Day, we interviewed Dr. John Marshall, Chief of the Division of Hematology and Oncology at the Lombardi Comprehensive Cancer Center at Georgetown University. Dr. Marshall is an internationally recognized expert in new drug development for gastrointestinal cancers and has served as the principal investigator for more than 100 clinical trials. Not only is he a leading researcher, but he is also an on-the-ground advocate, most recently participating in the Alliance’s DC ScopeItOut 5K on March 18.

We’ve got to ask, Dr. Marshall: After so many years of hard work, pushing for innovation, and treating cancer, do you think you’ve made a good career choice?

I could not imagine doing anything else or working with different people. The cause and goal of this work are the most important things we can do in life. Believe it or not, there is a lot of joy and humor in it, so I couldn’t think of anything better to do.  

When it comes to doctors who treat gastrointestinal cancers, what do you think is the driving force for their interest in this particular part of the body?

Mostly, they are physicians who are trying to change the so-called standard of care. We must do this to move this cause forward. Across the board, people who take care of gastrointestinal cancers like the complexity of the patients. Also, there is a personality to gastrointestinal patients that is warm and endearingthey are partners. I think those physicians who find themselves in this world are very glad they here.

As a leading researcher, I would that guess you treat your digestive system in a fairly kind manner. Do you have any personal habits that you’ve picked up over the years to help treat you body right?

I think exercise is very important, and I’m staying the right body sizeI’m lucky enough on that front. And I think a little bourbon every day helps, too.

You’re regarded as a leader in immunotherapy, a type of treatment that was long thought of with suspicion. Can you provide a snapshot of where immunotherapy is today and if we can expect it to become a greater force in cancer treatment?

We initially believed that a cancer patient’s immune system is broken, and that’s why they had cancer. So for 20-plus years I and others have tried to wake up the immune system against cancer. More recently, there was a discovery that during cancer the immune system was, in fact, wide awake, and was perched and ready to kill cancer, but there was a blocka forcefield, if you willthat was in place, so cancer survived. The immune system was perfectly able to fight, if only allowed to get to the cancer.

The newest wave of immunotherapy drugs breached that barrier. These new medicines have made great success for some patients, but our new charge is to address all the other patients, in which the immune system is not seeing the cancer. So we are now doing combination studies where we try to stimulate the immune system and cut the breaks, if you will. Our immune systems are not broken, and that’s not why we get cancer. We believe we can harness the immune system for good.

A few years back, you suggested a need for doctors to fight a “smarter war on cancer.” What does that mean, and do you think the clinical community is now following your lead?

We have an embarrassing sum of riches in the US around healthcare. We spend an incredible amount of money on cancer and cancer care. And when I look at how we’re using that money, well, I think we’re extremely wasteful. What I mean by “smart war” is improving our benefit rate. We need to quit wasting time on medicines that don’t work. We need to incorporate the science we have to make decisions and operate more efficiently. And finally, we need to encourage and incentivize more patients to participate in clinical trials. Every time we give someone the so-called standard of care, we miss an opportunity. Yes, we are making some progress. You’re seeing precision medicine emerge. We’re also having a frank, open discussion about costs and access to healthcare. So I’m very proud that since that editorial you referenced, we’re seeing progress.

What are three things a patient should look for in a doctor treating their colorectal cancer?
Obviously, expertise. Cancer is a rapidly moving field, and you want to ensure your physician is up to speed on the particulars. You can do this by politely asking, is this something you do a lot? It can’t be rude or accusatory sounding, though. I would also recommend that most patients at some point get a second opinion.

Second, seek someone who is willing to work collaboratively. Cancer is a two-way street. It requires a physician to set priorities, and patients need to understand what’s feasible and what’s not. It’s an ongoing education and discussion.

The third is the sum of one and two, and that’s trust. This becomes one of the most intimate relationships a patient will ever get into, personal or professional, and in order for it to work, there needs to be trust.  

Finally, do you believe cancer will be defeated and, if so, what gives you hope?

I think we already know that the majority of patients diagnosed with cancer are cured of the disease. So it is the remaining group of patients we’re after. And we’re seeing significant progress. The answer is yes, and it’ll come through a combination of research, participation from patients, luck, and, as we get smarter, cancer will fall.  

In March, we observe National Colorectal Cancer Awareness Month. Join us as we build our nation of passionate allies, fiercely determined to end this disease within our lifetime.

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