John L. Marshall, MD


November 25, 2014

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This is John Marshall for Medscape, on a beautiful, crisp fall morning in Washington, DC. I want to drill down on immunotherapy, which is possibly one of the coolest things out there. If we could just teach the immune system to find our cancers, go after them, and attack them, then maybe our job would be done. That is the hope, of course.

We have been studying the science here in our group for many years and we have crept along, particularly focusing on gastrointestinal (GI) cancers. There has been an explosion of checkpoint inhibitors—drugs that, by "clipping the force field of the tumor," have demonstrated significant clinical benefit in patients with lung cancer, melanoma, kidney cancers, and other cancers, but not much in GI cancers. I am nervous because the companies that develop these medicines are saying, "They are not going to work in GI cancers," the most common and most fatal cancers on the planet.

We are working to try to reopen their eyes to this target for immunotherapy. On December 5, we are assembling here in Washington, DC, a great program at our annual Ruesch Center Symposium, where we tackle very challenging issues. This year we are going to focus on immunotherapy in GI cancers.

People from all over the world will be coming to drill down on why we aren't seeing more evidence of benefit. If you look at colon cancer, the lymphocytic infiltrates and the quality of the T cells are strong predictors for outcome,[1,2,3] and yet we ignore this. How do we learn from all of this and take the step forward to treat these very significant major diseases?

I hope you are interested in immunotherapy and know that what is happening is really cool. Maybe on December 5, you can find your way to Washington, DC, to our symposium to hear about how GI cancers can be affected by immunotherapy—looking at both checkpoint inhibitors and vaccines—and how to measure the immune response. It may be one of the most important topics of the decade ahead as we figure out how to cure GI cancers.


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