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The Molecular Space Race: Will It Bring Earlier Detection and Better Treatment?
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Released: November 18, 2025

John Marshall
John Marshall, MD
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The Molecular “Space Race”: Will It Bring Earlier Detection and Better Treatment?

 

John Marshall for Oncology Unscripted. An amazing amount of science is going on right now in the cancer world—on the molecular side of things—and I like to think of it kind of like a molecular space race. Because the technology that’s out there—of being able to measure what’s going on in a tumor, what’s going on in the blood, finding different genetic characteristics, and being able to act on those—has never grown quite as fast as what we are seeing now. Just like we were racing to get to the moon or racing to orbit around the Earth, we are now seeing companies and different groups from all over the world developing and improving technologies to try and read the tea leaves of whatever’s going on in the blood, whatever’s going on in a tumor—in what I think of as a molecular space race. And I wanted to feature a paper about this that I thought was quite interesting and will set us up for the beginnings of what will be, really, a few-month-long discussion around precision medicine—to try and understand better how it’s going to help us evolve and become more efficient in the practice of not just cancer care, but healthcare in general.

 

Now, the paper I want to talk about is in this journal called The Journal of Clinical Oncology. Yeah, I still do get a paper version. And this one is from China. Now, I want to start by saying that I’m a little surprised this paper made it into JCO, because it is a molecular analysis done totally in China.

 

But where I wanted to start from was that the funding for this work came from a bunch of philanthropic and government-supported stuff in China. A big, long list of different resources—including the healthcare system where it was started out of.

 

And I keep thinking about here in the United States—where we’ve been leading in investment, where we’ve been leading in discovery—we are now finding it more and more difficult to access the kind of support that came to make this science possible. So, when we think about our individual U.S.-based impact on outcomes and research and progress—without that funding—we’re going to clearly keep falling behind.

 

And the two papers I want to talk about—this one in China and the other one out of the European Union group—show that all of this novel, positive work is coming from other sources, other investment. Just food for thought.

 

But anyway, this group took patients with the attempt to try and find a blood-based test to detect early, early-stage pancreas cancer. Because, as you know, it is very, very difficult to cure pancreas cancer if it shows up clinically. I won’t go into the weeds on this paper—it’s in JCO—but they basically took some learning sets and some training sets, et cetera, and developed a panel—a blood-based panel. And they were able to show, with very high precision, that they could distinguish who had small-volume pancreatic cancer and who didn’t. They even had a cyst sub-study subgroup in there to look at—and things like that. And I think it’s worthy of being presented in JCO, because if you think about what we’ve been doing with our blood-based testing, is people who already have cancer—who then get blood-based or tissue-based genetic testing to decide what we’re going to do to treat them or how to follow them: looking for minimal residual disease or what targeted agent might be available for that individual patient. But this is the other end of where I think this kind of technology is going to go—and that is screening. Healthy population. Blood-based testing. See if you’ve got cancer or not—and intervene. And I’m very, very interested in seeing over the next 5, 10-plus years how this kind of technology shifts from just coaching us to be more efficient in the treatment of existing disease—existing cancer—and more shifting towards early detection and prevention strategies.

 

So, I think there’s nothing hotter than this blood-based testing that’s going on now, which is why we’ve decided to spend a few months on it. And this paper sets the stage.

 

The other paper I want to contrast that with also just came out in the Annals of Oncology. So yeah, good group, good journal—but not quite JCO, right? So, a little bit off the beaten path. But to me, maybe the most important paper of the week.

 

And this was the group from the PRODIGE 13 adjuvant colon cancer study, where after the intervention was done, patients were randomized into four groups of follow-up. Now, I don’t know what you do. NCCN says I’m supposed to do it maybe once a year. I do it a little more often than that, if I can get away with it—although that sometimes means I’ve got to do a peer-to-peer to get a scan or other things. I’ve incorporated, more recently, doing MRD testing. But the standard right now is a CEA every now and then, and a scan every now and then, and a colonoscopy every now and then.

 

Well, the study actually randomized patients into more intensive follow-up versus less. Now, remember why we do this in colon cancer. The primary reason is that we feel like if we can find a met before the patient feels it, that we could remove it—and maybe cure the patient, right? And so, unexpectedly, this study basically said the opposite. It didn’t matter how intensive your follow-up was. You had the same overall survival. Well-done study. Prospectively looked at.

 

So, then I’m thinking, oh my gosh—if it doesn’t really matter, like should we do what the breast cancer doctors do? They don’t even do follow-up scans at all, right? They do an occasional LFT and a physical exam, and that’s it. Should we begin shifting to something like that?

 

Know that we are dialing up in the other direction—because we’re increasingly doing MRD testing, where we’ll have an even more sensitive measure than CEA or scan to determine if somebody’s got residual or persistent cancer.

 

And I am hopeful that what we will show is that by identifying patients at the molecularly positive level—like an MRD test—we can intervene.

 

And in fact, I’m helping to lead a study across our country to test new agents in that space. That if we intervene with those new therapies, we will, in fact, cure more people through that earlier intervention than by waiting to see what grows out there in the patient’s liver or lungs, et cetera.

 

Recently, I have a patient—a colon cancer patient, a young man—who had an MRD-positive blood test. And his scan—regular conventional CT scan—was negative.So, I ordered a PET. Now, you could argue maybe I shouldn’t have. But he had two in a row—blood tests, positive; CT, negative. I ordered a PET. Guess what? The insurance company said, “No, you can’t order that.” So, I ended up doing a peer-to-peer review.

 

Don’t you love peer-to-peer reviews? How many of you initially say, “Are you actually an oncologist?” when you talk? I wasn’t—I was polite to the doc on the other end. I told her the story. She plugged in the data that now the patient was MRD positive, and she read out the approval code to let me go ahead and get the PET scan. So, clearly, MRD testing is having an influence on decision-making and insurance coverage. But it’ll become our challenge to demonstrate that knowing MRD testing is important enough that it will influence survival—unlike that Annals of Oncology paper that showed that CTs and CEAs maybe not so much.

 

I think this paper puts us at a higher bar for challenge—to make sure that following patients closely makes sense, and that this MRD testing better work for us. Or else, we’ll just be pulling back in general after patients are initially treated.

 

So, I hope you find this next series of discussions about MRD testing, et cetera, interesting and useful to you. And I hope you find these two papers a bit challenging—one that takes us to a screening test for pancreatic cancer, the other that takes us to: should we be doing anything after we follow patients, outside of these newer tests that are coming?

 

So, more to come. I hope it’ll be useful to you, and I hope you’ll tune in next time for Oncology Unscripted.