From a sociology point of view, yes you should distrust any signs of p-hacking or selective reporting, especially when there is a low effect size.
From a technology point of view, I think we are already well past "no one.. really knowing what is going on." Take the current study. Past researchers had identified the CD19 antigen found (often exclusively) on B cells, and others had found that autologous T-cells could persist in a patient for many years, potentially providing a durable response. The current researchers built on this knowledge to design and engineer T-cells that could wipe out a patient's B cells.
So it's a very planned, targeted approach, more akin to engineering than the old approach of testing thousands of random molecules as potential treatments. When the targeted approach works, and especially when it has a large and consistent effect on patients as in this case, then you can be very confident at an early stage.
This needs to be recognized and medical practice needs to change as a result. We're entering an era of incredibly detailed knowledge and precision tools for research and development. The pace of development will continue to increase and treatments will become more patient-specific as individual targets are identified.
You could consider the large, slow, blunt clinical trials as being like optimization for a particular treatment. When new drugs are rare or not well understood it makes sense to spend time to optimize their use. But when new drugs come frequently and are well targeted this premature optimization costs lives.