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When a gastroesophageal tumor is positive for HER2, PD-L1, and claudin 18.2, which target should you treat first and how do you decide? On this episode of the BackTable GI Oncology Creator Weekend™, host Dr. Kate Baker interviews Dr. Geoffrey Buckle, a GI medical oncologist at UCSF, and Dr. Ronan Hsieh, a GI oncologist at Swedish Cancer Institute in Seattle, for a breakdown of therapy selection and management in advanced HER2-positive upper GI cancers. They start with a detailed case, covering biomarker workup, how to choose a first-line regimen without head-to-head data, and how to manage nutrition and palliative radiation when a patient presents with dysphagia and weight loss. --- Get the BackTable apphttps://www.backtable.com/app --- Timestamps 00:00 - Introduction01:41 - Case Presentation and Biomarker Workup05:07 - First-Line Treatment Selection11:27 - Oligoprogressive Disease and Local Therapy16:02 - HER2 Testing and Tumor Heterogeneity20:19 - ctDNA in Upper GI Cancers22:27 - HERIZON-GEA-01 and Zanidatamab27:18 - Triplet Versus Doublet and Diarrhea Management29:17 - Second-Line Therapy and Rebiopsy32:33 - Trastuzumab Deruxtecan and Interstitial Lung Disease36:33 - Later-Line Options and HER2-Low Disease39:17 - Future Directions and Closing Remarks --- More about this episode The conversation expands to interpreting equivocal HER2 results, tumor heterogeneity, and the importance of a second pathology review before committing to a treatment strategy. Dr. Hsieh explains how he approaches the HERIZON-GEA-01 trial data and the need to manage triplet therapy toxicity, especially diarrhea. The group discusses second-line rebiopsy to confirm HER2 status, the role of circulating tumor DNA (ctDNA), counseling and monitoring for interstitial lung disease on antibody-drug conjugates, and what to do for HER2 IHC 2+ FISH-negative tumors. They close with future directions, including trials moving HER2-directed therapies into earlier disease, the challenge of limited therapy lines, and why every line counts in this patient population. --- Resources Shitara K, et al. Zanidatamab with and without Tislelizumab in HER2-Positive Gastroesophageal Cancer (HERIZON-GEA-01). N Engl J Med. 2026https://pubmed.ncbi.nlm.nih.gov/42202319/ FDA approves zanidatamab-hrii and tislelizumab-jsgr for HER2-positive gastric, gastroesophageal junction and esophageal adenocarcinoma (August 2026)https://www.fda.gov/drugs/resources-information-approved-drugs/fda-approves-zanidatamab-hrii-and-tislelizumab-jsgr-her2-positive-gastric-gastroesophageal-junction Pembrolizumab plus trastuzumab and chemotherapy for HER2-positive gastric or gastro-oesophageal junction adenocarcinoma: interim analyses from the phase 3 KEYNOTE-811 randomised placebo-controlled trial. Lancet. 2023https://pubmed.ncbi.nlm.nih.gov/37871604/ Trastuzumab in combination with chemotherapy versus chemotherapy alone for HER2-positive advanced gastric or gastro-oesophageal junction cancer (ToGA). Lancet. 2010https://pubmed.ncbi.nlm.nih.gov/20728210/ Trastuzumab Deruxtecan in HER2-Low Gastric or Gastroesophageal Junction Adenocarcinoma: Exploratory Cohort Results in a Phase II Trial (DESTINY-Gastric01). J Clin Oncol. 2023https://pubmed.ncbi.nlm.nih.gov/36379002/ GEMINI-PeriOp GC: Novel Agents or Combinations as Perioperative Treatment in Locally Advanced Resectable Gastroesophageal Adenocarcinoma (trial record)https://clinicaltrials.gov/study/NCT07069712 Zolbetuximab plus CAPOX in CLDN18.2-positive gastric or gastroesophageal junction adenocarcinoma: the randomized, phase 3 GLOW trial. Nat Med. 2023https://pubmed.ncbi.nlm.nih.gov/37524953/ Perioperative Durvalumab in Gastric and Gastroesophageal Junction Cancer (MATTERHORN). N Engl J Med. 2025https://pubmed.ncbi.nlm.nih.gov/40454643/NCCN Clinical Practice Guidelines in Oncology: Gastric Cancer and Esophageal and Esophagogastric Junction Cancers (current versions)https://www.nccn.org/guidelines/category_1Dr. Geoffrey Buckle, UCSF Health physician profilehttps://www.ucsfhealth.org/providers/geoffrey-buckle Dr. Ronan Hsieh, Swedish physician profilehttps://www.swedish.org/doctors/medical-oncology/wa/seattle/ronan-hsieh-1457880031 Dr. Kate Baker, BackTable Tumor Board contributor pagehttps://www.backtable.com/shows/tumor-board/contributors/dr-kate-baker --- BackTable Tumor Board is the go-to multidisciplinary podcast for medical oncologists, surgical oncologists, and other healthcare professionals that play an active role in cancer care. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

How do you choose between perioperative chemotherapy and trimodality therapy for a patient with localized upper GI cancer, and what has the newest data actually settled? On this episode of BackTable Tumor Board, host Dr. Kate Baker interviews Dr. Dani Castillo, a medical oncologist at City of Hope in Duarte, California, and Dr. Alexandra Gangi, a gastrointestinal surgical oncologist at Cedars-Sinai in Los Angeles, about everything that happens between a new diagnosis and a resection in localized esophageal, gastroesophageal junction and gastric cancer. They cover diagnostic workup, Siewert classification, staging laparoscopy, histology, biomarker testing, surgical candidacy, and the challenges of nutrition and prehabilitation. --- Get the BackTable apphttps://www.backtable.com/app --- Timestamps 00:00 - Introduction01:42 - Diagnostic Workup and Siewert Classification04:20 - Histology, Risk Stratification, and Biomarkers07:03 - Surgical Candidacy and Preoperative Optimization10:26 - Perioperative Chemotherapy versus Trimodality Therapy13:37 - Chemotherapy Tolerability, Immunotherapy, and Dose Reduction15:10 - Gastrectomy, Esophagectomy, and Recovery20:05 - Pathologic Response and Adjuvant Decisions21:55 - Organ Preservation and ctDNA24:54 - Future Directions and Ongoing Trials26:35 - Multidisciplinary Care and Community Practice27:40 - Closing Remarks --- More about this episode The conversation tackles the choice between perioperative chemotherapy and chemoradiation, when to add immunotherapy, and the latest data from ESOPEC and MATTERHORN. Dr. Gangi explains why subtotal versus total gastrectomy, anastomotic technique, and node dissection matter for recovery. The team discusses the role of organ preservation, ctDNA for de-escalation, and why multidisciplinary care remains essential even in smaller community practices. The episode closes with real-world strategies for managing frailty, dose reduction, and ensuring patients and providers are aligned before heading to the OR and why upper GI cancer stays a multidisciplinary disease even where the team is small. --- Resources Hoeppner J, et al. Perioperative Chemotherapy or Preoperative Chemoradiotherapy in Esophageal Cancer (ESOPEC). N Engl J Med. 2025https://pubmed.ncbi.nlm.nih.gov/39842010/ ESOPEC trial registry record (NCT02509286)https://clinicaltrials.gov/study/NCT02509286 Al-Batran SE, et al. Perioperative chemotherapy with fluorouracil plus leucovorin, oxaliplatin and docetaxel versus fluorouracil or capecitabine plus cisplatin and epirubicin (FLOT4). Lancet. 2019https://pubmed.ncbi.nlm.nih.gov/30982686/ Perioperative durvalumab plus fluorouracil, leucovorin, oxaliplatin and docetaxel for resectable gastric and gastro-oesophageal junction adenocarcinoma (MATTERHORN). Lancet. 2026https://pubmed.ncbi.nlm.nih.gov/42716074/ MATTERHORN trial registry record (NCT04592913)https://clinicaltrials.gov/study/NCT04592913 Pembrolizumab Plus Chemotherapy Versus Chemotherapy as Perioperative Therapy in Locally Advanced Gastric and Gastroesophageal Junction Cancer: Final Analysis of KEYNOTE-585. J Clin Oncol. 2025https://pubmed.ncbi.nlm.nih.gov/40829093/ KEYNOTE-585 trial registry record (NCT03221426)https://clinicaltrials.gov/study/NCT03221426 Goodman KA, et al. Randomized Phase II Study of PET Response-Adapted Combined Modality Therapy for Esophageal Cancer: Mature Results of the CALGB 80803 (Alliance) Trial. J Clin Oncol. 2021https://pubmed.ncbi.nlm.nih.gov/34077237/ CALGB 80803 trial registry record (NCT01333033)https://clinicaltrials.gov/study/NCT01333033 Kelly RJ, et al. Adjuvant Nivolumab in Resected Esophageal or Gastroesophageal Junction Cancer (CheckMate 577). N Engl J Med. 2021https://pubmed.ncbi.nlm.nih.gov/33789008/ Cunningham D, et al. Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer (MAGIC). N Engl J Med. 2006https://pubmed.ncbi.nlm.nih.gov/16822992/ NCCN Guidelines Insights: Esophageal and Esophagogastric Junction Cancers, Version 4.2026. J Natl Compr Canc Netw. 2026https://pubmed.ncbi.nlm.nih.gov/42753809/ NCCN Clinical Practice Guidelines in Oncology, treatment by cancer typehttps://www.nccn.org/guidelines/category_1 Genomics of gastroesophageal junction adenocarcinomas and the Siewert classification. Transl Gastroenterol Hepatol. 2026https://pubmed.ncbi.nlm.nih.gov/42291157/ Dr. Dani Castillo, medical oncology, City of Hopehttps://www.cancercenter.com/physician-directory/dani-castillo Dr. Alexandra Gangi, Cedars-Sinai faculty profilehttps://researchers.cedars-sinai.edu/Alexandra.Gangi Dr. Alexandra Gangi, NANETS Board of Directors profilehttps://nanets.net/about/board-of-directors/450-gangi Dr. Kate Baker, BackTable contributor pagehttps://www.backtable.com/shows/tumor-board/contributors/dr-kate-baker --- BackTable Tumor Board is the go-to multidisciplinary podcast for medical oncologists, surgical oncologists, and other healthcare professionals that play an active role in cancer care. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

What options remain when a patient with microsatellite stable metastatic colorectal cancer (MSS mCRC) has progressed through every standard line of chemotherapy? On this episode of BackTable Tumor Board, Dr. Jun Gong is joined by Dr. Ibrahim Sahin and Dr. Sandra Algaze to explore the nuances of late-line management in MSS-mCRC. They discuss how to approach oxaliplatin retreatment and anti-EGFR rechallenge, the growing role of liquid biopsy and biomarker-driven selection, and the practicalities of DPYD testing after recent guideline changes. --- Get the BackTable apphttps://www.backtable.com/app --- Timestamps 00:00 - Introduction01:55 - Oxaliplatin Retreatment and Anti-EGFR Rechallenge07:53 - DPYD Testing and Liquid Biopsy14:00 - Comparing Rechallenge and Conventional Agents15:42 - STELLAR-303 and Third-Line Options22:53 - Immunotherapy and MSS Biology25:42 - SUNLIGHT, FRESCO-2, and CORRECT Trials30:41 - Alternative Dosing Strategies32:02 - Botensilimab and Balstilimab Update37:06 - Neoadjuvant Immunotherapy38:15 - Emerging Antibody-Drug Conjugates 42:02 - Closing Remarks --- More about this episode The conversation walks through the latest clinical trial results for third-line and beyond, including strategies for dosing and tolerability, and the unique challenges posed by liver metastases. Drs. Sahin and Algaze highlight new developments in immunotherapy, antibody-drug conjugates, and bispecific antibodies, as well as the importance of matching therapy to both tumor biology and patient needs. They close with insights on patient monitoring, toxicity management, and the value of multidisciplinary care for this complex population. --- Resources STELLAR-303: Zanzalintinib Plus Atezolizumab Versus Regorafenib in Refractory Colorectal Cancer (The Lancet)https://pubmed.ncbi.nlm.nih.gov/41130252/ SUNLIGHT: Trifluridine-Tipiracil and Bevacizumab in Refractory Metastatic Colorectal Cancer (NEJM)https://www.nejm.org/doi/full/10.1056/NEJMoa2214963 FRESCO-2: Fruquintinib Versus Placebo in Refractory Metastatic Colorectal Cancer (The Lancet)https://www.thelancet.com/article/S0140-6736(23)00772-9/abstract CAPRI-2 GOIM: Liquid Biopsy Genomic Profiling to Predict FOLFIRI Plus Cetuximab Efficacy (ESMO Open)https://www.esmoopen.com/article/S2059-7029(25)00380-1/fulltext Botensilimab Plus Balstilimab in Relapsed/Refractory MSS Metastatic Colorectal Cancer (Nature Medicine)https://www.nature.com/articles/s41591-024-03083-7 Phase I Study of Telisotuzumab Adizutecan (ABBV-400), a c-Met Antibody-Drug Conjugate, in Late-Line Colorectal Cancer (JCO)https://ascopubs.org/doi/10.1200/JCO-25-01525 --- BackTable Tumor Board is the go-to multidisciplinary podcast for medical oncologists, surgical oncologists, and other healthcare professionals that play an active role in cancer care. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

Which molecular alterations in colorectal cancer now change treatment and how quickly do you need the results to make the right call? On this episode of BackTable Tumor Board, Dr. Jun Gong interviews Dr. Ibrahim Sahin and Dr. Sandra Algaze about the latest advances in molecular-driven therapy across adjuvant and metastatic settings. They cover aspirin in PI3K-altered disease, the shift toward early next-generation sequencing, and the operational realities of systematic profiling at diagnosis. --- Get the BackTable apphttps://www.backtable.com/app --- Timestamps 00:00 - Introduction07:50 - BREAKWATER and First-Line BRAF Therapy13:00 - Biomarker Turnaround and Systematic Profiling17:58 - MSI-High Disease and Immunotherapy Trials21:54 - Anti-PD-1 vs Anti-PD-L1 in CRC25:17 - Doublet vs Single-Agent Immunotherapy27:41 - KRYSTAL-10 and KRAS G12C Inhibition33:34 - Anti-EGFR Sequencing and CR-SEQUENCE38:47 - New Targets and Emerging Therapies43:02 - Closing Remarks --- More about this episode The discussion moves from first-line BRAF and MSI-high options to anti-EGFR sequencing, ctDNA hyperselection, and the nuances of chemotherapy backbone choice. Drs. Sahin and Algaze review new trial data including BREAKWATER, KEYNOTE-177, CheckMate 8HW, KRYSTAL-10, and CR-SEQUENCE, highlight the promise and pitfalls of targeted strategies, and close with a look at emerging therapies and the multidisciplinary teamwork needed to match biology to treatment. --- Resources ALASCCA: Low-Dose Aspirin for PI3K-Altered Localized Colorectal Cancer (NEJM)https://www.nejm.org/doi/full/10.1056/NEJMoa2504650 BREAKWATER: Encorafenib, Cetuximab, and mFOLFOX6 in BRAF-Mutated Colorectal Cancer (NEJM)https://www.nejm.org/doi/full/10.1056/NEJMoa2501912 COMMIT (NRG-GI004 / SWOG-S1610): Atezolizumab Monotherapy vs mFOLFOX6/Bevacizumab/Atezolizumab in dMMR/MSI-H mCRChttps://clinicaltrials.gov/study/NCT02997228 CheckMate 8HW: Nivolumab Plus Ipilimumab Versus Nivolumab in MSI-High Metastatic Colorectal Cancer (The Lancet)https://pubmed.ncbi.nlm.nih.gov/39874977/ KRYSTAL-10: Adagrasib Plus Cetuximab Versus Chemotherapy in Previously Treated KRAS G12C-Mutated Colorectal Cancerhttps://clinicaltrials.gov/study/NCT04793958 CR-SEQUENCE: Anti-EGFR Versus Anti-VEGF Sequencing in RAS Wild-Type Left-Sided mCRC (ASCO 2026 Abstract)https://ascopubs.org/doi/10.1200/JCO.2026.44.16_suppl.3512 --- BackTable Tumor Board is the go-to multidisciplinary podcast for medical oncologists, surgical oncologists, and other healthcare professionals that play an active role in cancer care. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

How much of perioperative colorectal cancer management has changed in just one year, and what does it mean for patient care? On this episode of BackTable Tumor Board, Dr. Jun Gong is joined by Dr. Ibrahim Sahin and Dr. Alexandra Gangi to review the latest practice-changing data in colon and rectal cancer. They discuss observation versus maintenance immunotherapy in MSI-high disease, the CHALLENGE trial's surprising results on exercise and disease-free survival, and the evolving role of ctDNA and local therapies after liver metastasis resection. The conversation also covers adjuvant immunotherapy duration, comparing microwave ablation with SBRT, and how molecular residual disease (MRD) can guide post-resection decisions. They walk through a complex case of liver metastases, highlight the use of hepatic arterial infusion pumps, and discuss the future of transplant for unresectable disease. The discussion closes with practical advice on patient selection, multidisciplinary care, and the ongoing need for consensus as new therapies and biomarkers emerge. --- Get the BackTable apphttps://www.backtable.com/app --- Timestamps 00:00 - Introduction05:29 - Monotherapy, Doublet, and Treatment Duration10:35 - CHALLENGE Trial and Exercise After Surgery16:18 - Adjuvant Immunotherapy and Liver Metastases23:39 - ctDNA and Molecular Residual Disease29:44 - Case: Unresectable Liver Metastases and HAI Pump39:17 - Closing Thoughts --- Resources CHALLENGE Trial: Structured Exercise after Adjuvant Chemotherapy for Colon Cancerhttps://pubmed.ncbi.nlm.nih.gov/40450658/ ATOMIC Trial (Alliance A021502): Atezolizumab plus FOLFOX for Stage III Mismatch Repair Deficient Colon Cancerhttps://pubmed.ncbi.nlm.nih.gov/41880612/ Phase 2 LAVA-CRLM Trial: Microwave Ablation versus SBRT for Colorectal Liver Metastaseshttps://clinicaltrials.gov/study/NCT03654131 COLLISION Trial: Thermal Ablation versus Surgical Resection of Small-Size Colorectal Liver Metastaseshttps://pubmed.ncbi.nlm.nih.gov/39848272/ --- BackTable Tumor Board is the go-to multidisciplinary podcast for medical oncologists, surgical oncologists, and other healthcare professionals that play an active role in cancer care. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

How should a breast cancer team manage central nervous system (CNS) disease now that systemic therapy, radiation, and surgery all compete for the first move? On this episode of BackTable Tumor Board, host Dr. Lindsay Peterson interviews Dr. Barbara O'Brien, neuro-oncologist at MD Anderson, about diagnosis, sequencing, and follow-up for CNS disease in breast cancer. They discuss risk by subtype, when to image and screen, and the importance of multidisciplinary workup for new brain metastases, as well as how to choose and sequence local and systemic options. --- Get the BackTable apphttps://www.backtable.com/app --- Timestamps 00:00 - Introduction04:24 - Risk by Subtype and CNS Screening Decisions07:42 - Multidisciplinary Evaluation of New Brain Metastases10:35 - Local Therapy Choices and Radiation Advances15:43 - HER-2 Positive Disease and CNS Active Therapy18:36 - Intrathecal Therapy, Response Imaging and CSF Testing23:34 - Triple Negative and HR+ Disease28:33 - Prognosis and Patient Counseling32:59 - Symptom Management and Supportive Care36:02 - Advice for Community Oncologists39:34 - Key Takeaways for Clinicians and Patients44:16 - Prevention of CNS Metastases46:46 - Closing Remarks --- More about this episode Dr. O'Brien reviews the shift away from whole brain radiation toward stereotactic radiosurgery, when to try CNS-active systemic therapy before radiation, and the role of proton craniospinal irradiation in leptomeningeal disease. The conversation covers HER2-positive disease, intrathecal trastuzumab, MRI and lumbar puncture for surveillance, and the evolving evidence for triple negative and hormone receptor positive disease. They close with strategies for symptom management, patient counseling, referral pathways for community oncologists, and why clinical trials and prevention are the future for patients with brain and leptomeningeal metastases. --- Resources HER2CLIMB, tucatinib with trastuzumab and capecitabine in pretreated HER2 positive metastatic breast cancerhttps://doi.org/10.1056/NEJMoa1914609 DESTINY-Breast12, trastuzumab deruxtecan in HER2 positive advanced breast cancer with or without brain metastaseshttps://doi.org/10.1038/s41591-024-03261-7 ASCO guideline update on management of advanced HER2 positive breast cancer and brain metastaseshttps://doi.org/10.1200/JCO.22.00520 American Society of Clinical Oncologyhttps://www.asco.org/ --- BackTable Tumor Board is the go-to multidisciplinary podcast for medical oncologists, surgical oncologists, and other healthcare professionals that play an active role in cancer care. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

How does delivering CAR-T in the community change patient care, and what has to happen next for these programs to scale? On this episode of the BackTable Tumor Board Podcast, host Aaron Lyss interviews Dr. Mike Byrne, hematologist at Tennessee Oncology and medical director for cellular therapy at OneOncology, about operational lessons and future directions for outpatient CAR-T therapy. They discuss the impact of faster time to treatment, building trust through local relationships, and the weekly pipeline management that keeps the program moving. --- Get the BackTable apphttps://www.backtable.com/app --- Timestamps 00:00 - Introduction02:21 - Patient Impact and Access to Therapy04:42 - Reducing Friction in the Referral Pathway07:50 - Expectations Versus Reality in Program Development10:35 - Managing the Weekly Patient Pipeline13:08 - Priorities for the Next Generation of CAR T16:14 - Iterating on CD19 Constructs and Manufacturing19:07 - Safety Profiles and Care Delivery Models23:54 - Cellular Therapy in Autoimmune Disease27:47 - Allogeneic and In Vivo CAR T32:09 - Wrap Up and Closing Remarks --- More about this episode Dr. Byrne describes two groups the program has reached: patients with rapidly progressing disease who could not withstand referral delays, and patients with low health literacy who followed treatment recommendations from their local oncologist. He describes operational changes that reduced vein-to-vein time to about a third of published figures and enabled the program to function independently of any single individual. The conversation then shifts to the future of cell therapy, covering innovations such as dual-targeting CD19 and CD20 constructs with a 4-1BB arm and shorter manufacturing times, the safety thresholds community oncology will use to select new products, early developments in autoimmune disease and the potential need for rheumatology partnerships, and whether allogeneic and in vivo CAR-T can reach patients in what Dr. Byrne calls cell therapy deserts. The episode closes by addressing ongoing challenges in access, evolving institutional partnerships, and the need for mature data as CAR-T therapy expands across new settings. --- Resources KITE-363 and KITE-753 in relapsed or refractory B-cell lymphoma, the dual targeting CD19 and CD20 CAR T program https://clinicaltrials.gov/study/NCT04989803 KITE-363 in refractory autoimmune disease, the autoimmune arm of the same constructhttps://clinicaltrials.gov/study/NCT07038447 iMMagine-1, pivotal study of anitocabtagene autoleucel, the BCMA CAR T with a December FDA decision date https://clinicaltrials.gov/study/NCT05396885 First in human data for in vivo CAR T in multiple myeloma, presented at the ASH annual meetinghttps://ascopost.com/issues/february-25-2026-supplement-ash-meeting-highlights-2025/early-findings-from-first-human-study-of-in-vivo-car-t-in-myeloma/ In vivo CAR T cell therapy, review of the 2025 ASH annual meeting updateshttps://pubmed.ncbi.nlm.nih.gov/41957634/ American Society of Hematology Annual Meetinghttps://www.hematology.org/meetings/annual-meetingMichael T. Byrne, DO, FACP, physician profile at Tennessee Oncologyhttps://tnoncology.com/physicians/michael-t-byrne-m-d/OneOncology appoints Dr. Michael Byrne as Medical Director for Cellular Therapyhttps://www.oneoncology.com/blog/oneoncology-appoints-dr-michael-byrne-as-medical-director-for-cellular-therapy/Aaron Lyss on the administrative demands of bringing CAR T into community practicehttps://www.ajmc.com/view/taking-the-giant-leap-into-car-t-managing-financial-and-administrative-challenges ---BackTable Tumor Board is the go-to multidisciplinary podcast for medical oncologists, surgical oncologists, and other healthcare professionals that play an active role in cancer care. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

Does catching cancer earlier with surveillance always translate to better outcomes for gynecologic cancer patients? On this episode of BackTable Women’s Health, hosts Dr. Mona Guo and Dr. Marcia Ciccone interview Dr. Ritu Salani, Professor of OBGYN at UCLA and lead author of the updated SGO surveillance clinical practice statements. They discuss how post–curative-intent surveillance has evolved amid limited prospective evidence, review the latest guidelines, and highlight the real-world challenges of balancing early detection, patient safety, and cost. --- Get the BackTable apphttps://www.backtable.com/app --- Timestamps 00:00 - Introduction03:05 - Evolving Guidelines and Consensus10:02 - Lead-Time Bias and Cost Considerations12:05 - Maintenance Therapy and Surveillance Nuances14:44 - Ovarian and Endometrial Cancer: Imaging vs Exam20:24 - Key Takeaways from the TOTEM Trial24:04 - Future Tools, Lifestyle Counseling, and Shared Care27:21 - Cytology, HPV Testing, and Post-Radiation Surveillance31:13 - Hormone Therapy Considerations34:37 - ctDNA and MRD Testing37:39 - Emerging Technologies and Limitations43:22 - Rapid Fire Takeaways45:33 - Closing Thoughts --- More about this episode The conversation explores practice variability, the lack of clear survival benefits from routine imaging and tumor markers, and the risks of cascade testing and lead-time bias. Dr. Salani reviews the TOTEM trial data for endometrial cancer, the importance of symptom review and pelvic exams (especially for lower genital tract cancers), and the reduced role of cytology, even in cervical cancer after radiation. They also discuss shared-care models, lifestyle counseling, hormone therapy considerations, and the promise and limitations of emerging technologies like ctDNA and MRD testing during maintenance therapy. --- Resources TOTEM Trialhttps://ascopubs.org/doi/abs/10.1200/jco.22.00471 2010 Ovarian Cancer CA-125 Trialhttps://pubmed.ncbi.nlm.nih.gov/20888993/ Society of Gynecologic Oncology Clinical Practice Statement on Surveillancehttps://pubmed.ncbi.nlm.nih.gov/41308226/ --- BackTable Tumor Board is the go-to multidisciplinary podcast for medical oncologists, surgical oncologists, and other healthcare professionals that play an active role in cancer care. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

Where does access to cell therapy actually break down, and can community practices close the gap? On this episode of BackTable Tumor Board, host Aaron Lyss interviews Dr. Mike Byrne, a hematologist at Tennessee Oncology, about the challenges and successes of building an outpatient CAR T program in the community setting. They discuss the critical stakeholder relationships, operational and financial structures, and patient pathways that enable a physician-owned practice to offer cellular therapy outside a hospital system. --- Get the BackTable apphttps://www.backtable.com/app --- Timestamps 00:00 - Introduction03:50 - What Community Oncology Actually Means Here08:15 - Speed as the Differentiator: One EMR, No Repeat Workup10:40 - Look Before You Leap: Pipeline and Standard-of-Care Shifts17:30 - Why Cell Therapy Sits Outside Existing Payer Contracts20:35 - Pre-Treatment Evaluation, Insurance Vetting, and FACT Accreditation26:10 - Adding a BCMA CAR T30:30 - Infusion Day Logistics35:20 - Outpatient Monitoring Without a Six-Figure Platform39:00 - Co-Managing With the Referring Oncologist46:00 - Wrap Up and Closing Remarks --- More about this episode The conversation details how the Tennessee Oncology team aligned hospital, apheresis, and manufacturer partnerships, navigated payer arrangements outside traditional contracts, and streamlined workflows for rapid referral, insurance vetting, scheduling, and just-in-time cell shipping. The conversation explores practical decisions about when to build versus outsource services, the need for a robust patient pipeline amid shifting standards of care, and the risk management required to deliver high-cost therapies. Dr. Byrne shares how the program prioritizes access, leverages telehealth for monitoring, empowers advanced practice providers for overnight care, and adapts quickly for unique patient needs. The episode closes with real-world stories of patients who benefited from flexible, community-based care. --- BackTable Tumor Board is the go-to multidisciplinary podcast for medical oncologists, surgical oncologists, and other healthcare professionals that play an active role in cancer care. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

Where is AI already making oncology practice more efficient, and where does human expertise remain irreplaceable? In this episode of BackTable Tumor Board, medical oncologists Dr. Kate Baker and Dr. Larry Bilbrey discuss how AI is improving oncology workflow, such as scribing and information retrieval, but is far from replacing clinicians, especially for hands-on care. --- Get the BackTable apphttps://www.backtable.com/app --- Timestamps 00:00 - Introduction 03:17 - Evolution of Technology08:12 - The Role of AI in Healthcare Workflow18:57 - Prioritizing Provider-First Approach for Use of AI24:08 - Liability Disclosure Audits28:48 - Human Audits in Quality Assurance32:55 - Patients Using ChatGPT40:05 - The Potential of AI Care Companions42:59 - The Future of AI --- More about this episode Despite its advantages, the doctors discuss using AI in higher-stakes clinical settings with caution, as it is often limited by accuracy, liability, regulation, culture, and patient acceptance. They emphasize the importance of transparent patient disclosure and human auditing for quality assurance, as well as a focus on using AI for repetitive digital tasks rather than supporting clinical decisions. They also address patient use of ChatGPT, the potential of AI companions for helping patients navigate care, and the future of AI in the years ahead. --- BackTable Tumor Board is the go-to multidisciplinary podcast for medical oncologists, surgical oncologists, and other healthcare professionals that play an active role in cancer care. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

Is GU oncology entering a new era of early intensification and precision therapy? On this episode of the BackTable Tumor Board Podcast, Dr. Katy Beckermann and Dr. Alan Tan break down the latest GU oncology highlights from ASCO, including key updates in prostate, renal cell, and urothelial carcinoma. They discuss new data supporting HRR/BRCA-focused therapy in HSPC, the importance of early biomarker testing, and ongoing debates about overtreatment and real-world practice impact. --- Get the BackTable apphttps://www.backtable.com/app --- Timestamps 00:00 - Introduction01:56 - Frontline Prostate Cancer & TALAPRO-3 Highlights07:11 - PROTEUS Plenary Breakdown & Controversies13:47 - RCC Rampart and ctDNA19:47 - Bladder EV Pembro Updates23:34 - Next-Gen Nectin-4 ADC26:51 - Wrap-Up --- More about this episode The conversation covers the PROTEUS trial and perioperative intensification, RAMPART and Keynote-564 ctDNA findings in RCC, and new standards in perioperative bladder cancer treatment with EV plus pembrolizumab. Drs. Tan and Beckermann also discuss next-generation ADCs, pharmacogenomic toxicity considerations, and the promise of AI and ctDNA for patient selection and de-escalation strategies in advanced GU cancers. --- Resources TALAPRO-3 Trialhttps://www.nejm.org/doi/full/10.1056/NEJMoa2604126 PROTEUS Trialhttps://www.nejm.org/doi/full/10.1056/NEJMoa2603878 RAMPART Trialhttps://www.nejm.org/doi/full/10.1056/NEJMoa1107494 KEYNOTE-564 ctDNA Biomarker Sub-Studyhttps://www.urotoday.com/conference-highlights/asco-2026/asco-2026-kidney-cancer/169387-asco-2026-ctdna-analysis-in-participants-with-rcc-treated-with-adjuvant-pembrolizumab-in-the-keynote-564-trial.html --- BackTable Tumor Board is the go-to multidisciplinary podcast for medical oncologists, surgical oncologists, and other healthcare professionals that play an active role in cancer care. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

Is it time to rethink the definition of “cure” for stage IV colorectal cancer? In this episode of BackTable Tumor Board, medical oncologist Jun Gong interviews Dr. Cathy Eng about updates from the phase III CheckMate-8HW trial in centrally confirmed MSI-high/dMMR metastatic colorectal cancer, comparing nivolumab/ipilimumab, nivolumab, and chemotherapy. They discuss initial findings demonstrating improved progression-free survival and response rates with combination immunotherapy, as well as safety considerations and how comorbidities and frailty guide the choice between single-agent and combination regimens. --- Get the BackTable apphttps://www.backtable.com/app --- This podcast is supported by Bristol Myers Squibb https://www.bms.com/ --- Timestamps00:00 - Introduction01:40 - Trial Design Breakdown03:37 - Initial Efficacy Results09:47 - ASCO Update Highlights13:18 - Induction Tolerability15:12 - Rechallenge After Relapse17:26 - COMMIT Trial Breakdown22:55 - BRAF Mutant MSI High Strategy24:54 - Closing Remarks --- More about this episodeThe conversation reviews the ASCO post-hoc update with 55.1 months follow-up, highlighting higher 4-year survivor rates and longer treatment-free intervals for patients on combination therapy. Drs. Gong and Eng also discuss the implications of the underpowered COMMIT trial, the unexpectedly poor performance of atezolizumab monotherapy, and why chemo-immunotherapy is not currently recommended. The episode concludes with impressions from ESMO GI, including a negative second-line KRAS G12C adagrasib plus EGFR study, and broader reflections on the evolving definition of cure in advanced colorectal cancer. --- Resources Checkmate-8HW Phase III Trialhttps://www.nejm.org/doi/full/10.1056/NEJMoa2402141 Keynote 177https://www.nejm.org/doi/full/10.1056/NEJMoa2017699 COMMIT Phase III Trialhttps://ascopubs.org/doi/10.1200/JCO.2026.44.2_suppl.14 --- BackTable Tumor Board is the go-to multidisciplinary podcast for medical oncologists, surgical oncologists, and other healthcare professionals that play an active role in cancer care. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty.► https://www.backtable.com/app

What first-line therapies should be considered for patients with higher-grade, metastatic neuroendocrine tumors (NETs)? In this new episode of BackTable Tumor Board, Drs. Lingling Du, Chih-Yi Liao, and Robert Ramirez discuss the use of systemic or radioligand therapies for metastatic well-differentiated NETs. --- Get the BackTable apphttps://www.backtable.com/app --- This podcast is supported by Novartishttps://www.novartis.com/ --- Timestamps 00:00 - Introduction 02:31 - NGS Testing in NETs05:45 - Starting with Somatostatin Analog (SSA)08:01 - NETTER-2 Trial and Front-Line PRRT11:58 - High Dose SSA After Progression14:59 - Sequencing Systemic Therapy Options18:56 - Picking the Right PRRT Candidate21:28 - PRRT: Responses, Toxicities & Risks31:58 - Lung NET Treatment Strategy34:16 - Using Immunotherapy for Low-Grade NET36:05 - First-Line Treatment for Poorly Differentiated Extrapulmonary Neuroendocrine Carcinoma41:40 - What’s Next: Ongoing Clinical Trials --- More about this episode The doctors cover the use of next generation sequencing for newly diagnosed patients, highlighting that although results rarely changes upfront management, it can occasionally reveal actionable findings such as high tumor mutation burden and mismatch repair deficiency. In addition to NGS, care should prioritize imaging, pathology review, and multidisciplinary collaboration and planning. They then review several clinical trials, including the NETTER-2 and CLARNET FORTE trials to evaluate the role of peptide receptor radionuclide therapy (PRRT) and somatostatin analog (SSA) therapy while considering sequencing of multimodal treatments. The episode wraps up with ongoing and future clinical trials investigating other potential therapies for NETs. --- Resources Phase 3 NETTER-2 Trialhttps://pubmed.ncbi.nlm.nih.gov/38851203/ Phase 2 CLARINET FORTE Trialhttps://pubmed.ncbi.nlm.nih.gov/34597974/ Corticosteroid Prophylaxis for for Patient with Neuroendocrine Tumorshttps://pmc.ncbi.nlm.nih.gov/articles/PMC12609636/ Phase 3 CABINET Trial (Alliance A021602)https://pubmed.ncbi.nlm.nih.gov/41524552/ SWOG S2012 Trialhttps://www.asco.org/abstracts-presentations/213198 DAREON-Lung-1 Trialhttps://clinicaltrials.gov/study/NCT07472517 212-lead VMT-ɑ-NET Safety Studyhttps://clinicaltrials.gov/study/NCT06148636 RayzeBio Phase 3 ACTION-1 Studyhttps://www.ncf.net/clinical-trials-1/action-1%3A-alpha-prrt-with-ac-225-in-gep-nets RayzeBio Phase I RYZ401 Trialhttps://clinicaltrials.gov/study/NCT07165132 Phase I & II CHM-2101 Trialhttps://ascopubs.org/doi/10.1200/JCO.2026.44.16_suppl.2536 --- BackTable Tumor Board is the go-to multidisciplinary podcast for medical oncologists, surgical oncologists, and other healthcare professionals that play an active role in cancer care. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

When breast cancer treatment ends, recurrence surveillance can easily overshadow the symptoms and concerns that continue to affect daily life. In this episode of the BackTable Tumor Board Podcast, Dr. Kate Baker and Dr. Lindsay Peterson discuss how effective survivorship care can address recurrence anxiety, endocrine therapy toxicities, bone health, sexual health, and the broader emotional and practical needs of patients after treatment. --- Get the BackTable apphttps://www.backtable.com/app --- Timestamps00:00 - Introduction03:29 - First Survivorship Visit & Clinic Workflow13:40 - Addressing Recurrence Anxiety in Breast Cancer Survivors18:41 - Endocrine Therapy Side Effects20:01 - Managing Aromatase Inhibitor-Induced Arthralgias & Joint Pain23:56 - Hot Flash Treatment Options26:20 - Addressing Sexual Side Effects30:14 - Bone Health, Bisphosphonates & Dental Clearance35:20 - Calcium and Vitamin D Dosing in Diet vs Supplement36:54 - Survivorship Care Takeaways --- More about this episode The conversation begins with different models for survivorship clinics and the priorities of an initial survivorship visit. Drs. Baker and Peterson explore how clinicians can address recurrence anxiety while also evaluating patients’ emotional, social, and financial needs. They then review common endocrine therapy toxicities, including arthralgias, hot flashes, fatigue, reduced bone density, and sexual side effects. The discussion includes practical strategies for managing aromatase inhibitor–associated joint pain, available treatments for hot flashes, and approaches to sexual health concerns. Drs. Baker and Peterson also examine bone-health management, including bisphosphonate therapy, dental clearance, and appropriate calcium and vitamin D intake. The episode concludes with guidance for building a more comprehensive and patient-centered approach to breast cancer survivorship. --- BackTable Tumor Board is the go-to multidisciplinary podcast for medical oncologists, surgical oncologists, and other healthcare professionals that play an active role in cancer care. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

What factors come into play when deciding whether to use liver-directed therapy or systemic therapies for neuroendocrine tumors? In this episode of the BackTable Tumor Board Podcast, Dr. Lingling Du, Dr. Chih-Yi Liao, and Dr. Abdul Khan discuss the structure of a multidisciplinary tumor board and how they approach decision-making for patients with neuroendocrine tumors. The conversation explores who benefits most from liver-directed therapy, optimal timing for intervention, and the importance of individualized treatment planning. --- Get the BackTable apphttps://www.backtable.com/app --- Timestamps 00:00 - Introduction 02:04 - How The NET Tumor Board Works at UChicago04:15 - Patients Who Benefits From Liver-Directed Therapy10:45 - Non-candidates for Liver-Directed Therapy13:37 - Choosing Modalities of Therapy: Bland TACE, Y90 and Ablation15:16 - RETNET Trial Takeaways21:38 - Histotripsy for Neuroendocrine Tumors25:42 - Sequencing Liver-Directed Therapy With Systemic Therapy or PRRT28:11 - Case One: Heavy Liver Burden33:12 - Case Two: Aggressive NEC & Miracle Response38:23 - Wrap Up and Credits --- More about this episode The doctors review contraindications, modality selection, and sequencing with systemic therapy and PRRT before breaking down the RETNET trial, which shows similar hepatic progression-free survival between bland embolization and conventional TACE. They then discuss two patient cases, highlighting upfront embolization for heavy low-grade liver burden and repeat Y90 for oligometastatic high-grade neuroendocrine carcinoma with durable control. --- Resources RETNET Trialhttps://www.jvir.org/article/S1051-0443(25)00027-2/fulltext --- BackTable Tumor Board is the go-to multidisciplinary podcast for medical oncologists, surgical oncologists, and other healthcare professionals that play an active role in cancer care. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app