Gastrointestinal Cancer Journal

Unpacking the Treatment Algorithm of Hepatocellular Carcinoma with Dr. Tanios S. Bekaii-saab

In this episode of the podcast, the Oncology Brothers were joined by Dr. Tanios S. Bekaii-saab from Mayo Clinic to discuss the treatment landscape for hepatocellular carcinoma (HCC). The discussion focused on various aspects of HCC management, including early-stage treatment options such as liver transplant and local therapies like Y90, SBRT, or ablation.

For advanced or metastatic disease, the conversation delved into the use of Atezolizumab with Bevacizumab or dual checkpoint inhibitors based on the stride regimen. Dr. Tanios S. Bekaii-saab emphasized the importance of considering patient factors and performance status when choosing between treatment regimens.

The episode also touched on treatment options beyond the frontline and provided clinical pearls regarding the management of available TKIs. Overall, the discussion highlighted the complexity of HCC treatment decisions and the need for a multidisciplinary approach to patient care.

Journal Club

Breakthrough in Bladder Cancer: FDA approval – Enfortumab Vedotin + Pelbrolizumab with Dr. Tom Powles

In this podcast episode, the Oncology Brothers, Drs. Rahul and Rohit Gosain, had the privilege of interviewing Dr. Thomas Powles, a medical oncologist whose work on the EV302 study has significantly impacted the field of bladder cancer treatment. The study focused on the combination of Enfortumab and Pembrolizumab as a first-line treatment for advanced or metastatic bladder cancer. Dr. Powles highlighted the transformative results of the study, showing a substantial improvement in overall survival benefit compared to traditional chemotherapy.

The EV302 study demonstrated a median survival of 31.5 months with the Enfortumab and Pembrolizumab combination, compared to 16.1 months with chemotherapy. Dr. Powles emphasized the importance of managing the side effects of this new treatment regimen, including skin toxicities, neuropathy, and immune-related adverse events. He provided insights on how to effectively address these toxicities to ensure patient safety and treatment efficacy.

Furthermore, Dr. Powles discussed the potential role of circulating tumor DNA (ctDNA) in monitoring disease progression and treatment response, particularly in the adjuvant setting. He also touched upon the possibility of stopping Enfortumab in patients who have achieved a complete response to the treatment, highlighting the potential for durable remission and improved quality of life.

Overall, the podcast episode shed light on the groundbreaking EV302 study and the paradigm shift it has brought to the treatment algorithm for bladder cancer. The Oncology Brothers expressed their gratitude to Dr. Powles for sharing his expertise and insights, providing valuable information for oncologists and patients navigating the evolving landscape of bladder cancer treatment.

Algorithms Genitourinary oncology (GU) Cancer

Bladder Cancer Treatment Algorithm Discussion with Drs. Karine Tawagi and Sia Daneshmand

In this episode of the podcast, the Oncology Brothers were joined by Dr. Karine Tawagi, a medical oncologist, and Dr. Sia Daneshmand, a urologist, to discuss the current standard of care and treatment options for bladder cancer. The discussion covered various aspects of bladder cancer management, starting from non-muscle invasive bladder cancer to metastatic disease.

Dr. Daneshmand highlighted the importance of categorizing bladder cancer based on risk categories and discussed the use of intravesical chemotherapy for low-grade tumors and the role of BCG in high-grade tumors. Dr. Tawagi emphasized the significance of adequate biopsy and the approval of pembrolizumab for high-risk non-muscle invasive bladder cancer.

The conversation delved into the management of muscle-invasive bladder cancer, including neoadjuvant chemotherapy options for cisplatin-eligible patients and considerations for bladder preservation. The podcast also touched on the evolving landscape of metastatic bladder cancer treatment, with a focus on the groundbreaking EV Pembro regimen and potential second-line treatment options.

The hosts and guests discussed the importance of managing toxicities associated with new treatment modalities like infortumab, sasituzumab, and ertifitinib. They also highlighted the role of ctDNA in assessing treatment response and the need for close monitoring and collaboration among specialty services.

Overall, the episode provided a comprehensive overview of the current approaches to bladder cancer treatment, emphasizing the need for personalized care and ongoing research to improve outcomes for patients.


Exploring the Latest in Renal Cell Cancer Therapies with Dr. Monty Pal using an Algorithm

In this episode, we had the honor of hosting Dr. Monty Pal from City of Hope, a renowned leader, educator, clinician, and mentor in the field of GU malignancies. The discussion primarily focused on the evolving landscape of treatment options for localized and metastatic renal cell cancer.

Localized Disease: The approval of adjuvant pembrolizumab in 2021 based on DFS and overall survival data has significantly impacted the treatment approach for high-risk patients. Dr. Monty Pal emphasized the superiority of pembrolizumab over sunitinib due to its efficacy and tolerability.

Metastatic Space: The conversation delved into the role of surgery in the era of modern therapies, highlighting the importance of systemic therapy as the primary focus. Various treatment options, including TKI-IO combinations and doublet regimens, were discussed based on risk stratification and disease burden.

Second-Line Treatment: Dr. Monty Pal provided insights into second-line treatment options, emphasizing the use of cabozantinib and everolimus-lenvatinib for robust patients requiring a quick response. The discussion also touched on newer agents like belzutifan and tevosinib, highlighting their efficacy and side effect profiles.

Clinical Pearls: Managing side effects of TKIs and immune checkpoint inhibitors was emphasized, with a focus on recognizing and addressing overlapping toxicities. The importance of individualized treatment based on patient characteristics and response rates was underscored throughout the episode.

Future Directions: Dr. Monty Pal highlighted ongoing clinical trials for non-clear cell histology and the importance of staying updated on evolving treatment strategies in renal cell cancer.

Overall, the episode provided a comprehensive overview of the current standard of care practices in renal cell cancer, offering valuable insights for clinicians and researchers in the field.


How to treat Prostate Cancer in 2024 with Dr. Rana McKay

In discussion with Dr. Rana McKay, Associate Professor of Medicine from UC San Diego Health, we covered the treatment algorithm for Prostate cancer, starting from localized disease and then focusing on CSPC and CRPC.

Journal Club

Dr. Hope Rugo discusses Capivasertib FDA Approval based on CAPItello-291 Study

In this discussion with Dr. Hope Rugo, we covered her study Capitello-291, which led to the approval of Capivasertib in hormone receptor-positive breast cancer with AKT1, PTEN, and PIK3CA mutations, which are seen in 40-50% of the cases. We touched base on sequencing of this therapy, and important clinical pearls around the side effect management associated with this drug.

Journal of Breast Cancer

How to Treat HR+ Breast Cancer with Dr. Virginia Kaklamani

In discussion with Dr. Virginia Kaklamani, we cover treatment algorithm of HR+ breast cancer. We covered the current standard of care treatment options for HR+ breast cancer.

2024 ASCO

GU ASCO 2024 Highlights with Dr. Tian Zhang – CONTACT-02, BRCAAway, AMBASSADOR, Keynote-564

In discussion with Dr. Tian Zhang, covering the Genitourinary ASCO 2024 meeting highlights from the Community Oncology perspective. We covered 4 important practice informing studies from GU ASCO with Dr. Zhang:

– CONTACT-02: Phase 3 study of cabozantinib plus atezolizumab vs second novel hormonal therapy in patients with metastatic castration-resistant prostate cancer

– BRCAAway: A randomized phase 2 trial of abiraterone, olaparib, or abiraterone + olaparib in patients with metastatic castration-resistant prostate cancer bearing homologous recombination-repair mutations

– AMBASSADOR: Phase III randomized adjuvant study of pembrolizumab in muscle-invasive and locally advanced urothelial carcinoma vs observation

– Keynote-564: Overall survival results from the phase 3 KEYNOTE-564 study of adjuvant pembrolizumab versus placebo for the treatment of clear cell renal cell carcinoma

Journal of Breast Cancer

How to treat HER2+ Breast Cancer in 2024 with Dr. Harold Burstein

In discussion with Dr. Harold Burstein, we cover treatment algorithm of HER2+ breast cancer. We covered the current standard of care treatment options for HER2+ breast cancer.

2024 ASCO

GI ASCO 2024 Highlights with Dr. Pamela Kunz – CheckMate 8HW, EMERALD-1, NETTER-2

In discussion with Dr. Pamela Kunz, covering the Gastroenterology ASCO 2024 meeting highlights from Community Oncology perspective. We covered 3 important practice informing studies from GI ASCO with Dr. Kunz:

– CheckMate 8HW: Nivolumab plus ipilimumab vs chemotherapy as first-line (1L) treatment for microsatellite instability-high/mismatch repair-deficient (MSI-H/dMMR) metastatic colorectal cancer

– EMERALD-1: A phase 3, randomized, placebo-controlled study of transarterial chemoembolization combined with durvalumab with or without bevacizumab in participants with unresectable hepatocellular carcinoma eligible for embolization

– NETTER-2: [177Lu]Lu-DOTA-TATE in newly diagnosed patients with advanced grade 2 and grade 3, well-differentiated gastroenteropancreatic neuroendocrine tumors

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Dr. Rahul

Dr. Rahul is a Chief of Medical Oncology, making up one-half of the ‘Oncology Brothers.’ He is a valued member of the Guthrie Corning Cancer Center, contributing his extensive knowledge of technology