Ep. 62 Advancements in Managing Locally Advanced Pancreatic Cancer with Dr. Rebekah White and Dr. Michael Sherer

Ep. 62 Advancements in Managing Locally Advanced Pancreatic Cancer with Dr. Rebekah White and Dr. Michael Sherer

Can a tumor deemed permanently unresectable actually be downstaged to surgery? In this episode of BackTable Tumor Board, host Dr. Zach Berman (interventional radiologist, UC San Diego) is joined by Dr. Rebekah White (surgical oncologist) and Dr. Michael Sherer (radiation oncologist) to discuss the complexities of managing locally advanced, unresectable pancreatic cancer and evaluate how individualized patient factors, treatment response, and multidisciplinary expertise can turn inoperable tumors into surgical candidates. --- Get the BackTable app https://www.backtable.com/app --- Timestamps 00:00 - Meet the Tumor Board 06:17 - Induction Chemo Pathway 11:54 - Imaging Workup and PET 16:45 - Chemoradiation Basics 21:01 - SBRT Dose Escalation 28:00 - IRE NanoKnife Explained 31:14 - Emerging Options RAS and Fields 36:27 - Wrap Up and Credits --- More about this episode The doctors define locally advanced versus borderline resectable disease using NCCN vascular criteria, while emphasizing institutional nuance, tumor biology, patient fitness, and response to induction systemic therapy (modified FOLFIRINOX vs. gemcitabine/Abraxane). They discuss how biomarkers like CA 19-9 and CEA inform decisions in the absence of significant radiographic shrinkage, and review the use of pancreas-protocol CT, MRI, PET, and staging laparoscopy for optimal assessment. The doctors explore post-chemotherapy strategies, including when to switch regimens, the choice between chemoradiation and SBRT, surgical aggressiveness, and the application of local therapies like IRE (NanoKnife). The conversation also touches on innovative techniques, histotripsy, intra-arterial options, tumor treating fields and looks ahead to the promise of KRAS inhibitors and ctDNA-driven personalized treatment. --- Resources NCCN Guidelines for Pancreatic Cancer https://www.nccn.org/patients/guidelines/content/PDF/pancreatic-patient.pdf ACSO 2025 Presentation on Tumor Treating Fields https://www.asco.org/abstracts-presentations/241499 May 2026 Metastatic RAS Inhibitor Clinical Trial https://www.dana-farber.org/newsroom/news-releases/2026/rason-inhibitor-daraxonrasib-shows-promising-results-in-advanced-pancreatic-cancer-phase-12-study --- 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

Ep. 61 Radiation Therapy Advances for Gynecologic Cancers with Dr. Andrew Lim

"The treatment of cervical cancer is definitely a team sport." Hear how recent radiation advancements are impacting gynecologic cancer care, and how to partner with your radiation oncologist to tailor therapy. This BackTable Women’s Health / Tumor Board episode features hosts Dr. Mona Guo and Dr. Marcia Ciccone joined by USC radiation oncologist and brachytherapy director Dr. Andrew Lim discussing modern radiation techniques, indications for definitive/adjuvant therapy, and toxicity management in gynecologic cancers. --- Get the BackTable app https://www.backtable.com/app --- Timestamps 00:00 - Introduction 02:39 - Modern External Beam IMRT 05:47 - Planning With CT And AI 08:14 - Daily Setup Imaging Workflow 13:30 - Dose and Fractionation Basics 18:50 - HDR Image Guided Brachy 21:50 - Brachy Vs External Boost Evidence 24:54 - Managing Side Effects and Menopause 28:49 - Hormone Therapy Benefits 30:37 - Dilators and Pelvic Rehab 33:12 - Long Term Radiation Effects 38:14 - Spacers and Prolapse Planning 41:42 - Reirradiation and Plan Review 44:05 - Palliative Radiation Choices 46:50 - Gamma Knife Explained 50:16 - Conclusion --- More about this episode Dr. Lim contrasts historical four-field box radiation with contemporary IMRT, CT-based planning, daily cone-beam verification, and AI-assisted contouring with dosimetrist support. They review pelvic radiation treatment timelines, emerging hypofractionation data, and the essential role of image-guided brachytherapy for cervical cancer, including outpatient workflows and improved tumor coverage with reduced bladder/rectum dose. The group covers patient counseling on expected side effects, radiation-induced menopause, fertility, sexual health, vaginal stenosis prevention with dilators/pelvic floor therapy, late effects, re-irradiation considerations, spacers, palliative regimens, and stereotactic radiosurgery/Gamma Knife for brain metastases. --- 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

Ep. 60 PARP Inhibitors: Clinical Trials & Real-World Applications with Dr. Neeraj Agarwal and Dr. Arun Azad

Keeping patients on PARP inhibitors long enough to see real benefit often comes down to proactive side effect management. In this episode of BackTable Urology, Dr. Neeraj Agarwal and Dr. Arun Azad join host Dr. Alan Tan to discuss practical, evidence-based strategies for managing hematologic and GI toxicities in advanced prostate cancer patients receiving PARP inhibitors. --- Get the BackTable app https://www.backtable.com/app --- This podcast is supported by an educational grant from Pfizer. --- Timestamps 00:00 - Introduction 06:17 - Managing Anemia 11:12 - Side Effect Profiles 19:33 - Transfusions vs ESAs 26:43 - Docetaxel vs PARP Inhibitors 30:27 - Side Effect Management Pearls 40:18 - Team Based Monitoring 52:27 - Tissue Versus Liquid 01:01:24 - Genetic Counseling Workflow 01:07:07 - Trial Equity and Access --- More about this episode The doctors discuss the importance of close anemia monitoring during the critical first 3 to 4 months of therapy, maintaining dose intensity, proactive antiemetic use, and the role of exercise and resistance training in combating fatigue. The conversation also covers differences in toxicity profiles between PARP agents, the value of multidisciplinary care teams, molecular advances in molecular and germline testing, and the evolving landscape of emerging therapies in prostate care. --- Resources Talazoparib plus enzalutamide in men with metastatic castration-resistant prostate cancer: final overall survival results from the randomised, placebo-controlled, phase 3 TALAPRO-2 trial https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(25)00684-1/abstract BRCAAway: A randomized phase 2 trial of abiraterone, olaparib, or abiraterone + olaparib in patients with metastatic castration-resistant prostate cancer (mCRPC) bearing homologous recombination-repair mutations (HRRm). https://ascopubs.org/doi/10.1200/JCO.2024.42.4_suppl.19 --- 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

Ep. 59 Evolving Treatment Paradigms in Hepatocellular Carcinoma: What's on the Horizon? with Dr. A Craig Lockhart and Dr. Lingling Du

With new systemic and liver-directed approaches under investigation, which targets and treatment strategies are most likely to shape HCC care? In this final episode of the BackTable 2026 HCC Creator Weekend™, Drs. Lingling Du, A. Craig Lockhart, and Jon Mizrahi focus on the future of hepatocellular carcinoma beyond established PD-1/CTLA-4 regimens. --- Get the BackTable app https://www.backtable.com/app --- Timestamps 00:00 - Introduction 01:34 - Beyond PD-1 and CTLA-4: Anti-TIGIT plus Atezolizumab 03:24 - Combination Strategies: Immunotherapy plus Radioembolization 09:14 - SBRT in Oligometastatic Disease 10:55 - Neoadjuvant Immunotherapy in HCC 12:07 - Targeted Therapies: ctDNA, CAR T-cells & GPC3 15:18 - Liver Transplant & Immunotherapy 23:07 - Future Directions and Closing Thoughts --- More about this episode The clinicians discuss promising results from emerging immune checkpoint targets like anti-TIGIT and note ongoing interest in other targets like TIM-3. They emphasize combining systemic immunotherapy with liver-directed therapies like Y90 across heterogeneous patient groups and discuss potential neoadjuvant approaches for resectable cases, despite limited benefit seen in adjuvant studies. Additionally, they outline early-phase cellular and targeted strategies, such as GPC3-directed bispecifics and CAR T-cell therapies, noting tolerance challenges tied to liver function and the risks of using immunotherapy after liver transplant. --- Resources TIGIT plus atezolizumab phase II study https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(24)00679-X/fulltext LEAP-002 Trial https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(23)00469-2/abstract EMERALD-1 Trial https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)02551-0/abstract --- 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

Ep. 58 Advanced Hepatocellular Carcinoma: Navigating Second-Line Therapy Options with Dr. A. Craig Lockhart and Dr. Lingling Du

When first-line treatment for advanced hepatocellular carcinoma (HCC) fails and the disease progresses, what options are available for second-line therapy? In this episode of the BackTable 2026 HCC Creator Weekend™, Drs. Lingling Du, A. Craig Lockhart, and Jon Mizrahi explore the uncertain landscape of second-line treatment after first-line immunotherapy, such as atezolizumab and bevacizumab or the STRIDE regimen, including practical considerations for choosing which second-line therapy to use. --- Get the BackTable app https://www.backtable.com/app --- Timestamps 00:00 - Introduction 01:15 - Second-Line Treatment for HCC: Lenvatinib vs Ramucirumab 04:28 - Tolerability And Sequencing Reality: Cabozentinib 06:35 - Treatment Options for Rapid Progression After Atezolizumab + Bevacizumab 11:40 - Practical Tyrosine Kinase Inhibitor Dosing for HCC 13:44 - Next-Generation Sequencing vs Biopsy In HCC Practice 19:10 - Future Biomarker Clinical Trials: Risks and Impact on Practice 24:31 - Role of Second-Line Immunotherapy in HCC --- More about this episode The doctors discuss real-world dosing strategies for tyrosine kinase inhibitors (TKI), management of rapid progression, and the limited utility of next-generation sequencing and biopsy in HCC. They also highlight ongoing biomarker clinical trials and the evolving role of second-line immunotherapy. They note that few patients reach third-line therapy due to declining performance status and liver function, as well as mixed results from adding CTLA-4 inhibitors after disease progression. --- Resources HIMALAYA Clinical Trial https://www.annalsofoncology.org/article/S0923-7534(24)00049-8/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