UCI Health Physician Huddle

KRAS-targeted therapy and the future of pancreatic cancer treatment

Jennifer Valerin, MD, PhD, a UCI Health medical oncologist and pancreatic cancer specialist, joins Physician Huddle to discuss breakthrough treatments in the landscape of pancreatic cancer care. Valerin shares how a family member's pancreatic cancer diagnosis more than 20 years ago shaped her decision to pursue medicine and focus her career on bringing new therapies to patients with pancreatic cancer. She also discusses her MD-PhD training path, her work in hereditary pancreatic cancer, and how clinical questions from patient care can inform research from bench to bedside and back. The conversation explores why pancreatic cancer is often diagnosed late, including nonspecific symptoms such as weight loss and back pain, the role of imaging and endoscopic ultrasound-guided biopsy, and why the disease has historically been so difficult to treat. Valerin also explains the significance of KRAS in pancreatic cancer and how emerging KRAS-targeted therapies — including daraxonrasib — may represent a major step forward for patients who previously had limited options. She discusses the importance of clinical trials, side effect management, multidisciplinary care and UCI Health leadership as a pancreatic cancer referral center in Southern California. The episode closes with a discussion of cautious optimism on how oncologists can balance realism with hope and how treatment goals can be individualized around patient milestones. Topics discussed:  * Valerin’s career in pancreatic cancer was shaped by a deeply personal experience caring for her aunt through diagnosis and treatment.  * Pancreatic cancer can be difficult to detect because symptoms are often nonspecific, including unexplained weight loss and back pain.  * Tissue diagnosis remains essential, but ctDNA and mutation profiling can help inform molecular understanding and treatment planning.  * KRAS has long been a major driver in pancreatic cancer and was historically considered difficult to target.  * Emerging KRAS-directed therapies are creating new possibilities for patients with pancreatic cancer, particularly through clinical trials.  * Side effect management is central to helping patients remain on therapy, including close collaboration with dermatology for rash associated with KRAS inhibitors.  * The UCI Health pancreatic cancer program is positioned around multidisciplinary care, clinical trials, nutrition, psycho-oncology, surgery, interventional radiology, and close collaboration with community oncologists. Connect with UCI Health physicians online at clinicalconnection.ucihealth.org [https://clinicalconnection.ucihealth.org], on LinkedIn @UCI Health Physicians [https://www.linkedin.com/company/uci-health-physicians/], on Instagram @ucihealthphysicians [https://www.instagram.com/ucihealthphysicians/], or at @uciphysicians [https://x.com/uciphysicians] on X. Refer a patient at referralportal.ucihealth.org [https://referralportal.ucihealth.org/] and learn more about ongoing clinical trials at ucihealth.org/clinical-trials [https://www.ucihealth.org/clinical-trials].

How pain medicine is evolving for physicians and patients

Shalini Shah, MD, professor and vice chair of the Department of Anesthesiology and Perioperative Care and director of pain services at UCI Health, joins Physician Huddle to discuss the growth and evolution of pain medicine. Shah reflects on her path from anesthesiology training at Cornell to adult and pediatric pain fellowships at Harvard-affiliated hospitals, and how she was recruited to UCI Health to help establish a pediatric pain program. She describes how UCI Health developed one of the country’s largest pediatric pain programs by volume, with care designed to improve access for children and adolescents who should not have to wait for care. The conversation explores how UCI Health has expanded pain services across Orange County, including the growth of multiple pain clinics and a multidisciplinary model that brings together physicians from anesthesiology, physical medicine and rehabilitation, neurology, psychiatry, and other specialties under a coordinated structure. Shah discusses the state of opioid prescribing, including how the pendulum has shifted from overprescribing to fear of prescribing. She emphasizes that opioids are neither “the hero” nor “the villain,” but one component of a personalized treatment plan when used appropriately. The episode also covers interventional pain therapies, longevity and function, lifestyle approaches to pain management, advocacy through organized medicine, and Shah’s reflections on physician leadership, work-life integration, and building teams that support people through different seasons of life. Topics discussed:  * UCI Health has developed a high-volume pediatric pain program focused on timely access, multidisciplinary care and community relationships. * Shah emphasizes that pain care should not be siloed; the UCI Health model brings multiple pain-trained specialties under one coordinated structure. * Shah’s leadership philosophy centers on building strong teams, understanding what people need to succeed and recognizing that team members operate at different capacities during different life stages. * Medical education around pain and opioid prescribing has historically been limited, contributing to broader challenges in clinical practice. * Shah helped advance a University of California-wide curriculum to improve medical student education in pain care and opioid prescribing. * Opioids should be viewed as part of a personalized treatment plan — not as either the central solution or something to categorically avoid.  * Interventional pain medicine is evolving rapidly, with new therapies, modalities and devices expanding treatment options. * Pain management increasingly intersects with longevity, mobility, function and quality of life. * Physician advocacy matters because healthcare policy is often shaped by people who have not directly cared for patients. Connect with UCI Health physicians online at clinicalconnection.ucihealth.org [https://clinicalconnection.ucihealth.org], on LinkedIn @UCI Health Physicians [https://www.linkedin.com/company/uci-health-physicians/], on Instagram @ucihealthphysicians [https://www.instagram.com/ucihealthphysicians/], or at @uciphysicians [https://x.com/uciphysicians] on X. Refer a patient at referralportal.ucihealth.org [https://referralportal.ucihealth.org/] and learn more about ongoing clinical trials at ucihealth.org/clinical-trials [https://www.ucihealth.org/clinical-trials].

Rethinking menopause care for midlife women

Rebecca Sauer, MD, associate professor of obstetrics and gynecology at UCI Health, joins Physician Huddle to discuss the evolving field of menopause and midlife care. Sauer reflects on her path from medical school at UC Irvine to her current focus on perimenopause, menopause, and women’s health. She explains that menopause care historically has received limited attention in medical training, despite the wide range of symptoms and health concerns that can arise during this stage of life. The conversation covers common symptoms of perimenopause and menopause, including hot flashes, night sweats, sleep disturbances, mood changes, urogenital symptoms, and cognitive concerns. Sauer also discusses emerging associations with joint issues, tinnitus, cardiovascular changes, and broader health implications. She outlines how clinicians can approach evaluation, including when to consider thyroid, rheumatologic, autoimmune, nutritional or mood-related conditions before attributing symptoms to perimenopause. The discussion also explores hormone therapy, nonhormonal options, osteoporosis prevention, resistance training, and the importance of setting realistic expectations for treatment. Sauer also illustrates UCI Health leadership in developing a comprehensive menopause program, built around certified menopause providers, multidisciplinary collaboration and evidence-based guidance for women navigating midlife health. Topics discussed:  * Sauer emphasizes that listening, validation, and individualized care can significantly improve quality of life. * Nonhormonal therapies may be appropriate for patients who are not candidates for hormone therapy or have targeted symptoms.  * Menopause and perimenopause have historically been underrepresented in medical education, even within OB-GYN training.  * Common symptoms include hot flashes, night sweats, sleep disturbances, mood changes, urinary symptoms and vaginal dryness.  * Midlife care may also involve cognitive symptoms, joint concerns, cardiovascular risk, bone health, mood disorders and metabolic changes.  * Perimenopausal symptoms are often a diagnosis of exclusion; clinicians should evaluate for thyroid disease, autoimmune conditions, nutritional deficiencies and other possible causes when indicated.  * Hormone therapy remains a standard-of-care option for vasomotor symptoms and may help prevent osteoporosis in appropriate patients.  * UCI Health progress toward a comprehensive, evidence-based menopause care model across OB-GYN, primary care, and other key subspecialties.  Connect with UCI Health physicians online at clinicalconnection.ucihealth.org [https://clinicalconnection.ucihealth.org], on LinkedIn @UCI Health Physicians [https://www.linkedin.com/company/uci-health-physicians/], on Instagram @ucihealthphysicians [https://www.instagram.com/ucihealthphysicians/], or at @uciphysicians [https://x.com/uciphysicians] on X. Refer a patient at referralportal.ucihealth.org [https://referralportal.ucihealth.org/] and learn more about ongoing clinical trials at ucihealth.org/clinical-trials [https://www.ucihealth.org/clinical-trials].

How biportal endoscopic spine surgery is changing the present and future of outpatient spine care

Don Park, MD, professor of orthopedic surgery and director of minimally invasive spine surgery at UCI Health, joins Physician Huddle to discuss the evolution of endoscopic spine surgery and the development of the UCI Health outpatient spine surgery program at the UCI Health — Irvine medical campus. Park explains how endoscopic techniques allow surgeons to treat common spine conditions through millimeter-sized incisions, using high-resolution cameras and specialized instruments. He describes how these approaches may support faster recovery, reduced pain, and a transition of appropriate spine procedures from the inpatient setting to an ambulatory surgery center. The conversation also explores why the adoption of minimally invasive and endoscopic spine surgery has been gradual in the United States, the importance of hands-on training and mentorship, and how the UCI Health multidisciplinary spine program brings together orthopedic surgery and neurosurgery in a collaborative environment. Park also discusses his use of an augmented reality headset during endoscopic lumbar fusion, the role of emerging technologies in the operating room, and the future potential of AI as an adjunct to surgical decision-making, visualization, and safety. Topics discussed: * Endoscopic spine surgery uses small incisions and high-resolution visualization to treat selected spine conditions, including lumbar disc herniations and lumbar stenosis. * UCI Health is developing an endoscopic and outpatient spine surgery program that aligns with the Irvine medical campus and its ambulatory surgery capabilities.  * Not every patient is a candidate for endoscopic surgery; Park emphasizes matching the right patient, pathology, and surgical approach.  * Training is central to broader adoption because many surgeons did not learn endoscopic spine techniques during residency or fellowship.  * Park views new technology through a patient-safety lens: It must make surgery better, more efficient or safer.  * Augmented reality technologies may offer enhanced visualization and improved ergonomics during selected endoscopic spine procedures. * AI’s future role in spine surgery may be as an adjunct that supports surgeons, rather than a replacement for clinical judgment. Connect with UCI Health physicians online at clinicalconnection.ucihealth.org [https://clinicalconnection.ucihealth.org], on LinkedIn @UCI Health Physicians [https://www.linkedin.com/company/uci-health-physicians/], on Instagram @ucihealthphysicians [https://www.instagram.com/ucihealthphysicians/], or at @uciphysicians [https://x.com/uciphysicians] on X. Refer a patient at referralportal.ucihealth.org [https://referralportal.ucihealth.org/] and learn more about ongoing clinical trials at ucihealth.org/clinical-trials [https://www.ucihealth.org/clinical-trials].

Lung cancer in never-smokers: What physicians should know

In this episode of Physician Huddle by UCI Health, thoracic surgeon Hari B. Keshava, MD, joins the show to discuss the rising incidence of lung cancer in never-smokers, persistent gaps in lung cancer screening, and the growing importance of coordinated follow-up for incidental lung nodules. Keshava also explains how advances in minimally invasive and robotic thoracic surgery, along with targeted therapies and immunotherapy, are reshaping treatment pathways for patients with lung cancer. He also shares his unusual path to medicine, from electrical engineering to thoracic surgery, and reflects on how a personal, family experience with serious lung disease continues to shape the way he cares for patients and their loved ones. Topics discussed:  * Why lung cancer screening rates have improved, but remain far below where they should be * Common physician and patient barriers to low-dose CT screening * How to talk with patients about smoking history without judgment * What to do when a lung nodule is found incidentally * How the UCI Health lung nodule clinic helps streamline follow-up and next steps * The rising incidence of lung cancer in never-smokers, particularly in certain patient populations * Questions surrounding genetics, driver mutations, and environmental exposure * How robotic and minimally invasive thoracic surgery is improving recovery * Why targeted therapies and immunotherapy are changing surgical decision-making * Keshava’s path from electrical engineering to thoracic surgery * How personal experience shapes empathy, expectation-setting, and patient communication * What makes thoracic surgery and multidisciplinary cancer care at UCI Health distinctive Connect with UCI Health physicians online at clinicalconnection.ucihealth.org [https://clinicalconnection.ucihealth.org], on LinkedIn @UCI Health Physicians [https://www.linkedin.com/company/uci-health-physicians/], on Instagram @ucihealthphysicians [https://www.instagram.com/ucihealthphysicians/], or at @uciphysicians [https://x.com/uciphysicians] on X. Refer a patient at referralportal.ucihealth.org [https://referralportal.ucihealth.org/] and learn more about ongoing clinical trials at ucihealth.org/clinical-trials [https://www.ucihealth.org/clinical-trials].