Ep. 70 Diagnosis & Initial Management of Neuroendocrine Tumors with Dr. Chih-Yi Liao and Dr. Xavier Keutgen

Ep. 70 Diagnosis & Initial Management of Neuroendocrine Tumors with Dr. Chih-Yi Liao and Dr. Xavier Keutgen

How do you unravel the complexity of diagnosing and managing neuroendocrine tumors, where every case demands a tailored approach? In this episode of BackTable TumorBoard, host Dr. Lingling Du is joined by Dr. Chih-Yi Liao and Dr. Xavier Keutgen to break down the essential steps from first symptoms to staging, imaging, and early treatment decisions for NET patients. The discussion covers the spectrum of NET biology, individualized imaging strategies, and when surgery or systemic therapy is the best path forward. --- Get the BackTable app https://www.backtable.com/app --- Timestamps 00:00 - Introduction 07:16 - Imaging Approaches for Staging Neuroendocrine Tumors 16:47 - Biomarkers for Neuroendocrine Tumor Diagnosis 22:33 - Surgical Candidacy Guidelines 26:03 - Ki-67 and Tumor Biology Consideration 30:11 - Co-morbid Obesity and GLP-1 Use 35:11 - Working Therapies to Manage Neuroendocrine Tumors 38:02 - Tumor Board Case Walkthrough and Closing Statements --- More about this episode The doctors review the strengths and limitations of DOTATATE PET, MRI, CT, and FDG PET for diagnosis and staging, and clarify the limited role of biomarkers such as chromogranin A and serotonin. They outline key factors in surgical candidacy, including tumor location, burden, grade, and comorbidities like obesity, and discuss the use of GLP-1 and pancreas-sparing surgery in high-risk cases. The episode also examines managing discordant imaging, evolving guidelines for adjuvant therapy, and a case study where CAPTEM is used for tumor shrinkage in locally advanced pancreatic NET. Throughout, they emphasize the importance of multidisciplinary decision-making and the need for experienced pathology review in this heterogeneous disease. --- Resources SWOG S2104 https://clinicaltrials.gov/study/NCT05040360 Postoperative long-acting somatostatin analog therapy during surgical debulking https://www.sciencedirect.com/science/article/abs/pii/S0039606025006142 --- 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. 69 Managing Intravesical Therapy Toxicities in Bladder Cancer with Dr. Meredith Donahue and Mary Dunn, NP

How can clinics minimize toxicity and maximize outcomes in intravesical bladder cancer treatment? In this episode of BackTable Urology, host Dr. Vignesh Packiam talks with nurse practitioners Mary Dunn (UNC) and Meredith Donahue (Vanderbilt) about how advanced practice providers (APP) workflows and hands-on management are transforming care for non-muscle-invasive bladder cancer. The discussion highlights innovative strategies for symptom management, patient education, catheter techniques, and streamlined operational protocols across both established and emerging intravesical therapies. --- Get the BackTable app https://www.backtable.com/app --- This podcast is supported by an educational grant from Johnson & Johnson. --- Timestamps 00:00 - Introduction 04:25 - Non Drug Symptom Tips 09:39 - Day Of Treatment Clearance 14:50 - Post Treatment Triage 20:36 - Treatment Fatigue Strategies 24:48 - Pelvic Floor And IC Tools 27:33 - Teamwork Final Pearls --- More about this episode They share individualized pharmacologic and non-pharmacologic approaches for managing lower urinary tract symptoms, such as NSAIDs, anticholinergics, beta-3 agonists, Pyridium, timed voiding, avoidance of irritants, and constipation management. The episode covers patient education resources from the Bladder Cancer Advocacy Network (BCAN), catheterization techniques tailored to patient needs, and a gravity installation method to reduce spasms. The conversation also reviews day-of-treatment clearance and triage protocols, operational considerations for new agents like Enlexo, Adstiladrin, and gemcitabine/docetaxel, as well as financial workflows that prevent drug wastage. Additional topics include managing cumulative bladder toxicity, pelvic floor PT, addressing treatment fatigue, and integrating multifactorial evaluation and exercise into patient care. --- Resources Bladder Cancer Advocacy Network (BCAN) Basic Handbook & Patient Resources https://bcan.org/bladder-cancer-basics-handbook/ --- 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. 68 Metastatic Pancreatic Cancer: Treatment Options & Trials with Dr. Dawood Findakly

Can the latest therapies, lessons from clinical trials, and a focus on emotional support improve outcomes for patients with metastatic pancreatic cancer? In this BackTable Tumor Board episode, GI medical oncologist Dr. Greg Botta and medical oncologist Dr. Dawood Findakly discuss current treatment options, the importance of emotional support, and strategies for overcoming barriers such as insurance delays. They highlight the value of personalized care, from diagnosis and staging scans to tumor markers, tissue biopsy, and genomic profiling, as well as the expanding role of clinical trials and targeted therapies. --- Get the BackTable app https://www.backtable.com/app --- Timestamps 00:00 - Introduction 02:57 - Workup and Biopsy in Metastatic Pancreatic Cancer 07:33 - Approach to Care for Metastatic Patients 10:39 - Managing Symptoms Early and Personalizing Therapy 16:52 - Assessing Combination Chemo and Clinical Trials 22:30 - Discussing Alternatives with Patients 28:19 - Measuring Treatment Response 32:51 - Emerging Role of Liquid Biopsy 35:34 - RAS Revolution: Oral Pill vs. Chemotherapy 40:49 - Wrap Up --- More about this episode The doctors cover common patient presentations, early management of complications, and the rationale behind systemic chemotherapy choices and regimen selection. They discuss practical methods for monitoring response to treatment, the growing access to clinical trials, including the promise of KRAS/RAS-targeted oral therapies, and the critical role of ongoing communication, psychological support, and individualized care planning. The episode offers insights on integrating palliative care, supporting patients through side effects, and tailoring conversations around prognosis and quality of life. --- Resources PANThEON Study https://pubmed.ncbi.nlm.nih.gov/41318310/ RAS Revolution https://www.asco.org/about-asco/press-center/multi-selective-ras-inhibitor-nearly-doubles-survival-pancreatic-cancer --- 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. 67 Bladder Cancer Risk Stratification: Best Practices with Dr. Sunil Patel and Dr. Kristen Scarpato

Why does up to 10% of bladder cancer pathology change on expert review, and what does that mean for your intermediate and high-risk patients? In this episode of BackTable, Dr. Bogdana Schmidt interviews urologists Dr. Kristen Scarpato and Dr. Sunil Patel to explore the complexities of diagnosis and risk assessment in non–muscle invasive bladder cancer (NMIBC). They discuss the real-world challenges of pathology interpretation, risk-group assignment, evolving diagnostic tools, and the impact these factors have on treatment decisions and patient outcomes. --- Get the BackTable app https://www.backtable.com/app --- This podcast is supported by an educational grant from Johnson & Johnson. --- Timestamps 00:00 - Introduction 01:02 - Risk Stratification 07:22 - Upstaging to High Risk 10:06 - Calculators and Patient Education 15:22 - Specific Tests Use Cases 18:50 - Conflicting Biomarker Results 21:36 - Adjunct Tests and Counseling 24:03 - Recurrence After Chemo Next Steps 27:01 - Escalation Deescalation Balance 32:48 - Future Research Priorities 35:43 - Biology Based Risk Stratification 38:03 - Clinical Pearls and Wrap Up --- More about this episode The conversation highlights the heterogeneity of intermediate-risk disease, the role and importance of expert pathology over-reads, and the need to accurately document the risk category for ongoing care. They discuss selective use of urinary and genomic assays and how these tests fit alongside cystoscopy and blue light endoscopy. Practical treatment approaches are reviewed, including when to use intravesical gemcitabine or BCG, managing care during BCG shortages, and balancing escalation versus de-escalation of therapy. Additional topics include strategies for long-term surveillance, upper tract imaging, rising rates of bladder cancer in younger patients, and why thorough TURBT and strong patient-provider communication remain central to optimal management. --- Resources The Memorial Study https://www.mskcc.org/cancer-care/clinical-trials/19-288 The BRIDGE Study https://www.nejm.org/doi/full/10.1056/NEJMoa1501035 --- 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. 66 Managing Complications in Pancreatic Cancer with Dr. Zach Berman and Dr. Rebekah White

How do seasoned clinicians navigate the complex web of complications that accompany pancreatic cancer? In this episode of BackTable Tumor Board, Drs. Greg Botta, Rebekah White, and Zachary Berman discuss real-world strategies for managing pain, digestive complications, and the many challenges patients face. They explore multidisciplinary approaches, emphasizing the importance of tailored pain management, careful use of enzyme supplementation, and anticipating both surgical and medical risks, especially after procedures like the Whipple. --- Get the BackTable app https://www.backtable.com/app --- Timestamps 00:00 - Introduction 01:36 - Interventional Radiology Approach to Pain Relief 05:37 - Nerve Blocks and Neurolysis for Treatment 09:05 - Expectations for Post-operative Recovery 10:46 - Whipple Anatomy and Side Effects 13:49 - Clot Prevention After Surgery 19:11 - Managing Nutritional Challenges and Gastric Outlet Obstruction 24:37 - Treating Malignant Ascites 29:54 - Mental Health Support for Pancreatic Cancer Patients 31:16 - Setting Expectations When Communicating with Patients 39:41 - Stent Choices and Sequencing --- More about this episode The conversation covers classifying and treating pain (visceral, neuropathic, somatic, and existential), multimodal and non-opiate therapies, and targeted nerve blocks for symptom relief. The doctors address nutrition and cachexia, strategies for managing post-surgical clotting risk, and the use of stents and interventional radiology to restore digestive flow. They also highlight the need for psychosocial support, exercise to combat fatigue, and streamlined team communication for standardized, patient-centered care. The episode wraps up with practical advice on setting patient expectations, troubleshooting persistent symptoms, and leveraging clinical trials and multidisciplinary expertise. --- Resources CASSINI Study https://pmc.ncbi.nlm.nih.gov/articles/PMC7476843/ --- 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