BackTable Tumor Board

Don’t miss the “curative window”! This episode takes a closer look at how evolving perioperative strategies and biomarker integration are changing bladder cancer care, with a focus on preserving opportunities for cure. Jun Gong hosts Tyler Stewart to review key bladder cancer updates from ASCO Genitourinary Cancers Symposium 2026. --- Get the BackTable app https://www.backtable.com/app --- Timestamps 00:00 - Introduction01:50 - KEYNOTE-905 Overview07:09 - Practice-Changing Takeaways13:28 - Bladder Preservation Trials16:06 - ctDNA Biomarker Updates21:16 - Using ctDNA in Clinic28:48 - Metastatic ADC Data33:36 - Wrap-Up --- More about this episode The discussion begins with KEYNOTE-905/EV-303 in cisplatin-ineligible muscle-invasive bladder cancer, where perioperative enfortumab vedotin plus pembrolizumab demonstrated improvements in event-free and overall survival. This is followed by KEYNOTE-B15, which compares perioperative EVP with gemcitabine/cisplatin and identifies EVP as the first non-platinum regimen to outperform cisplatin-based therapy. Implications for clinical adoption are considered, including the potential for EVP to extend across cisplatin eligibility groups, unresolved questions regarding perioperative duration and adjuvant use, and the need to avoid premature de-escalation outside of trial settings.The latter portion of the episode focuses on biomarker-driven decision-making. Data from RETAIN-2 highlight the prognostic value of post-neoadjuvant ctDNA positivity for systemic relapse risk, while underscoring its limitations in detecting intravesical recurrence. Complementary findings from NIAGARA suggest that urine tumor DNA may more accurately reflect local disease burden and pathologic complete response. Together, these studies frame an evolving role for circulating and urine-based biomarkers in guiding surveillance, treatment selection, and timing—central considerations in maintaining the curative window. --- Resources KEYNOTE-B15https://ascopubs.org/doi/10.1200/JCO.2026.44.7_suppl.LBA630 KEYNOTE-905https://www.nejm.org/doi/abs/10.1056/NEJMoa2511674 EV-302 Clinical Trialhttps://www.nejm.org/doi/full/10.1056/NEJMoa2312117

When to test, how to prevent, and what you need to know about hereditary gynecologic cancer syndromes. Two USC gynecologic oncologists, Dr. Mona Guo and Dr. Marcia Ciccone, go in-depth in this BackTable OBGYN x Tumor Board crossover episode. --- Get the BackTable app https://www.backtable.com/app --- Timestamps 00:00 - Introduction01:37 - Why Hereditary Cancer Matters04:51 - Family History Red Flags09:01 - Who Should Order Genetic Testing11:32 - Variants and Counseling Pitfalls13:30 - Access and Remote Testing Options19:27 - BRCA1 Positive Patient Walkthrough24:52 - Risk-Reducing Surgeries29:11 - Prevention and Screening Limits32:38 - Why Ovarian Cancer Is Hard34:04 - Combining Breast and Gyn Surgery35:41 - Preop Ultrasound and CA-12536:27 - BRCA Timing and HRT Nuance42:32 - Nonhormonal Menopause Options47:14 - Lynch Syndrome Screening Basics54:22 - Endometrial Biopsy Debate56:43 - Insurance and Coverage Pitfalls59:00 - Fertility Preservation and REI01:01:41 - Cascade Testing01:02:45 - Conclusion --- More about this episode Dr. Guo and Dr. Ciccone discuss how careful family history can identify patients who may benefit from genetic evaluation and highlight key red flags, including a family history of ovarian cancer, breast cancer at age 50 or younger, and metastatic prostate cancer. They explain the role of genetic counseling, including pre- and post-test discussions and how to approach variants of uncertain significance. They then cover BRCA counseling and risk-reduction strategies, including the timing of risk-reducing bilateral salpingo-oophorectomy, ongoing salpingectomy trials, and considerations for hysterectomy. Additionally, they touch on pathology protocols, breast cancer screening, and the potential protective effect of hormonal contraception. The doctors address the limitations of ovarian cancer screening and outline patterns suggestive of Lynch syndrome, such as endometrial cancer occurring alongside gastrointestinal or urinary tract cancers. They review the Lynch workup, including tumor mismatch repair immunohistochemistry and MLH1 hypermethylation testing. Finally, they discuss practical considerations like barriers to access, Medicare coverage challenges, fertility preservation referrals, menopause management, and cascade testing in families, including the timing of testing in children. --- Resources NCCN Guidelines: Detection, Prevention, and Risk Reductionhttps://www.nccn.org/guidelines/category_2

Antibody-drug conjugates (ADCs) are expanding treatment options in breast cancer, but their use requires careful attention to toxicity. In this episode of the BackTable Tumor Board Podcast, Dr. Kate Baker and Dr. Sara Nunnery review the role of ADCs in HER2-positive disease and their growing application in HER2-low and HER2-ultralow metastatic settings. --- Get the BackTable app https://www.backtable.com/app --- Timestamps 00:00 - Introduction01:46 - How ADCs Work08:40 - ILD Risk and Monitoring13:46 - Next-Generation HER2 ADCs24:14 - HER2-Low and Ultralow Disease29:56 - Sequencing After Endocrine Therapy33:42 - Future Targets and Bispecifics38:08 - Wrap Up --- More about this episode The discussion outlines ADC mechanisms and recent trial-driven shifts in clinical practice, with emphasis on interstitial lung disease (ILD) risk, monitoring, and patient counseling. They address practical considerations including patient selection, sequencing after endocrine therapy, and potential maintenance approaches. Additional topics include evolving pathology reporting, considerations for earlier-stage use in high-risk patients, and the development of next-generation HER2- and HER3-targeted ADCs, as well as bispecific therapies. --- Resources DESTINY Breast 09https://www.nejm.org/doi/full/10.1056/NEJMoa2508668 DESTINY Breast 05https://www.nejm.org/doi/full/10.1056/NEJMoa2514661 DESTINY Breast 06https://www.nejm.org/doi/abs/10.1056/NEJMoa2407086

When standard-of-care checkpoint blockade fails in metastatic melanoma, how can oncologists and interventional radiologists join forces to turn around patient outcomes? In this episode of the BackTable Podcast, medical oncologist Dr. Jennifer McQuade and interventional radiologist Dr. Rahul Sheth join host Dr. Tyler Sandow to discuss the growing evidence for intratumoral oncolytics as a therapeutic strategy for frontline immunotherapy-refractory melanoma and the interdisciplinary work that is required for successful implementation in practice. --- This podcast is supported by:Replimunehttps://www.replimune.com/ --- SYNPOSIS The physicians review how engineered viral vectors, particularly RP1, complement checkpoint blockade through direct tumor lysis and immune activation, and summarize the IGNYTE trial data supporting their use in patients with metastatic melanoma refractory to anti-PD-1 and anti-CTLA-4 agents. The discussion then shifts to practical administration, highlighting the central role of interventional radiology in delivering these therapies to visceral and deep-seated lesions under image guidance. The doctors go on to address the nuances of patient and lesion selection, injection technique, and response assessment, including the importance of recognizing pseudo-progression. They place particular emphasis on the need for multidisciplinary collaboration and stakeholder buy-in efforts on the part of IRs seeking to integrate intratumoral oncolytic injections into their scope of practice. The episode concludes with a forward-looking discussion on the potential for expansion of oncolytic platforms into other solid tumors, underscoring this field as a growing, IR-forward frontier in cancer treatment. --- TIMESTAMPS 00:00 - Introduction02:28 - Immunotherapy Basics06:51 - How Oncolytic Viruses Work11:01 - IGNYTE Trials and Why IR Matters18:14 - T-VEC vs RP1 Indications and Logistics21:57 - Physician Communication and Multidisciplinary Treatment23:06 - RP1 Protocol and Administration Techniques30:28 - RP1 Safety Profile32:46 - Follow-Up Imaging and Response Assessment35:44 - Future Applications Beyond Melanoma41:42 - Final Thoughts and Closing Remarks --- RESOURCES Wong MK, et al. RP1 Combined With Nivolumab in Advance Anti-PD-1-Failed Melanoma (IGNYTE). J Clin Oncol. 2025;43(33):3589-3599.https://doi.org/10.1200/jco-25-01346 IGNYTE-3 Trialhttps://clinicaltrials.gov/study/NCT06264180

Though relatively new, there is a rapidly growing interest in the field of therapeutic radiopharmaceuticals and their potential to play a significant role in cancer treatment. This episode of BackTable Tumor Board covers recent developments in radiopharmaceutical therapies with radiation oncologists Dr. Dustin Boothe and Dr. Ryan Funk, where they discuss efficacy, side effects, and better tolerability of modern radiopharmaceuticals compared to older ones. --- This podcast is supported by: Siemens Healthineers https://cancercare.siemens-healthineers.com/products/software/digital-oncology/aria-core-for-theranostics --- SYNPOSIS Dr. Boothe and Dr. Funk cover the roles of radiation oncologists in treating patients and collaborating with different specialists, the challenges in starting a radiopharmaceutical program, and the importance of having an authorized user and radioactive materials license. They also delve into the promising future of radiopharmaceuticals, emphasizing potential advancements such as personalized dosimetry, new indications, and combination therapies. --- TIMESTAMPS 00:00 - Introduction02:54 - Understanding Radiopharmaceutical Terminology04:40 - The Evolution of Radiopharmaceuticals07:07 - The Rise of Targeted Radiopharmaceutical Therapies12:35 - Radiation Oncologists’ Role in Systemic Therapy23:55 - Challenges and Strategies in Practice Development30:33 - Starting Up a Radiopharmaceutical Practice: Challenges, Authorized Users & RAM Licensing37:47 - Advancing Practices with Clinical Trials and Dosimetry44:48 - Future of Radiopharmaceutical Therapy52:39 - Final Thoughts --- RESOURCES Siemens Healthineers: ARIA CORE for Theranosticshttps://cancercare.siemens-healthineers.com/products/software/digital-oncology/aria-core-for-theranostics PREEMPT Trial (NRG-CC014)https://clinicaltrials.gov/study/NCT06745024#collaborators-and-investigators Community Theranosticshttps://www.communitytheranostics.com/

Inflammatory breast cancer (IBC) is rare but highly aggressive, and often hides in plain sight. Rather than presenting as the distinct lump, IBC typically appears as redness or swelling in the breast and skin changes that can mimic mastitis or infection, leading to dangerous delays in diagnosis. In this episode of BackTable Tumor Board, breast medical oncologists Dr. Lindsay Peterson and Dr. Bora Lim break down how to recognize IBC’s typical and atypical presentations, approach diagnostic workup, and tailor treatment across subtypes. --- SYNPOSIS Dr. Peterson and Dr. Lim explore evolving neoadjuvant strategies, emerging clinical trials, combination therapies, IBC vaccine development, and the growing role of AI and MRI pattern recognition in predicting recurrence and guiding surveillance. The discussion highlights the importance of multidisciplinary expertise and calls for broader clinician awareness–especially in primary care, dermatology, and urgent care–so that persistent “infection-like” breast changes prompt timely evaluation and treatment for IBC. --- TIMESTAMPS 0:00 - Introduction3:26 - Typical Presentations of Inflammatory Breast Cancer (IBC)8:30 - Atypical Presentations of IBC11:48 - Routine Diagnostic Workup16:06 - Treatments for Different Subtypes of IBC19:49 - Clinical Trials22:53 - Surveillance for Different Stages of IBC25:59 - Current Clinical Trials for Best Treatments29:18 - Central Nervous System Recurrence and Other Relapse Patterns in IBC33:29 - Novel Neoadjuvant Therapy 37:27 - Centers Dedicated to Treating IBC42:13 - Final Thoughts --- RESOURCES Atezolizumab, Cobimetinib, and Eribulin in Treating Patients With Chemotherapy Resistant Metastatic Inflammatory Breast Cancerhttps://clinicaltrials.gov/study/NCT03202316?tab=researcher#study-record-dates Dana-Farber Cancer Institutehttps://www.dana-farber.org/cancer-care/treatment/breast-oncology/programs/inflammatory-breast-cancer MD Anderson Inflammatory Breast Cancer Clinichttps://www.mdanderson.org/patients-family/diagnosis-treatment/care-centers-clinics/breast-center/inflammatory-breast-cancer-clinic.html

In a patient with metastatic HER2-positive breast cancer, what should guide the next decision: trial data, toxicity, or durability of response? In this episode of BackTable Tumor Board, Dr. Lindsay Peterson (Washington University) sits down with Dr. Erica Hamilton (Sarah Cannon Research Institute) to examine how next-generation HER2-directed therapies are reshaping the management of metastatic disease. As treatment options expand beyond trastuzumab-based regimens to agents such as trastuzumab deruxtecan and tucatinib, clinical decision-making increasingly hinges on sequencing strategy, interpretation of evolving trial data, and thoughtful toxicity management. --- SYNPOSIS The discussion integrates findings from pivotal studies including DESTINY-Breast09 and PATINA, highlighting how these data influence frontline and maintenance approaches. Dr. Hamilton outlines practical considerations in balancing depth and durability of response with quality-of-life concerns, and how she approaches therapy transitions in real-world practice. The episode also explores the management of CNS involvement within the broader systemic treatment landscape and considers whether current advances meaningfully shift long-term outcomes for patients with HER2-positive metastatic breast cancer. --- TIMESTAMPS 00:00 - Introduction01:16 - Metastatic HER2-Positive Breast Cancer06:46 - Treatment Strategies and Patient Management11:57 - Maintenance Therapy Options16:28 - HER2-Positive Breast Cancer Trials20:13 - Brain Metastases and Systemic Therapy27:38 - Future Directions in HER2-Positive Breast Cancer --- RESOURCES DESTINY-Breast09 Trialhttps://www.nejm.org/doi/full/10.1056/NEJMoa2508668 PATINA Trialhttps://www.nejm.org/doi/full/10.1056/NEJMoa2511218 HER2CLIMB Trialhttps://www.nejm.org/doi/full/10.1056/NEJMoa1914609

Bispecific antibodies are emerging as an important therapeutic class in non-small cell lung cancer (NSCLC); but how do they work, where do they fit in clinical practice, and what should oncologists be thinking about next? In this episode of Back Table Tumor Board, Dr. Kate Baker and Dr. Wade Iams from Tennessee Oncology answer these questions and more. --- SYNPOSIS Dr. Baker and Dr. Iams discuss the evolving role of bispecific antibodies in NSCLC, covering the clinical data behind amivantamab, the practical benefits of subcutaneous vs IV administration, and key considerations for managing unique bispecific-related toxicities in real-world practice. This episode also explores emerging data in NSCLC, highlighting tarlatamab and its promising results in various treatment scenarios, including potential earlier-stage applications. --- TIMESTAMPS 00:00 - Introduction 01:14 - Recent Developments in Bispecific Antibodies03:24 - Real-World Application of MARIPOSA Trial Data04:28 - Managing Toxicities and Side Effects06:28 - CNS Disease and Efficacy of Combination Therapy08:26 - Counseling Patients on Prognosis and Treatment Options12:45 - Challenges in Rolling Out New Treatments in Rural Areas18:21- Future Directions in Non-Small Cell Lung Cancer20:57 - BiTE Therapies in Small Cell Lung Cancer35:00 - Final Thoughts --- RESOURCES MARIPOSA Trialhttps://www.nejm.org/doi/full/10.1056/NEJMoa2503001 FLAURA2 Trialhttp://pubmed.ncbi.nlm.nih.gov/37937763/ COPERNICUS Trialhttps://clinicaltrials.gov/study/NCT06667076 DeLLphi-304 Trialhttps://clinicaltrials.gov/study/NCT05740566?tab=results

Pulsed electric field (PEF) therapy is an emerging cancer treatment that utilizes short electrical pulses to disrupt tumor cell membranes, leading to cell death—all without the risk of thermal damage seen in traditional ablation. How does this novel approach compare to gold-standard treatments like stereotactic body radiation therapy (SBRT) in primary and metastatic lung cancer? Find out in this episode of the BackTable Podcast featuring NYU radiation oncologist Dr. Benjamin Cooper, radiology professor Dr. William Moore, and cardiothoracic surgery professor Dr. Daniel Sterman. --- SYNPOSIS The doctors break down the unique mechanism of PEF and its potential immunological benefits over other ablation techniques like cryoablation and microwave ablation. They also discuss PEF’s evolving role in both primary and metastatic cancer, its integration with therapies like SBRT, procedural efficiency and safety considerations, and why multidisciplinary collaboration and clinical trials are critical to defining its future in lung cancer care. --- TIMESTAMPS 00:00 - Introduction01:38 - Understanding Pulsed Electric Field (PEF) Ablation05:36 - Comparing Ablation Techniques: Cryoablation vs Microwave Ablation vs PEF Ablation10:08 - Potential Immunological Responses, Safety, and Efficacy of PEF23:40 - The Imprint Lung Trial: Exploring Immune System Stimulation in Cancer Treatment29:18 - Patient Case Studies and Treatment Outcomes32:41 - Challenges in Post-Treatment Imaging36:41 - Procedure Times and Techniques for Ablation41:51 - Comparing Pneumothorax Rates in Different Ablative Technologies43:56 - Future Directions and Collaborative Efforts in Cancer Treatment --- RESOURCES PEF in Stage IV Lung Cancerhttps://pubmed.ncbi.nlm.nih.gov/40409026/ IMPRINT-Lung Trialhttps://www.cancer.gov/research/participate/clinical-trials-search/v?id=NCI-2018-01588 Phase 1b Study of Dazostinag plus Pembrolizumab after Hypofractionated Radiotherapy in Patients with Select Advanced Solid Tumorshttps://pmc.ncbi.nlm.nih.gov/articles/PMC12754119/ FLASH Radiotherapyhttps://pmc.ncbi.nlm.nih.gov/articles/PMC9591027/

Is the era of cisplatin over, or are we simply becoming more precise about who benefits from it? As perioperative strategies in bladder cancer continue to evolve, emerging tools like circulating tumor DNA (ctDNA) are playing a bigger role in how clinicians assess recurrence risk and tailor treatment. In this episode of BackTable Tumor Board, host Alan Tan, medical oncologist at Vanderbilt-Ingram Cancer Center, is joined by bladder cancer experts Dr. Amanda Nizam and Dr. Brad McGregor to discuss recent advances in the diagnosis and treatment of urothelial carcinoma. --- SYNPOSIS The doctors examine the evolving management of muscle-invasive bladder cancer (MIBC), including the role of neoadjuvant and adjuvant therapies, the integration of immunotherapy, and the recent approval of enfortumab vedotin plus pembrolizumab. The discussion explores the rapidly changing perioperative landscape, the prognostic utility of ctDNA, and how biomarkers such as HER2 and FGFR are influencing treatment selection across disease states. They also address bladder preservation strategies, management of treatment-related toxicities, and the importance of multidisciplinary coordination. The episode concludes with a forward-looking discussion on emerging therapies and the potential to improve cure rates in bladder cancer. --- TIMESTAMPS 00:00 - Introduction01:44 - Overview of Bladder Cancer Treatment04:54 - Patient Staging and Treatment Goals10:12 - Bladder Preservation vs. Radical Cystectomy16:39 - Emerging Trials and Future Directions22:40 - ctDNA and Precision Medicine33:50 - Metastatic Disease and Biomarker Strategies42:16 - Managing Neuropathy in Metastatic Treatment48:44 - HER2 and FGFR in Bladder Cancer54:15 - Future Directions in Bladder Cancer Treatment --- RESOURCES EV-302/303 Trialhttps://newsroom.astellas.com/2023-12-15-PADCEV-R-enfortumab-vedotin-ejfv-with-KEYTRUDA-R-pembrolizumab-Approved-by-FDA-as-the-First-and-Only-ADC-Plus-PD-1-to-Treat-Advanced-Bladder-Cancer NIAGARA Regimenhttps://www.nejm.org/doi/full/10.1056/NEJMoa2408154 KEYNOTE-905 Studyhttps://www.annalsofoncology.org/article/S0923-7534(25)04894-X/fulltext