With multiple clinical trials evaluating PARP inhibitor combinations, how do clinicians determine the best approach for advanced prostate cancer? In this episode of BackTable Urology, Dr. Alan Tan is joined by Dr. Rana McKay and Dr. Emmanuel Antonarakis to discuss how evolving evidence, patient selection, timing, toxicity, and genetic testing are shaping the use of PARP inhibitor combinations in clinical practice.

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This podcast is supported by an educational grant from Pfizer.

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Timestamps

00:00 - Introduction
02:51 - PARPi Basics
14:12 - Major Study Differences
19:00 - Timing and Selection of PARPi Combinations
26:39 - Case: Somatic BRCA2 loss and mHSPC
35:51 - Case Continued: BRCA2 Reversion
39:57 - BRCAAway Study
42:59 - Takeaways from the 2026 APCCC

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More about this episode

The conversation reviews lessons learned from major clinical trials, including PROpel, MAGNITUDE, TALAPRO-2, and AMPLITUDE, and addresses how these studies inform real-world treatment choices. The doctors dig into case examples, such as BRCA2 loss and reversion, and highlight practical strategies for using germline and somatic testing to personalize care. Key insights from the 2026 Advanced Prostate Cancer Consensus Conference are also shared, emphasizing the importance of precision medicine in this rapidly evolving field.

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Resources

Study on Olaparib Plus Abiraterone as First-line Therapy in Men With Metastatic Castration-resistant Prostate Cancer (PROpel) https://clinicaltrials.gov/study/NCT03732820

A Study of Niraparib in Combination With Abiraterone Acetate and Prednisone Versus Abiraterone Acetate and Prednisone for Treatment of Participants With Metastatic Prostate Cancer (MAGNITUDE) https://clinicaltrials.gov/study/NCT03748641?tab=study

Talazoparib + Enzalutamide vs. Enzalutamide Monotherapy in mCRPC (TALAPRO-2) https://clinicaltrials.gov/study/NCT03395197

A Study of Niraparib in Combination With Abiraterone Acetate and Prednisone Versus Abiraterone Acetate and Prednisone for the Treatment of Participants With Deleterious Germline or Somatic Homologous Recombination Repair (HRR) Gene-Mutated Metastatic Castration-Sensitive Prostate Cancer (mCSPC) (AMPLITUDE) https://clinicaltrials.gov/study/NCT04497844

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://pubmed.ncbi.nlm.nih.gov/39115414/

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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.

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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.

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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

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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.

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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

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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.

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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.

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This podcast is supported by an educational grant from Johnson & Johnson.

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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

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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.

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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.

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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.

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---

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

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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.

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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

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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.

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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.

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---

This podcast is supported by an educational grant from Johnson & Johnson.

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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

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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.

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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

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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

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.

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---

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

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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.

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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.
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What matters most to patients with non-muscle invasive bladder cancer (NMIBC)? In this episode of BackTable Urology, Dr. Kelly Bree, Dr. Saum Ghodoussipour, and Meredith Donahue, N.P., join host Dr. Vignesh Packiam to discuss the power of shared decision-making across the NMIBC spectrum. They explore risk-adapted treatment selection, when to escalate or de-escalate therapy, and how to navigate conversations about recurrence risk, treatment burden, quality of life, and the possibility of cystectomy.

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This podcast is supported by an educational grant from Johnson & Johnson.

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Timestamps

00:00 - Introduction
01:55 - Second Opinions and Patient Counseling
06:08 - Intermediate Risk Stratification
12:13 - Treatment Options for Intermediate Risk NMIBC
16:20 - BCG and Alternative Treatments for High Risk NMIBC
26:49 - Options for BCG-Unresponsive NMIBC
31:42 - Sequencing and Cystectomy
37:03 - Financial and Time Toxicity
41:08 - Biomarkers and ctDNA
44:04 - Future Trials and NMIBC Innovations

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More about this episode

They also review emerging therapies such as ZUSDURI, the evolving role of intravesical treatments, and the promise of biomarkers and ctDNA for personalized care. The discussion covers practical strategies for patient counseling, key updates to clinical guidelines, and a preview of innovations shaping the future of NMIBC management.

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Resources

Active Surveillance Versus Intravesical Bacillus Calmette-Guérin for High-grade T1 Bladder Cancer with Negative Second Transurethral Resection: The Randomized Noninferiority Phase 3 JCOG1019 Trial:
https://pubmed.ncbi.nlm.nih.gov/41571573/

Twelve-Month Results From the CISTO Study Comparing Radical Cystectomy Versus Bladder-Sparing Therapy for Recurrent High-Grade Non–Muscle-Invasive Bladder Cancer
https://ascopubs.org/doi/10.1200/JCO-25-01324

CIRCULATING TUMOR DNA AS A BIOMARKER FOR UPSTAGING AND ADVERSE PATHOLOGY IN HIGH-RISK NON–MUSCLE-INVASIVE BLADDER CANCER:
https://www.auajournals.org/doi/abs/10.1097/01.JU.0001191388.74345.c9.09

Preoperative Circulating Tumor DNA Predicts Upstaging and Recurrence in High-Risk Nonmuscle-Invasive Bladder Cancer Undergoing Radical Cystectomy
https://pubmed.ncbi.nlm.nih.gov/41843048/

---

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

Is personalized, surgery-sparing treatment becoming a reality for patients with gastric adenocarcinoma? In this episode of BackTable Tumor Board, Dr. Eric Lander and Dr. Michael Gibson break down the rapidly changing landscape of treatment for resectable gastric and gastroesophageal junction adenocarcinoma. They trace the evolution from surgery as the standard, through difficult postoperative chemoradiation and perioperative chemotherapy (MAGIC, FLOT4), to the new strategies that are moving beyond traditional chemoradiation in the wake of the ESOPEC trial.

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This podcast is supported by

AstraZeneca
https://www.astrazeneca.com/our-therapy-areas/oncology/gastrointestinal-cancer.html

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Timestamps

00:00 - Introduction
09:41 - FLOT Becomes Standard
19:54 - Keynote 585 and Matterhorn
28:35 - Managing DFL Toxicity
35:10 - Path CR and Deescalation
38:46 - Future Directions and Organ Preservation

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More about this episode

The conversation highlights the Matterhorn trial’s positive results with durvalumab added to perioperative FLOT, including manageable toxicity and benefits seen across PD-L1 expression levels. Lander and Gibson share practical management tips for patients who cannot tolerate FLOT, staging nuances like selective diagnostic laparoscopy, and future directions such as targeted therapy combinations, total neoadjuvant approaches, ctDNA-guided de-escalation, and organ preservation for MSI-high disease.

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Resources

Matterhorn Trial
https://www.nejm.org/doi/abs/10.1056/NEJMoa2503701

ESOPEC Study
https://www.nejm.org/doi/abs/10.1056/NEJMoa2409408

CheckMate 577
https://www.nejm.org/doi/full/10.1056/NEJMoa2032125

---

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.

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Are traditional bladder cancer care models falling behind as new therapies flood the field and reshape the landscape? In this episode of BackTable Urology, Dr. Bogdana Schmidt talks with Dr. Amy Luckenbaugh and DNP/APP Meredith Donahue about building a co-managed intravesical therapy clinic that rethinks care for patients with non–muscle invasive bladder cancer (NMIBC). With innovative agents increasing patient volume and complexity, the team discusses adapting care models to new realities.

---

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This podcast is supported by an educational grant from Johnson & Johnson.

---

Timestamps

00:00 - Why Clinic Models Need to Change Now
04:03 - Overcoming Financial and J-Code Hurdles
11:04 - High Volume Workflow
14:10 - Pharmacy Coordination And Timing
19:02 - Proactive Lower Urinary Tract SYmptom Management
22:25 - Handling Difficult Catheters
32:08 - Defining Clinic Success

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More about this episode

The conversation covers prioritizing clinical trials, managing operational challenges such as prior authorizations and billing hurdles, and the importance of pharmacy coordination and predictable clinic workflows. Donahue describes a high-efficiency installation day model managing up to 50 patients a week with specialized staff, real-time decisions, and tailored logistics for therapies like Adstiladrin. They also discuss symptom prevention, patient triage, and clinic success measures including therapy availability, patient satisfaction, and opportunities to preserve bladder function.

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Resources

Gemcitabine IDRS Drug Delivery Trial
https://ascopubs.org/doi/10.1200/JCO.2026.44.7_suppl.635

BCG-IO Combination Trial
https://www.astrazeneca.com/media-centre/press-releases/2026/imfinzi-approved-in-us-for-early-bladder-cancer.html

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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.

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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.

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---

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

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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.

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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