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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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.

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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.

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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.

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"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.

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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

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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.

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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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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.

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This podcast is supported by an educational grant from Pfizer.

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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

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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.

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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

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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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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.

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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

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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.

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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

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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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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.

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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

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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.

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Resources

HIMALAYA Clinical Trial
https://www.annalsofoncology.org/article/S0923-7534(24)00049-8/fulltext

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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