The Fellow on Call: The Heme/Onc Podcast

This week we continue our Pancreatic Cancer series with the two middle categories of non-metastatic disease: borderline resectable and locally advanced. Using the case of a 61-year-old woman with a pancreatic body mass abutting the superior mesenteric artery, we walk through the vascular definitions that separate resectable, borderline resectable, and locally advanced disease, then trace how multi-agent chemotherapy borrowed from the metastatic setting became the neoadjuvant backbone. We dig into the newest challenger to mFOLFIRINOX, PAXG in the CASSANDRA trial, and the still-contested role of radiation, from Alliance A021501 to PREOPANC-2. Along the way, we cover why restaging CT can understate response, how LAP07 reframed consolidative chemoradiation in locally advanced disease, and what to offer patients who are not candidates for intensive therapy. As always, if you haven't heard the earlier episodes in this series, start there first.

As always, if you haven't listened to parts 1 and 2 (episodes 165 and 166, respectively)

This episode is sponsored by Primum! As questions of oncology experts (including pancreatic cancer) free! To learn more and to sign up for your free account, visit Primum.co/fellows

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This week our pancreatic cancer series moves from diagnosis to management, starting with resectable disease. Using the case of a 68-year-old man with a 2.8 cm adenocarcinoma of the pancreatic head, we define what "resectable" actually means, review the operation and the goal of an R0 resection, and explain why surgery alone is never enough. We then trace the adjuvant story from ESPAC-1 and CONKO-001 to today's two standards, modified FOLFIRINOX (PRODIGE 24) and gemcitabine-capecitabine (ESPAC-4), before taking on the surgery-first versus neoadjuvant debate (NORPACT-1, PREOPANC, SWOG S1505), the question of preoperative biliary stenting, and what is coming next.

As always, if you haven't listened to part 1 of this series, start there first.

This episode is sponsored by Primum! As questions of oncology experts (including pancreatic cancer) free! To learn more and to sign up for your free account, visit Primum.co/fellows

** Want to review the show notes for this episode and others? Check out our website.

Love what you hear? Tell a friend and leave a review on our podcast streaming platforms!

Twitter: @TheFellowOnCall

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This week we kick off a brand-new series on pancreatic cancer, starting with the fundamentals. Using the case of a 68-year-old man with painless jaundice, weight loss, and new-onset diabetes, we cover the epidemiology and sobering survival statistics of pancreatic ductal adenocarcinoma, the major risk factors (and why late-onset diabetes is often a consequence rather than a cause), universal germline testing and the hereditary syndromes worth knowing for the boards, and how tumor location in the head, body, or tail shapes presentation. We then walk through the diagnostic workup (pancreatic-protocol CT, MRI/MRCP, EUS-guided biopsy, and the therapeutic role of ERCP), the pitfalls of CA 19-9, precursor lesions and the four-gene molecular story led by KRAS, somatic profiling for actionable targets, and the resectability framework that will drive treatment decisions for the rest of the series.

This episode is sponsored by Primum! As questions of oncology experts (including pancreatic cancer) free! To learn more and to sign up for your free account, visit Primum.co/fellows

** Want to review the show notes for this episode and others? Check out our website.

Love what you hear? Tell a friend and leave a review on our podcast streaming platforms!

Twitter: @TheFellowOnCall

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This week we wrap up our two-part CLL update by turning to relapsed and refractory disease. We pick up with the 68-year-old man from Part 1, now a year out from frontline therapy and showing signs of relapse. We cover when relapse actually needs treatment, the history of BTK inhibitor resistance and why BTK mutation testing matters, and how to sequence therapy now that BTK inhibitors and venetoclax have both moved into the frontline. From there we get into venetoclax retreatment, the pirtobrutinib data from BRUIN CLL-321 and the new BRUIN CLL-322 triplet trial, the real-world CAR T experience that is changing how we think about cell therapy in CLL, bispecific antibodies, and the emerging class of BTK degraders. As always, if you haven't heard the earlier episodes in this series, start there first.

If you haven’t done so, be sure to check out our original CLL Series and our CLL Updates Part I episode as this update will draw on concepts covered previously!

**This episode is sponsored by The Lymphoma, Leukemia and Myeloma Congress! To learn more and register for the meeting, click here! Be sure to use our SPECIAL TFOC code TFOC40 to save 40% off registration.

** Want to review the show notes for this episode and others? Check out our website.

Love what you hear? Tell a friend and leave a review on our podcast streaming platforms!

Twitter: @TheFellowOnCall

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This week we kick off a two-part update to our CLL series, covering what has changed in frontline management since our original episodes. Using the case of a 68-year-old man with newly diagnosed, symptomatic CLL, we revisit the essential steps before treatment: confirming an indication to treat, ruling out Richter's transformation, and risk stratification, with the history behind FISH cytogenetics, IGHV status, and the CLL-IPI. We then trace how continuous BTK inhibitors and fixed-duration venetoclax-obinutuzumab displaced chemoimmunotherapy, before digging into the trials reshaping practice in 2026: AMPLIFY, SEQUOIA Arm D, and CLL17. Along the way, we cover the open questions for TP53-aberrant disease and why MRD, although prognostic, is not yet a reliable guide for treatment decisions with novel agents.

If you haven’t done so, be sure to check out our original CLL Series, as these updates will draw on concepts covered previously!

**This episode is sponsored by The Lymphoma, Leukemia and Myeloma Congress! To learn more and register for the meeting, click here! Be sure to use our SPECIAL TFOC code TFOC40 to save 40% off registration.

** Want to review the show notes for this episode and others? Check out our website.

Love what you hear? Tell a friend and leave a review on our podcast streaming platforms!

Twitter: @TheFellowOnCall

Instagram: @TheFellowOnCall

Listen in on: Apple Podcast, Spotify, and Youtube

This week the Head and Neck series turns to what happens when local therapy isn't enough — recurrent, relapsed, and metastatic disease. Using the case of a woman with a laryngeal cancer recurrence, we work through the first and most important question (recurrence versus second primary), the workup and biomarkers that steer therapy, local salvage options, the CPS-driven first-line systemic algorithm, second-line and beyond, the distinct world of nasopharyngeal cancer, oligometastatic disease, and the central role of early palliative and supportive care. As always, if you haven't heard the earlier episodes in this series, start there first.

**This episode is sponsored by Primum! Sign up for your free account at primum.co/fellows

** Want to review the show notes for this episode and others? Check out our website.

Love what you hear? Tell a friend and leave a review on our podcast streaming platforms!

Twitter: @TheFellowOnCall

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This week the Head and Neck series turns to radiation oncology, with guest Dr. David Palma, a Professor and Radiation Oncologist at the Verspeeten Family Cancer Centre and professor at the Schulich School of Medicine and Dentistry, Western University (London, Ontario). A clinician-scientist who splits his time between clinical-trials research and treating head and neck and lung cancers, David walks us through how radiation actually works and gets planned, the de-escalation question, PET after treatment, larynx preservation, re-irradiation, oligometastatic disease, and the proton-versus-photon debate - all with some of the best analogies we've had on the show.

**This episode is sponsored by Primum! Sign up for your free account at primum.co/fellows

** Want to review the show notes for this episode and others? Check out our website.

Love what you hear? Tell a friend and leave a review on our podcast streaming platforms!

Twitter: @TheFellowOnCall

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Listen in on: Apple Podcast, Spotify, and Youtube

This week, we are so excited to share the third episode of our Career Development Series episodes, developed in partnership with The American Society of Hematology, The ASH Trainee Council, and Hematopoiesis!

For years, our listeners have reached out to our show asking for guidance to help navigate their careers. We are so excited to be partnering with an amazing organization like ASH to help make this happen!

This week, we interview Hanny Al-Samkari, MD as he shares his insights on what constitutes clinical research, what a career in clinical research might look like, and how trainees can get involved in clinical research.

** This episode is created in partnership with The American Society of Hematology (https://www.hematology.org/), The ASH Trainee Council (https://www.hematology.org/education/trainees/fellows/trainee-council), and Hematopoiesis (https://www.hematology.org/education/trainees/fellows/hematopoiesis)

** Want to review the show notes for this episode and others? Check out our website.

Love what you hear? Tell a friend and leave a review on our podcast streaming platforms!

Twitter: @TheFellowOnCall

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Throughout this series, we have discussed how multidisciplinary the management of head and neck cancer is and the critical role that our surgical colleagues play in the management of this disease. This week, we welcome Dr. Michael Topf, Associate Professor for Associate Professor of Otolaryngology-Head and Neck Surgery at Vanderbilt University Medical Center to our show to share with us how he determines which patients are appropriate for surgery, what his approach is, and so much more. It’s rare that we get insights into the factors that our surgery colleagues think about when determining surgical candidacy and surgical approaches and so get ready for an incredibly informative conversation! Another high yield episode you do not to miss!

**This episode is sponsored by Primum! Sign up for your free account at primum.co/fellows

** Want to review the show notes for this episode and others? Check out our website.

Love what you hear? Tell a friend and leave a review on our podcast streaming platforms!

Twitter: @TheFellowOnCall

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This week we get into treatment. Building on Part 1's (episode 158: https://www.thefellowoncall.com/tfocpodcast/hncintro) workup and staging, we walk through three cases to highlight the important distinguishing details: an oral cavity cancer, a locally advanced oropharynx cancer, and a larynx cancer.

Content:

- Approach to locoregional oral, oropharynx, and larynx cancers

- How we arrived at the current dosing paradigms for chemotherapy for chemoRT

- Is there a role for induction therapy?

- What are the data for immunotherapy in this space?

- High risk factors and why they matter

**This episode is sponsored by Primum! Sign up for your free account at primum.co/fellows

** Want to review the show notes for this episode and others? Check out our website.

Love what you hear? Tell a friend and leave a review on our podcast streaming platforms!

Twitter: @TheFellowOnCall

Instagram: @TheFellowOnCall

Listen in on: Apple Podcast, Spotify, and Youtube