The Gut Onc Lab Podcast

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The Gut Onc Lab Podcast episodes

October 08Integrating Palliative Care Into GI Oncology with Dr. Joseph McCollom
In this episode of The Gut-Onc Lab, Drs. Nicholas Hornstein and Timothy Brown welcome double-boarded GI oncologist and palliative care specialist Dr. Joseph McCollom (known online as the "Real Bow Tie Doc" from Parkview Health / Packnett Family Cancer Institute). Bringing a unique perspective to the immense symptom burden of GI malignancies, Dr. McCollom explores how treating cancer and providing supportive care are not sequential steps, but rather "two doors to the same hallway."
Key Discussion Points
The 21st-Century Bowtie Model: Moving away from the outdated paradigm of reserving palliative care exclusively for end-of-life transitions. Dr. McCollum breaks down Dr. Pippa Hawley’s dual-triangle framework, illustrating how supportive care runs concurrently with disease-directed treatment—extending into curative survivorship, managing chronic toxicities, and navigating advanced metastatic care.
The "Cloak" Elevator Pitch: Defining palliation from its Latin root (palliare, to cover or cloak)—reminding clinicians and patients that while chemotherapy attempts to change the "weather" (disease course), palliative care acts as the coat protecting the patient through the storm.
Personalized Palliative Care: Shifting away from rigid, stage-based referral algorithms toward individualized clinical intuition—using validated tools like the "Surprise Question" ("Would I be surprised if this patient were not here next year?") to trigger supportive interventions early.
Restoring Dignity & Meaning: Looking beyond basic numerical survival curves to combat existential distress. The panel discusses emerging non-pharmacologic and creative modalities—from psilocybin-guided journeys to virtual reality (VR) immersive experiences in infusion suites—to maintain patient autonomy.
Physician Burnout & Institutional Humanism: Dr. McCollum reflects on his personal journey from the foster care system to dual subspecialization, highlighting institutional strategies to combat grief and burnout—such as solemn "Reading of the Names" monthly ceremonies.

Chapters:
00:00 Welcome and Introductions
01:53 Why Palliative Care Matters
02:32 Bow Tie Model Explained
06:13 Palliative Care Elevator Pitch
07:18 Future of Palliative Oncology
09:56 Cancer Pain and Methadone
14:28 When to Refer Patients
18:40 Barriers and Misconceptions
22:34 Meaning Dignity and New Tools
26:17 Burnout and Staying Fulfilled
31:47 Closing Thanks and Wrap Up

You can find us on X: Gut Onc Lab (@TheGutOncLab) / X
34 min
September 09The POD1UM-303 Triumph: Retifalimab, Mitomycin Toxicity, and Frontline Anal Oncology
In this episode of The Gut-Onc Collab, Drs. Nicholas Hornstein, Timothy Brown, and Udhayvir Grewal dive into a disease site currently undergoing a massive therapeutic shift: anal cancer. As an inherently HPV- and HIV-associated malignancy, managing anal squamous cell carcinoma demands rigorous multidisciplinary staging, careful toxicological navigation, and an understanding of newly minted frontline survival data.
Key highlights from the discussion include:
The Diagnostic Checklist: Establishing the modern staging workflow—from digital rectal examinations and pelvic MRIs to the mandatory role of early PET/CT and universal HIV screening to preserve marrow baseline parameters.
The Nigro Protocol Legacy: Honoring the 1970s Wayne State breakthrough that pioneered organ preservation in solid tumors, demonstrating that 5-FU and mitomycin C combined with radiation could reliably cure patients without sacrificing the anal sphincter.
The Great Cisplatin Debate: Dissecting the trial data from ACT II and RTOG 9811 to weigh mitomycin’s long-term myelotoxicity risks against the non-inferior survival curves of weekly low-dose cisplatin backbones.
Drawing the Curative Line: Mapping out tumor board thresholds—why inguinal and pelvic lymph nodes demand aggressive, definitive chemoradiation, while para-aortic involvement above the diaphragm signals a transition to systemic therapy.
The POD1UM-303 / INTERACT2 Landmark: Breaking down the Phase III data combining carboplatin and paclitaxel with the PD-1 inhibitor retifanlimab. The team explores the drug’s massive duration of response doubling (from 7 to 14 months) and its recent definitive overall survival (OS) victory in all-comers, completely independent of baseline PD-L1 expression.
From historical chemotherapy milestones to managing immune-related adverse events in patients on antiretroviral therapy, this episode serves as a definitive clinical blueprint for modern anal cancer care.

Chapters:
00:00 Why Anal Cancer Now
01:08 Initial Workup and Staging
03:01 HPV HIV Testing Basics
04:19 Nigro Protocol Origins
06:05 Mitomycin vs Cisplatin
09:54 Defining Metastatic Boundaries
11:40 New First Line Metastatic Data
13:57 Toxicity Biomarkers HIV Safety
15:11 Key Takeaways and Wrap Up

You can find us on X: Gut Onc Lab (@TheGutOncLab) / X
17 min
August 25Curative Intent in CRLM: Surgery, ctDNA, and the Biology of Liver Metastases
In this episode of The Gut-Onc Lab, Drs. Nicholas Hornstein and Timothy Brown welcome renowned HPB and surgical oncologist Dr. Robert Martin (University of Louisville) to dismantle the management of colorectal cancer liver metastases. While metastatic colorectal cancer carries a heavy prognosis overall, oligometastatic liver-limited disease represents a unique, potentially curable window when local interventions and systemic therapies are deployed in tandem.
Key discussion points include:
Optimism vs. Biology: Dr. Martin shares his 26-year perspective on why two-thirds of resected patients eventually recur, and how classic risk tools like the Fong Score combine with molecular drivers (BRAF and KRAS mutations) to dictate surgical timing.
The "Simple First" Rule: How to prioritize combined operations when managing an intact primary alongside liver metastases, minimizing chemotherapy washout windows to keep patients fit and functional.
The Perioperative Debate: Analyzing why solitary, long-interval metastases can go straight to the operating room, while high-risk node-positive or BRAF-mutated tumors require a perioperative chemotherapy "tincture of time" to prevent futile surgeries.
The GALAXY / JAMA Oncology Data: A deep dive into the 2026 JAMA Oncology analysis of 298 CRLM patients from the CIRCULATE-Japan registry. The team analyzes why post-op MRD positivity carries a massive hazard ratio (>9) for overall survival, why adjuvant chemo significantly improves survival in upfront-surgery MRD-positive patients, and why neoadjuvant-pretreated patients derive no added benefit from post-op chemo regardless of ctDNA status.
The "Two-Point" ctDNA Rule: Why Dr. Martin advocates for repeating a positive ctDNA test at 4 and 6 weeks post-op before declaring minimal residual disease, using temporal kinetics to guide diagnostic MRI intensity rather than jumping directly to futile cytotoxic escalation.
From avoiding "gut-punch" recurrences to refining chemo-free holidays for MRD-negative patients, this session provides a comprehensive blueprint for the modern, multidisciplinary management of liver-limited colorectal cancer.

Chapters:
00:00 Welcome and Introductions
01:23 Why Liver Mets Matter
02:35 Assessing Biology and Risk
04:10 Choosing Local Therapies
08:18 Primary vs Liver Timing
11:05 Perioperative Chemo Strategy
14:10 ctDNA Basics and Use
16:47 Galaxy Data and Chemo Debate
21:32 Managing MRD Positive Patients
23:11 Future Trials and Kinetics
27:07 Tumor Board and Next Five Years
30:07 Key Takeaways and Wrap Up

You can find us on X: Gut Onc Lab (@TheGutOncLab) / X
32 min
August 07Systemic Therapies in HCC: Immunotherapy and Beyond with Mark Yarchoan
In this episode of The Gut-Onc Lab, Drs. Nicholas Hornstein, Timothy Brown, and Udhayvir Grewal welcome physician-scientist Dr. Mark Yarchoan (Johns Hopkins / Sidney Kimmel Comprehensive Cancer Center) to navigate the rapid evolution of hepatocellular carcinoma (HCC) management. Moving away from the era when single-agent TKIs offer limited survival extension at high toxicity costs, the panel outlines how modern immune checkpoint combinations and redefined staging guidelines are transforming clinical expectations.
Key discussion points include:
The Frontline IO Framework: Dr. Yarchoan details his decision matrix for choosing between the three primary frontline combinations:
Second-Line Sequencing Realities: Why TKI-naive post-IO patients should transition to frontline-caliber TKIs (like lenvatinib), while atezo/bev progressors derive long-term durability from CTLA-4 salvage doublets (Ipi/Nivo) if they suffered primary non-response.
Updating the Staging Paradigm (BEACON vs. BCLC): Why the classic Barcelona Clinic Liver Cancer (BCLC) system over-simplifies micro-vascular invasion as non-curable, and how the emerging BEACON guidelines incorporate SBRT, Y-90, and multidisciplinary down-staging pathways.
Post-ASCO 2026 Local-Regional Updates: Analyzing EMERALD-3 and ABC-HCC—explaining why administering dual checkpoint immunotherapy before TACE preserves the tumor microenvironment for superior antigen presentation, and why TACE is increasingly shifting toward oligoprogressive control rather than diffuse intermediate-stage deployment.
The Histotripsy Reality Check: A candid evaluation of non-invasive ultrasound cavitation, contrasting Facebook marketing claims against the HOPE Liver trial data regarding high local failure rates, treatment-related mortality, and general anesthesia requirements compared to established microwave ablation.

Chapters:
00:00 HCC Treatment History
02:40 Life in the Sorafenib Era
04:35 Immunotherapy Breakthroughs
07:29 Choosing First-Line Therapy
14:01 Second Line Strategy
20:00 Staging Beyond BCLC
24:42 ASCO 26 TACE Combinations
30:36 Neoadjuvant Timing Insights
32:18 Histotripsy Hype vs Data
35:03 Closing Thoughts and Trials

You can find us on X: Gut Onc Lab (@TheGutOncLab) / X
37 min
August 03Approaching Clinical Trials As A Patient, What To Know.
In this special foundational episode of The Gut-Onc Collab, Drs. Nicholas Hornstein, Timothy Brown, and Udhayvir Grewal step back from individual disease sites to pull back the curtain on clinical trials. As the literal engines of modern oncology, trials bridge the gap between bench discovery and real-world clinic operations. The panel outlines everything from the hidden logistics of study startups to the nuances of statistical endpoints, providing a comprehensive guide for both patients and clinicians.
Key highlights from the discussion include:
Dismantling the Trial Phases: A clear breakdown of the structural ladder—from Phase I safety dose-escalation (RP2D) and intensive pharmacokinetic (PK) blood draws to Phase II exploratory signals and Phase III randomized comparative endpoints.
The Clinical Validity Trap: Tim analyzes why "cherry-picking" hyper-fit, idealized trial populations harms external validity, explaining why study groups must mirror the diverse lab values of actual community clinics.
Critiquing the Literature (An Oncologist's Lens): Udhayvir shares his method for analyzing fresh publications—scrutinizing whether control arms are substandard, tracking how protocol amendments pivot to shifting standards, and evaluating when to look past PFS surrogate lines to demand Overall Survival (OS) clarity.
Navigating "Time Toxicity" & Burden: A realistic assessment of patient commitment—how standard clinic visits transform into prolonged multi-staff interactions, and how patients maintain agency under randomized computer control.
Early-Career PI Survival Guide: Practical parameters for new site investigators, including managing study-startup pipelines, navigating site initiation visits (SIVs), and leveraging senior institutional mentors.
Modern Scouting Tools: Spotlighting user-centric discovery methods—from utilizing advanced AI agents to scrape ClinicalTrials.gov to partnering with premiere advocacy networks like PanCAN, the Colorectal Cancer Alliance (Colon Town), and NETRF.
From evaluating adverse events using Lexicomp and NEJM snapshots to understanding the unique tracking exceptions of rare, indolent neuroendocrine cancers, this episode serves as the definitive primer for the entire framework of modern oncology research.

Chapters:
00:00 Why Clinical Trials Matter
01:36 Phase 1 Basics and Safety
03:14 Phase 1 Patient Burden and Upside
05:31 Phase 2 Proving Activity
07:39 Phase 3 Standards Randomization
09:53 Choosing and Judging Trials
15:00 Patient Commitment and Toxicity
17:50 Becoming a Trial Investigator
19:48 Finding Trials and Advocacy
22:25 Final Takeaways and Wrap Up

You can find us on X: Gut Onc Lab (@TheGutOncLab) / X
24 min
July 09The Gut-Onc Collab: Universal Testing Laws, BRCA1 Discordance, and the RAS Wave with Dr. Kim Reiss
On this in-person episode of The Gut Onc Lab podcast, Drs. Nicholas Hornstein, Timothy Brown, and Udhayvir Grewal welcome world-renowned BRCA specialist Dr. Kim Reiss to dismantle the historic view of pancreatic cancer as a monolithic, chemo-only disease. The group dives deep into the 5% to 9% of pancreatic ductal adenocarcinoma (PDAC) patients harboring germline or somatic homologous recombination repair (HRR) defects and how to maximize their survival.
Key discussion points include:
First-Line Crosscurrents: Why the team remains FOLFIRINOX traditionalists over the newly approved NAPOLI-3 Nalirifox regimen, and the operational reality that universal testing must start at day zero.
The APOLLO Trial Blueprint: Dr. Reiss details the international Phase III ECOG-ACRIN EA2192 trial—mirroring breast cancer's landmark Olympia study—bringing a year of adjuvant olaparib maintenance into the curative-intent space.
Brainwashing Fellows & Hunting Rare Variants: Raw advice for junior investigators on leveraging advocacy groups, social media, and temporal NGS tracking to keep specialized clinical trials accruing.
The BRCA1 vs. BRCA2 Paradox: Dissecting Dr. Talia Golan’s Cancer Discovery data revealing why 50% of BRCA1 pancreatic tumors are actually sporadic bystander events, compared to the 90% true biallelic loss seen in BRCA2.
Dismantling Negative Data: A critical look at SWOG 2001 and the European durvalumab/olaparib updates, explaining why adding immunotherapy to PARP inhibitors failed broadly across all-comers unless a specific T-cell inflamed microenvironment is isolated.
The Golden Era of Targeted PDAC: Looking past the immediate RASolute-302 pan-RAS plenary drop to the fast-approaching pipelines of Claudin 18.2 combinations and MTAP-deletion / PRMT5 inhibitors.
From the immediate necessity of split-dose Cis-Gem pivots to a world where targeted pills dominate frontline care, this conversation frames the exact moment pancreatic oncology permanently moved into the precision era.

Chapters
(00:00) Why Pancreatic Cancer Needs Better Options
(01:29) First Line Chemo Choices Today
(02:33) Testing and When to Pivot
(04:19) Subtype Assays and Practical Limits
(05:59) POLO and PARP Maintenance Lessons
(07:49) APOLLO Trial Design and Progress
(09:28) Recruiting Rare Variant Patients
(11:34) Standard Care for BRCA PALB2
(12:13) BRCA1 vs BRCA2 Biology and HRD
(13:48) ASCO Outlook and KRAS Era
(15:54) PARP Plus Immunotherapy Biomarkers
(19:12) Closing Thoughts and RAS Revolution

You can find us on X: Gut Onc Lab (@TheGutOncLab) / X
21 min
June 22The Precision Shift: Re-Writing the Colorectal Cancer Roadmap with Dr. Arvind Dasari
In this special in-person episode filmed straight from the floor at ASCO 2026, Drs. Nicholas Hornstein, Timothy Brown, and Udhayvir Grewal welcome guest Dr. Arvind Dasari (MD Anderson) to discuss why colorectal cancer is officially having its precision medicine moment. From the epidemic of young-onset disease to the frontline tracking of ultra-specific biomarkers, the panel discusses why molecular profiling is now just as critical as a histological diagnosis.

Key discussion points include:
Universal Testing & The ALASCCA Data: Why every patient—localized or metastatic—requires immediate biomarker staging, including a look at using adjuvant aspirin to target PI3K/PTEN/PIK3CA pathway alterations.
The CIRCULATE-North America Blueprint: Dr. Dasari shares the technical and regulatory hurdles of designing a major serial ctDNA trial, the removal of the Phase II/III FDA hold, and how the study is dynamically expanding eligibility rules for stage III de-escalation.
The Turnaround Revolution: A practical look at clinic operations in 2026—how combining liquid biopsy with fast-tracked DPYD and UGT1A1 panels delivers actionable genomic results in under seven days.
Targeting the Known Frontiers: Breaking down the current state of BREAKWATER (BRAF V600E), CheckMate 8HW (Nivo/Ipi doublets in dMMR), and the downstream nuances of RAS co-occurrence in HER2-targeted therapies vs. ADCs.
Post-Conference Takeaways: The panel's real-time analysis of the major ASCO abstracts, including the Dutch PUMP trial (adjuvant hepatic artery infusion pumps for liver metastases) and the data validating the cessation of immunotherapy for complete responders.

From institutional operator expertise in HAI pumps to the future of "unknown target" molecular glues, this session bridges the gap between massive data drops and Monday morning clinic realities.

Chapters:
(00:00) Welcome and Introductions
(00:54) Meet Dr Dasari
(04:15) Who Gets Molecular Testing
(07:41) CIRCULATE Trial Explained
(09:00) Trial Design Challenges
(14:11) Whats Next in CRC Therapy
(16:16) HER2 Positive Approach
(17:02) ASCO Highlights and Practice Changers
(18:43) Nonoperative and Supportive Care
(20:25) HAI Pump PUMP Study
(21:45) Closing Thoughts and Sign Off

You can find us on X: Gut Onc Lab (@TheGutOncLab) / X
23 min
May 26ASCO 2026: GI Oncology Abstracts to Look Forward To.
With the 2026 ASCO Annual Meeting just days away, Drs. Nicholas Hornstein, Timothy Brown, and Udhayvir Grewal sit down for a rapid-fire, "mouth-to-butt" preview of the most practice-altering abstracts hitting the floor in Chicago. Armed with top-line press releases and early data, the team highlights their top three high-stakes selections across the entire GI tract.
Key previews include:
The Upper GI Blockbusters (Tim’s Picks): Updated HORIZON-GEA data showing why HER2/PD-1 bispecific synergy doesn't care about baseline PD-L1 expression; a compliance deep-dive from the Matterhorn trial; and the arrival of IsaBrin (an EGFR/HER3 bispecific ADC) moving the needle in second-line squamous cell esophageal cancer.
The Midgut & Plenary Hype (Udhayvir’s Picks): Front-row seats for RESOLUTE-302, the monumental plenary session showcasing deruxantrib doubling overall survival (13 months vs. 6.7 months) in second-line RAS-mutant pancreatic cancer. Plus, the PHITE-302 trial proving frontline pemigatinib works for FGFR2-rearranged cholangiocarcinoma despite notorious accrual challenges.
Below-the-Belt Tech & Wild West De-escalation (Nick’s Picks): The highly anticipated late-breaking PUMP trial testing adjuvant hepatic artery infusion (HAI) pumps for colorectal liver metastases. Then, a massive look at China's Abstract 3502, confirming that MSI-High colorectal patients who hit a Complete Clinical Response can safely stop maintenance immunotherapy and maintain a 100% 3-year overall survival rate.
The Sci-Fi Future: A look outside the box at the Archer trial in lung cancer—utilizing a prophylactic peptide vaccine to train the immune system to short-circuit targeted therapy resistance mutations before they occur.
Chapters:
(00:00) Welcome and ASCO Preview
(00:46) Top Three Picks Setup
(01:28) HORIZON GEA HER2 Triplet
(03:55) Matterhorn DFLOT Completion
(06:11) IsaBrin for ESCC Second Line
(08:10) RESOLUTE-302 RAS Inhibitor
(13:12) PHITE 302 Pemigatinib Frontline
(20:10) PUMP Trial Hepatic Infusion
(24:02) MSI-High CRC Stop PD-1
(29:15) Archer Vaccine vs Resistance
(33:30) Closing Thoughts and Chicago

You can find us on X: Gut Onc Lab (@TheGutOncLab) / X
35 min
May 15Organ Preservation in Upper GI Cancers
In this landmark fifth episode of The Gut Onc Lab, Drs. Nicholas Hornstein and Timothy Brown welcome their first guest, radiation oncologist Dr. Nina Sanford, to discuss one of the most significant shifts in modern oncology: Organ Preservation. Historically, esophageal and gastric cancers have required highly morbid, "life-changing" surgeries. Today, the team explores how we can leverage advanced imaging, radiation, and immunotherapy to potentially spare the organ without sacrificing survival.

Key highlights include:
Defining Organ Preservation: Why avoiding esophagectomy or gastrectomy is the goal, provided we maintain oncologic outcomes.
The SANO Trial Deep Dive: A look at the Phase 3 data establishing "Watch and Wait" as a non-inferior strategy for complete responders, and the modeling studies that suggest where surgery might still pull ahead long-term.
The MSI-High Exception: How medical oncology is leading the way with chemo-free immunotherapy (PD-1 and CTLA-4 doublets) to achieve near-miraculous clinical complete responses in a subset of patients.
Radiation as a Biological Tool: Dr. Sanford explains why "one-size-fits-all" radiation is a thing of the past.
The Burden of Surveillance: A realistic look at "Time Toxicity"—the intensive endoscopy, PET, and CT schedules required to safely manage patients who forgo surgery.
Multidisciplinary Buy-In: Why organ preservation isn't just about biology; it’s about having a surgical team ready for "salvage" and a GI team dedicated to frequent monitoring.
Whether you're curious about the biological "Magic Rays" of radiation or the latest "Infinity" and "NEONIKA" trial results, this episode defines the current frontier of upper GI sparing.

Chapters:
(00:00) Why Organ Preservation Matters
(03:48) Immunotherapy Enters the Chat
(06:45) Key Evidence for Watch and Wait
(09:45) Quality of Life and Long Term Tradeoffs
(13:10) Radiation Dose and Adaptive Future
(17:32) Cross vs FLOT and RT in Gastric
(20:38) MSI High Chemo Free Pathway
(26:48) Surveillance Protocols and Logistics
(28:23) Ideal Candidates and Feasibility
(31:43) Infrastructure for Community Practice
(33:03) Final Takeaways and Wrap Up

You can find us on X: Gut Onc Lab (@TheGutOncLab) / X
36 min
April 27MSI-High in GI Oncology: When Biology Opens the Door
In this episode of The GutOnc Lab, Drs. Nicholas Hornstein, Timothy Brown, and Udhayvir Grewal break down MSI-High GI cancers. A cancer diagnosis is never good news—but this is a setting where tumor biology meaningfully changes what’s possible, with immunotherapy offering real potential for durable responses and even cure.

Key discussion points include:
MMR vs. MSI: A diagnostic primer on the difference between IHC (protein) and NGS/PCR (molecular), including how to handle the discordance.
The “Parachute” Data: Breaking down the practice-changing CheckMate 8HW results—and why a hazard ratio of 0.21 is hard to ignore. Nick walks through why nivo/ipi is increasingly his frontline default.
The COMMIT Curveball: Why the COMMIT trial data didn’t deliver—and what it may tell us about PD-L1 vs PD-1 strategies in colorectal cancer.
Pseudoprogression vs Hyperprogression: Tim shares practical, in-the-clinic ways to tell whether a scan is showing immune infiltration… or true disease acceleration.
ctDNA at 6 Weeks: How Nick uses early ctDNA dynamics as a real-time readout of response—especially when you’re pushing toward non-operative management.
When IO Fails: What next? From CTLA-4 “immune salvage” approaches to where targeted therapy (including BRAF-directed options) fits.
Whether you’re screening for Lynch or choosing between single-agent PD-1 and dual checkpoint blockade, this episode covers how we’re actually managing dMMR/MSI-H disease right now.

Chapters:
(00:00) MSI High Basics
(02:31) MSI vs MMR Methods
(05:12) Choosing Tests in Practice
(09:59) TMB Pitfalls
(12:14) Pivotal Immunotherapy Trials
(15:13) CheckMate 8HW Results
(21:03) Biomarkers for Ipi Nivo
(25:47) PD1 vs PDL1 Debate
(31:52) Using ctDNA in Practice
(34:42) How Long to Treat

You can find us on X: Gut Onc Lab (@TheGutOncLab) / X
44 min

About The Gut Onc Lab Podcast

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Dr. Nicholas Hornstein, Udhayvir Grewal, and Dr. Timothy Brown dive into all things oncology related to the gut in these short but info-packed episodes.

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About The Gut Onc Lab Podcast