The Gut Onc Lab Podcast

gutonclab1
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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.

  1. 4d ago

    Frontline Radioligands: Sparing the Marrow and Moving PRRT Upfront with Dr. Simron Singh

    In this episode of The Gut-Onc Lab, Drs. Nicholas Hornstein and Udhayvir Grewal welcome world-renowned neuroendocrine authority Dr. Simron Singh (Sunnybrook Health Sciences Centre / University of Toronto) to explore why radioligand therapies are undergoing an explosive transformation. Moving from historical nuclear medicine "vibes" into a rigorous oncological trial framework, the panel dissects how the frontline map of gastroenteropancreatic neuroendocrine tumors (GEP-NETs) is being entirely redrawn. Key discussion points include: The Frontline Shift: Dr. Singh explains the rationale behind the practice-changing NETTER-2 trial—the first randomized trial of radioligand therapy in the first-line metastatic setting for any solid tumor—and its striking 72% reduction in the risk of progression or death for high-grade G2 and G3 well-differentiated tumors. The SSTR2 Landing Strip: Why PRRT relies entirely on stable somatostatin receptor expression (Krenning 3 or 4 score), and the operational necessity of integrating dual-PET imaging (SSTR-PET + FDG-PET) to calculate a comprehensive NetPET Score. Sequencing vs. Small Molecules: Analyzing the comparative data from COMPETE and OCCLURANDOM that establishes the clear progression-free survival and health-related quality of life superiority of PRRT over traditional small molecule choices like everolimus or sunitinib. The Alpha Frontier (ACTION-1): An exclusive preview of the highly anticipated Fall 2026 readout of the Phase III ACTION-1 trial evaluating Actinium-225 labeled dotatate (RYZ101) in patients who have progressed through Lutetium-177, contrasting heavy beta emissions against localized double-stranded DNA breaks. Therapy-Related Myeloid Neoplasms (TMN): A direct, honest dialogue on the long-term risk of treatment-related MDS and AML, the role of clonal hematopoiesis of indeterminate potential (CHIP), and how sequential alkylating agents alter the marrow baseline. The 5-Year Vision: Slicing past the limits of a simplistic, static pathology slice toward dynamic 3D tumor mapping, alongside the arrival of DLL3-targeted bispecifics and antibody-drug conjugates (ADCs) for aggressive neuroendocrine carcinomas. From the hockey analogies of "skating your best player in the first period" to eliminating the logistical 6-hour amino acid chair-time infusion burden, this conversation captures the precision medicine revolution hitting the neuroendocrine landscape.   Chapters: 00:00 PRRT and NETTER-1 Basics 02:08 Why NETTER-2 Went Frontline 04:50 NETTER-2 Results and Impact 05:26 Choosing First Line PRRT 07:56 NETTER-3 for Bulky Low Grade 10:32 Sequencing PRRT vs Other Drugs 14:13 Repeat PRRT and Key Trials 16:53 Dual PET and NetPET Score 20:09 Alpha PRRT Next Wave 25:08 TMN Risk and CHIP Biomarkers 27:35 Toxicities and Mitigation Tips 29:54 Future Outlook and Wrap Up   You can find us on X: Gut Onc Lab (@TheGutOncLab) / X

  2. Oct 22

    ESMO 2026: (Likely) Practice Changing Presentations We’re Excited About

    In this high-velocity conference preview episode of The Gut-Onc Lab, Drs. Nicholas Hornstein, Timothy Brown, and Udhayvir Grewal sit down to dissect the most anticipated late-breaking abstracts heading into ESMO 2026. Scanning the entire gastrointestinal tract, the panel evaluates high-stakes Phase III data drops, novel antibody-drug conjugates (ADCs), PD-1/VEGF bispecifics, and practice-defining de-escalation strategies.    Key Discussion Points Upper GI & Claudin 18.2 ADCs: gHOPE001 (LBA77): Previewing third-line claudin 18.2 ADC efficacy and assessing whether second-generation payloads mitigate historical emetic toxicities. CLARITY-Gastric-01 (LBA7): Analyzing the Phase III data for sonesi-v (sonidesib tugilimumab) in CLDN 18.2-positive gastroesophageal cancers, contrasting statistically significant overall survival (OS) against missed progression-free survival (PFS) endpoints. Long-Term SANO (LBA78) & REMIRAS: Evaluating five-year organ preservation data for clinical complete responders in esophageal cancer, alongside final second-line FOLFIRI-RAM vs. Ram-Pac taxane-pretreated outcomes. Biliary Tract Milestones: HARMONY-GI001: Evaluating first-line avenasimab (PD-1/VEGF bispecific) plus chemotherapy vs. durvalumab plus chemotherapy in advanced biliary tract cancers. ACTICA-1 / ActiCCA-1: Predicting whether six months of adjuvant Gemcitabine + Cisplatin (GemCis) will displace capecitabine (BILCAP) as the definitive post-resection standard of care. Colorectal & MSI-High Landmark Data: CheckMate-8HW Final OS (LBA32): Examining final overall survival curves for frontline Nivo/Ipi vs. single-agent Nivo and chemotherapy in dMMR/MSI-High metastatic colorectal cancer. AZUR-1 (LBA37): Reviewing global Phase II dostarlimab monotherapy results in locally advanced dMMR Stage II/III rectal cancer, detailing why a 100% complete clinical response rate renders randomized surgical control trials obsolete. ECLIPSE Phase II (788ro): Demonstrating why continuing encorafenib + cetuximab beyond progression alongside FOLFIRI prevents MAP-kinase unmasking in BRAF V600E-mutated metastatic colorectal cancer. Chapters: 00:00 Welcome and Introductions 00:48 Upper GI Preview 00:58 Claudin 18.2 ADC gHOPE001 03:17 CLARITY Gastric 01 Soni V 04:59 SANO Watch and Wait 07:29 REMIRAS Honorable Mention 08:29 Biliary HARMONY GI001 PD1 VEGF 12:51 ACTICA 1 Adjuvant Biliary 17:10 MSI High CRC CheckMate 8HW 20:33 Dostarlimab Rectal Azur 1 25:24 BRAF CRC ECLIPSE Beyond Progression 28:33 More Honorable Mentions and Posters 32:15 Final Thoughts and ESMO Wrap Up You can find us on X: Gut Onc Lab (@TheGutOncLab) / X

  3. Oct 8

    Integrating 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

  4. Sep 9

    The 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

  5. Aug 25

    Curative 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

  6. Aug 7

    Systemic 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

  7. Aug 3

    Approaching 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

  8. Jul 9

    The 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

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About

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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  • Creator
    gutonclab1
  • Years Active
    2026
  • Episodes
    16
  • Rating
    Explicit
  • Copyright
    © Copyright 2026 All rights reserved.
  • Show Website
    The Gut Onc Lab Podcast

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