The Gut Onc Lab Podcast

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.

The Gut Onc Lab Podcast is a health podcast hosted by gutonclab1, with 13 episodes on record and a Required Pod Score of 80.

gutonclab1 hosts The Gut Onc Lab Podcast, a health show with 13 episodes published.

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  Episode #14

  The POD1UM-303 Triumph: Retifalimab, Mitomycin Toxicity, and Frontline Anal Oncology

  Sep 9, 202616 min

  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

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  Episode #13

  Curative Intent in CRLM: Surgery, ctDNA, and the Biology of Liver Metastases

  Aug 25, 202631 min

  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

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  Episode #12

  Systemic Therapies in HCC: Immunotherapy and Beyond with Mark Yarchoan

  Aug 7, 202636 min

  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

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  Episode #11

  Approaching clinical trials as a patient, what to know.

  Aug 3, 202624 min

  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

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  Episode #9

  The Precision Shift: Re-Writing the Colorectal Cancer Roadmap with Dr. Arvind Dasari

  Jun 22, 202622 min

  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

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