The Gut Onc Lab Podcast

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

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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

 

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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

 

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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

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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

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