Oncology for the Inquisitive Mind

Ovarian cancer is notoriously difficult to treat, but treatment like most cancers continue to improve. This week we discuss two pivotal immunotherapy (Keynote) trials. KEYNOTE-826 was the first trial to show that adding immunotherapy to first-line chemotherapy helps women whose cervical cancer has come back or spread. They lived longer, and five-year results confirm the benefit lasts. KEYNOTE-A18...

This week we cover endometrial cancer. It is one of the clearest examples of molecular classification changing how we treat patients. PORTEC-3 randomised women with high-risk disease to pelvic radiotherapy with or without chemotherapy. Adding chemotherapy improved survival, and the benefit held at 10 years. The molecular analysis is where it gets interesting, but you'll have to tune in to find...

Last week Josh and Michael discussed early ovarian cancer, but as is always the case many patients either do not respond completely to treatment of their early disease or present with advanced disease and thus are robbed of that chance. In these patients, getting the treatment right is a complex discussion but a vital one. In this episode, we discuss two studies in the advanced ovarian cancer spac...

Our Back to Basics odyssey nears its end, a journey just as epic as Matt Damon's (we think so, anyway). As we enter the final stretch, we discuss ovarian cancer, a cancer with significant mortality and morbidity despite advances in treatment. In this episode Josh and Michael discuss two studies in the early ovarian cancer space, a topic fraught with challenges as unique as Scylla and Charybdis...

On this episode, Josh and Michael examine the treatment of advanced melanoma, the condition that blazed the trail for immunotherapy to change the face of cancer treatment. However, immunotherapy is not the ONLY treatment for melanoma, as a significant proportion of cases also harbour a BRAF mutation. So, if you have someone with such an example, what do you do? How would you sequence your treatmen...

Our guest today is someone whose work touches almost every corner of oncology: from the exam room to the lab to the systems we work within. Dr Narjust Florez, MD, FASCO, is a thoracic medical oncologist at Dana-Farber Cancer Institute and Assistant Professor of Medicine at Harvard Medical School, where she treats young patients and women with lung cancer and leads a research program spanning early...

In this episode, Michael and Josh delve into the world of early melanoma. Some may think that melanoma has had its moment in the sun (pun slightly intended) and that other cancer treatments are passing it by. But in this instance, you can teach an old dog new tricks, an old immunotherapy dog, to be precise. In addition, one of today's studies has Michael's favourite design of any trial: see if you...

If you like cemiplimab, you will like this episode. Since its introduction, cemiplimab has become the mainstay of treatment for cutaneous SCC, the most common non-melanoma skin cancer likely to attend an oncologist. Cemiplimab's scope is expanding; once reserved purely for the locally advanced or metastatic setting, evidence is emerging for its efficacy in the neoadjuvant setting. Today, Josh and...

For over a decade, sorafenib remained unchallenged as first-line therapy for hepatocellular carcinoma, based on the SHARP trial, which showed survival increasing from 7.9 to 10.7 months. This demonstrated modest efficacy in a disease notoriously resistant to systemic treatment. That drought broke in 2020, when IMbrave150 demonstrated that atezolizumab plus bevacizumab beat sorafenib outright, push...

Until recently, biliary tract cancers were relegated to orphan cancer status: rare cancers such as cholangiocarcinoma and gallbladder cancers. These aggressive malignancies were lumped together, historic trials were small, and patients were stuck with gemcitabine-cisplatin chemotherapy as the only real option, a regimen that hadn't changed for almost a decade. Then two trials cracked the field ope...

On today's episode, we have a very special guest: Dr Kerry Jewell is a nuclear medicine physician, medical advocate and very good friend of the show, who recently published her debut novel A Little Unwell. Kerry is wonderfully eloquent doctor who frequently chooses violence when with dealing with Michael, whom she has known for his entire medical career. Today, Kerry discusses her book, working as...

This episode is the ASCO 2026 Plenary Episode. This week, all of the pivotal, game-changing, life-changing trials are discussed here. Some describe the plenary session as practice-changing, and we will always agree that better treatments with significant improvements in life expectancy and quality of life need their time in the spotlight. Today, five trials are discussed, including SARC041, a lipo...

This week, Josh and Michael's ASCO 2026 coverage looks at "Agents of the Future", trials of intrigue, promise and potential beyond its status. This episode also sheds light on more orphan status cancers like head and neck cancer, basket cohort studies, resistant EGFR lung cancer, metastatic colorectal cancer and hepatocellular carcinoma. One more episode left of this arc - The Plenary! Stay tuned....

ASCO 2026 is done, and Michael and Josh have created a marathon episode for you all. This week we cover "Agents of the Present", where we summarise all the important trials with updates, overall survival and progression-free survival data that could influence your practice. They cover immunotherapy, lifestyle interventions, pan-PI3K inhibitors, rare cancers (such as uveal melanoma), and antibody d...

This week, we take a quick trip to Stockholm, Sweden, where ESTRO (European Society for Radiotherapy and Oncology) took place several weeks ago. A/Prof Steven David digs deep into the latest updates in the breast cancer radiation space, including hyperfractionation of treatment, the utilisation of AI for radiation planning (Archery Trial), and the DBCG RT Natural Trial, which examined whether omit...

This episode tells the story of how one man, Jake Messier, who is living with metastatic male breast cancer, is challenging the stigma surrounding this disease, which affects 1% of all breast cancer patients. It's an important reminder that not all cancers are funded and researched equally, and that behind every statistic is a person trying to live a normal life. Jake has used his lifelong PR skil...

This week, we take a "back to the future" look at the early-stage pancreatic cancer phase, a relatively stagnant area in terms of pivotal trials. The two trials are the ESPAC4 trial, which examines doublet chemotherapy in pancreatic cancer, and Josh does a traditional deep dive into the world of neoadjuvant chemotherapy. He highlights ESPAC-5, PREOPANC-2, and the TAPS consortium, to name a few. A...

Today, we accidentally skipped early pancreatic cancer and jumped straight to advanced pancreatic cancer. It was a sombre episode, with clinicians and advocates screaming for better treatment options for this cancer. While small incremental advances have been made, the holy grail remains elusive. Today our focus is on NAPOLI-3, the use of liposomal irinotecan (NALIRIFOX), and PANOVA-3, where TTFie...

On today's episode, Josh and Michael "advance" in their ongoing GI journey, as Michael continuously insists on saying, to discuss advanced gastric and GOJ cancer. Historically, an orphan disease with a very poor prognosis, perhaps the first rays of light are beginning to shine on this difficult-to-treat cancer type. Immunotherapy has been well established as standard of care, but are there any new...

This week, as we enter our 200th episode, Michael and Josh continue their journey through the alimentary canal, exploring the world of stomach cancer. Gastric cancer has been notoriously difficult to treat, with a thirty-year grace period of multiple trials seeking an appropriate regimen that reduces recurrences while remaining effective. This episode gives you all the answers, and just when we th...

Good therapeutic options for metastatic colorectal cancer are limited after the fluoropyrimidine-based options are exhausted. This week, we explore the role of trifluridine-tipiracil (Lonsurf) and bevacizumab (VEGF inhibitor), and a newish kid on the block, fruquitinib, an oral tyrosine kinase inhibitor and vascular endothelial growth factor receptor. While not perfect, they do represent later-lin...

Today's episode, like several of the greatest cult classics, comes a bit earlier than anticipated. Before we wrap up our epic recap of the colorectal space, we will give you a little taster of our UGI series with a look at early oesophageal cancer, focussing on the chemotherapy backbone and whether immunotherapy has any place in this space. Spoiler alert (as always): it does. Studies discussed in...

Metastatic Colorectal Cancer has a dearth of targetable mutations that have effective outcomes. This week, Michael and Josh see whether the wonder drug (trastruzumab deruxtecan) works in HER2-expressing colorectal cancer. Michael takes a more positive tone, with the recycling of aspirin to reduce recurrence risk for PI3K pathway cancers. Josh promised he will have the right audio this episode - th...

UPDATED WITH CORRECT AUDIO While Michael daydreams of getting a haircut, this week's topics are slightly more conventional as we explore the role of more targeted agents in metastatic colorectal cancer. KRAS and BRAF mutations in colorectal cancer were historically prognostic; this has now shifted with targeted therapies available for both. In the context of metastatic colorectal cancer, BRAF muta...

Historically, colorectal cancer treatment has been fairly standard, but this has shifted over the past decade with the introduction of targeted therapies. This week, our focus is on patients with microsatellite instability (dMMR) colorectal cancer, a small but meaningful cohort. This condition affects up to 15% of patients, many of whom carry germline mutations in the MLH1 and MSH2 genes, which si...