The Fellow on Call: The Heme/Onc Podcast

This week we continue our Pancreatic Cancer series with the two middle categories of non-metastatic disease: borderline resectable and locally advanced. Using the case of a 61-year-old woman with a pancreatic body mass abutting the superior mesenteric artery, we walk through the vascular definitions that separate resectable, borderline resectable, and locally advanced disease, then trace how multi-agent chemotherapy borrowed from the metastatic setting became the neoadjuvant backbone. We dig into the newest challenger to mFOLFIRINOX, PAXG in the CASSANDRA trial, and the still-contested role of radiation, from Alliance A021501 to PREOPANC-2. Along the way, we cover why restaging CT can understate response, how LAP07 reframed consolidative chemoradiation in locally advanced disease, and what to offer patients who are not candidates for intensive therapy. As always, if you haven't heard the earlier episodes in this series, start there first.As always, if you haven't listened to parts 1 and 2 (episodes 165 and 166, respectively)This episode is sponsored by Primum! As questions of oncology experts (including pancreatic cancer) free! To learn more and to sign up for your free account, visit Primum.co/fellows** Want to review the show notes for this episode and others? Check out our website. Love what you hear? Tell a friend and leave a review on our podcast streaming platforms!Twitter: @TheFellowOnCallInstagram: @TheFellowOnCallListen in on: Apple Podcast, Spotify, and Youtube

This week our pancreatic cancer series moves from diagnosis to management, starting with resectable disease. Using the case of a 68-year-old man with a 2.8 cm adenocarcinoma of the pancreatic head, we define what "resectable" actually means, review the operation and the goal of an R0 resection, and explain why surgery alone is never enough. We then trace the adjuvant story from ESPAC-1 and CONKO-001 to today's two standards, modified FOLFIRINOX (PRODIGE 24) and gemcitabine-capecitabine (ESPAC-4), before taking on the surgery-first versus neoadjuvant debate (NORPACT-1, PREOPANC, SWOG S1505), the question of preoperative biliary stenting, and what is coming next.As always, if you haven't listened to part 1 of this series, start there first.This episode is sponsored by Primum! As questions of oncology experts (including pancreatic cancer) free! To learn more and to sign up for your free account, visit Primum.co/fellows** Want to review the show notes for this episode and others? Check out our website. Love what you hear? Tell a friend and leave a review on our podcast streaming platforms!Twitter: @TheFellowOnCallInstagram: @TheFellowOnCallListen in on: Apple Podcast, Spotify, and Youtube

This week we kick off a brand-new series on pancreatic cancer, starting with the fundamentals. Using the case of a 68-year-old man with painless jaundice, weight loss, and new-onset diabetes, we cover the epidemiology and sobering survival statistics of pancreatic ductal adenocarcinoma, the major risk factors (and why late-onset diabetes is often a consequence rather than a cause), universal germline testing and the hereditary syndromes worth knowing for the boards, and how tumor location in the head, body, or tail shapes presentation. We then walk through the diagnostic workup (pancreatic-protocol CT, MRI/MRCP, EUS-guided biopsy, and the therapeutic role of ERCP), the pitfalls of CA 19-9, precursor lesions and the four-gene molecular story led by KRAS, somatic profiling for actionable targets, and the resectability framework that will drive treatment decisions for the rest of the series.This episode is sponsored by Primum! As questions of oncology experts (including pancreatic cancer) free! To learn more and to sign up for your free account, visit Primum.co/fellows** Want to review the show notes for this episode and others? Check out our website. Love what you hear? Tell a friend and leave a review on our podcast streaming platforms!Twitter: @TheFellowOnCallInstagram: @TheFellowOnCallListen in on: Apple Podcast, Spotify, and Youtube

This week we wrap up our two-part CLL update by turning to relapsed and refractory disease. We pick up with the 68-year-old man from Part 1, now a year out from frontline therapy and showing signs of relapse. We cover when relapse actually needs treatment, the history of BTK inhibitor resistance and why BTK mutation testing matters, and how to sequence therapy now that BTK inhibitors and venetoclax have both moved into the frontline. From there we get into venetoclax retreatment, the pirtobrutinib data from BRUIN CLL-321 and the new BRUIN CLL-322 triplet trial, the real-world CAR T experience that is changing how we think about cell therapy in CLL, bispecific antibodies, and the emerging class of BTK degraders. As always, if you haven't heard the earlier episodes in this series, start there first.If you haven’t done so, be sure to check out our original CLL Series and our CLL Updates Part I episode as this update will draw on concepts covered previously!**This episode is sponsored by The Lymphoma, Leukemia and Myeloma Congress! To learn more and register for the meeting, click here! Be sure to use our SPECIAL TFOC code TFOC40 to save 40% off registration.** Want to review the show notes for this episode and others? Check out our website. Love what you hear? Tell a friend and leave a review on our podcast streaming platforms!Twitter: @TheFellowOnCallInstagram: @TheFellowOnCallListen in on: Apple Podcast, Spotify, and Youtube

This week we kick off a two-part update to our CLL series, covering what has changed in frontline management since our original episodes. Using the case of a 68-year-old man with newly diagnosed, symptomatic CLL, we revisit the essential steps before treatment: confirming an indication to treat, ruling out Richter's transformation, and risk stratification, with the history behind FISH cytogenetics, IGHV status, and the CLL-IPI. We then trace how continuous BTK inhibitors and fixed-duration venetoclax-obinutuzumab displaced chemoimmunotherapy, before digging into the trials reshaping practice in 2026: AMPLIFY, SEQUOIA Arm D, and CLL17. Along the way, we cover the open questions for TP53-aberrant disease and why MRD, although prognostic, is not yet a reliable guide for treatment decisions with novel agents. If you haven’t done so, be sure to check out our original CLL Series, as these updates will draw on concepts covered previously!**This episode is sponsored by The Lymphoma, Leukemia and Myeloma Congress! To learn more and register for the meeting, click here! Be sure to use our SPECIAL TFOC code TFOC40 to save 40% off registration.** Want to review the show notes for this episode and others? Check out our website. Love what you hear? Tell a friend and leave a review on our podcast streaming platforms!Twitter: @TheFellowOnCallInstagram: @TheFellowOnCallListen in on: Apple Podcast, Spotify, and Youtube