Between 1933 and 1944, Americans huddled around their radios to listen to the words of Franklin Delano Roosevelt, the 32nd President of the United States. Covering topics ranging from the 1936 recession to World War II, FDR titled these addresses "Fireside Chats", giving very high-concept topics a more personal, intimate feel. Let it never be said that Oncology for the Inquisitive Mind is above shamelessly cribbing ideas from history.

In this series, on the first Wednesday of each month, Josh and Michael will go away from their usual format of data dissection. They will instead turn their attention to a cancer-related article, film or other media and discuss it with the same convivial atmosphere of FDR. In this episode, they discuss a New York Times opinion piece from August 2023 titled "Not Everything We Call Cancer Should Be Called Cancer," trying to strike a balance between personalisation and de-escalation of management of low-risk, pre-cancerous lesions while also viewing such discussions from the perspective of patients.

Neuroendocrine tumours (commonly referred to as NETs) is the topic for this week's episode of Oncology for the Inquisitive Mind. Michael and Josh thought it could be easily covered in a single episode, but they were wrong. This is not dissimilar to the recurrent cancellation of Futurama, a television series with nine lives saved by every network in existence.

Neuroendocrine tumours are a diverse, heterogeneous, rare group of cancers that can occur throughout the body. The most common location is the gastrointestinal tract, lung, and pancreas. Of course, these aren't the only locations with NETs forming in the thymus, prostate, breast and skin. To complicate things further, the classification of NETs has changed multiple times over the past two decades.

This first episode of our four-part "tour de force" will summarise well-differentiated neuroendocrine tumours and the pivotal studies of lanreotide and PRRT (peptide receptor radionucleotide therapy) with lutetium dotatate.

Previously, on Oncology for the Inquisitive Mind, Josh and Michael discussed the common systemic therapies available for early and advanced testicular cancer: single-dose carboplatin and bleomycin + etoposide + cisplatin (BEP). However, like the beginning of any good story, this is just the beginning. All the knowledge of chemotherapy in the world is nothing without knowing how to apply it. In this episode, our hosts attempt to tackle this very topic, dissecting the when, where and why of the treatment of testicular cancer. Consider this your Hitchikers' Guide to Germ Cell Tumours.

On this, the tenth episode of OncoSnacks, Josh and Michael discuss the management of a common but no less important problem: superficial venous thrombosis and thrombophlebitis. While for the majority of cases the treatment is purely symptomatic, in a small minority of cases superficial venous thromboses can be a precursor of more serious thromboembolic events. This broad range of possible outcomes makes the management and risk stratification of apparently minor thromboses all the more important, particularly in the oncology patient population. Listen on as Josh and Michael aim to shed some light in this dark topic.

Edward Gibbon, an English historian and politician, once quipped, "History is indeed little more than the register of the crimes, follies, and misfortunes of mankind." This episode, which lacks historians and politicians, covers testicular cancer, a topic humankind has had a love-hate relationship with for millennia. As a historical concept in the Middle Ages, men who wanted to have a male as an offspring would sometimes remove their left testicles as the belief was that "boy" sperm was made in the right testicle and "girl" sperm in the left.

We don't entertain such nonsense here on Oncology for the Inquisitive Mind. Instead, we discuss testicular cancer, an uplifting episode with high cure rates and a debate regarding observation versus treatment. Will there be a future when one can perform surgery alone? Does radiotherapy have a role, and do the pros outweigh the cons of chemotherapy?

In this episode, the Nautilus reaches its final destination, where Michael and Josh pursue a deeper understanding of ROS1, and KRAS mutated lung cancer. ROS1 reflected less than 3% of non-small cell lung cancer, while KRAS is abundant and can reflect up to 25% of lung cancer patients. The challenge lies in the targets, with the only approved KRAS treatment sotorasib targeting a single KRASG12C mutation. Many, many more KRAS mutations exist in the wild. Michael uses his oxygen tank to discuss an integrated efficacy and safety analysis of entrectinib, and Josh breaks free of a shark and highlights the CodeBreaK 200 study.

In this episode, Michael and Josh step onto the oncological Nautilus, to begin their journey of 20,000 Leagues Under Lung Cancer, to examine non-small cell lung cancer with mutations other than EGFR. The first step on their journey is discussing the anaplastic lymphoma kinase, a tyrosine kinase inhibitor associated with the development of non-small cell lung cancer in younger patients who have never smoked. Thankfully, unlike their previous episode, there are treatment options galore for patients with ALKmut NSCLC. Two of the contenders for the title of "The King of the ALK" are alectinib and lorlatinib. Alectinib has more robust overall survival data, but lorlatinib has hazard ratios so ridiculously good that they would almost meet statistical significance as p values! So which is better? Listen on to find out.

There are cancers that grow slowly. There are cancers that do not grow at all. And then there are cancer's like today's subject, that are notorious not just for their ability to completely overcome a patient in a very small amount of time. Extensive-stage small cell lung cancer remains a very difficult condition to treat, highly prone to relapse and with few effective options beyond - or perhaps even including - the first line setting. While the medical and scientific community remain stalwart in their quest for therapeutic options, success stories have been few and far between. In this episode, Josh and Michael look at one success story, and one study dredged up from the pre-Internet era, to illustrate the dichotomy and discuss the challenge of treating this, the most aggressive of solid tumours.

Chemotherapy extravasation can occur day or night, and one must always be vigilant. While many agents are irritants and may not pose significant risks, vesicants pose a different story. A tale of danger and intrigue, this situation can lead to the involvement of a friendly neighbourhood surgeon or Spiderman. In worst-case scenarios, significant tissue damage, treatment delay, and a sizeable psychological burden on the patient can occur. In this OncoSnacks episode, Michael and Josh explore this world, highlighting potential agents and how to prevent, diagnose and manage them.

Cancer is considered a great killer, an indefatigable bogeyman that claims the lives of everyone it afflicts. However, advances in medicine mean that for more people than ever before, cancer is something that people can survive or at least live with for longer. While an incredible achievement, this does raise many new challenges for patients and physicians alike. And thus, the concept of Cancer Survivorship was born, a service that aims to fill the gap in service for patients who have survived or are surviving with cancer but may feel somewhat adrift in stormy seas.

In this episode of Oncology for the Inquisitive Mind, Josh and Michael interview Dr Ash Malalasekera, an oncologist working in the South Western Sydney Local Health District, Chris O'Brien Lifehouse and Concord Repatriation Hospital, who has incredible insight into this emerging and truly holistic approach to the care of patients with cancer. We ask about her experiences, the challenges of this model of care and how it can improve or, in some cases, transform how patients can embrace life with or after cancer.

DCIS (ductal carcinoma in situ) and LCIS (lobular carcinoma in situ) are challenging areas of breast cancer oncology. Michael and Josh return from their short hiatus to find their podcast has been ranked one of the top oncology podcasts by feedspot. Do not fear; they won't rest on their laurels and are ready to roll and bring another exciting episode of management, intrigue, and choose your adventure. Neither DCIS nor LCIS are technically cancer, but they both have the propensity to develop into a malignancy. The benefit versus toxicity question becomes paramount in the episode when talking to patients about cancer risk and treatment options. What on earth does a precancerous lesion actually mean?