S4E3 The Oncology Journal Club Podcast: ‘Mouthwatering’ RAS(ON), Bob Marley’s Melanoma, ADT Hot Flushes + Prostate Cancer Terminology

A groundbreaking phase 2 trial shows that a single dose of pembrolizumab prior to surgery achieves a 98% overall survival and 96% disease-free survival in patients with dMMR, BRAF-mutant, right-sided colon cancer—raising the provocative question: if one dose works this well, do we still need 12 months of adjuvant immunotherapy? Meanwhile, a new RAS inhibitor called daroxacinib has delivered a jaw-dropping 13.1-month median overall survival in heavily pre-treated pancreatic cancer patients, with only 14% experiencing any grade fatigue—marking a potential paradigm shift in a disease long considered untreatable. The episode also unpacks a major overhaul of prostate cancer terminology, replacing outdated 'castrate-sensitive/resistant' labels with patient-centered terms like 'androgen pathway modulation naive/resistant'—driven by direct patient feedback. This shift, along with new standards for PSMA PET staging, re-biopsy protocols, and the concept of 'no longer clinically benefiting' (NLCB), signals a move toward more precise, patient-centric oncology. From repurposing oxybutynin for prostate cancer hot flashes to revealing that Bob Marley died of acral melanoma, the episode blends clinical breakthroughs with human stories, all while questioning long-held dogmas like maximum tolerated dose and the assumption that all melanomas respond equally to immunotherapy.