Welcome to The Five Under 5, your go-to roundup of the top 5 videos of the week.
These short videos are designed for busy oncologists to view on the go, and feature expert insights on breaking news, regulatory updates, practice-changing data shared at medical meetings, and other key topics in the realm of oncology.
Here’s what you may have missed:
Examining the ENVISION Trial in NMIBC: Sandip M. Prasad, MD
Sandip M. Prasad, MD, of Atlantic Health, discusses previous findings from the phase 3 ENVISION trial (NCT05243550) that evaluated complete response (CR) rates and duration of response (DOR) by EORTC recurrence score subgroups in patients with recurrent low-grade intermediate-risk non–muscle-invasive bladder cancer. The single-arm, open-label study examined mitomycin (UGN-102), a novel non-surgical chemoablative gel therapy that can be administered outpatient without discontinuing blood thinners, in 240 patients with the primary end point of 3-month CR rate. In those who received all 6 planned doses, the 3-month CR rate was 80% (95% CI, 73.9%-84.5%), with a response probability of 82% (95% CI, 75.9%-87.1%) at 1 year, a median DOR that was not estimable at a median follow-up of 13.9 months, and a favorable toxicity profile with 57% of patients experiencing a treatment-emergent adverse effect. Prasad concluded that these data provide powerful evidence supporting the efficacy of chemoablative therapy, with subsequent post hoc analyses presented at the 2026 Genitourinary Cancers Symposium.
Potential Role of the Microbiome in Early-Onset CRC: John L. Marshall, MD
John L. Marshall, MD, of the Otto J. Ruesch Center for the Cure of Gastrointestinal Cancers and Georgetown Lombardi Comprehensive Cancer Center, discusses the rising incidence of early-onset colorectal cancer (CRC) and its defining clinical characteristics in recognition of CRC Awareness Month. Unlike traditional CRC, where roughly 40% of tumors arise on the right side and 60% on the left, early onset CRC is characterized by an overwhelming predominance of left-sided distal tumors, frequently at the rectosigmoid junction, suggesting it is a biologically distinct disease entity. Marshall noted that microbiome alterations potentially driven by dietary or environmental factors concentrated in the distal colon could serve as a primary oncogenic catalyst, comparing the current state of research to Darwin's observation of natural selection before the mechanisms were fully understood. He noted that although similar rising cancer trends are observed in breast and other gastrointestinal malignancies among young adults, the phenomenon is most pronounced in CRC, and solving the microbiome's role could have broad downstream implications for treating other young-adult cancers.
Value of the Breast Cancer Index for Assessing Disease Recurrence Risk: Sami Diab, MD
Sami Diab, MD, of the Center for Cancer and Blood Research of Pagosa Springs Medical Center, highlights the clinical utility and prognostic significance of the Breast Cancer Index (BCI) in patients with breast cancer receiving adjuvant endocrine therapy. Although BCI is most commonly linked with decision making for extended adjuvant therapy in the 5-to-10-year post-diagnosis window, Diab clarified that the assay is also validated as a prognostic tool for early recurrence in the 0-to-5-year interval, providing comprehensive risk insight across a full 10-year trajectory. During the early treatment phase, oncologists must choose among options like aromatase inhibitors or tamoxifen, and for premenopausal patients, the decision of whether to incorporate ovarian suppression presents a particular clinical challenge where more data are still needed. By leveraging BCI's dual prognostic capabilities spanning both early and late recurrence windows, Diab concluded that endocrine therapy strategies can more effectively be tailored to each patient's individual risk profile.
Understanding How Patient Goals Drive TKI Selection in CML: Jorge Cortes, MD
Jorge Cortes, MD, of the Georgia Cancer Center of Augusta University, explains how prioritizing individual patient goals is the most important factor when selecting an initial TKI for the treatment of patients with chronic myeloid leukemia. Although disease risk classifications and other clinical factors also inform treatment decisions, Cortes underscored that common patient priorities like finishing therapy quickly, minimizing adverse effects (AEs), maximizing quality of life, or managing cost often narrow the available TKI options to a manageable set. Practical considerations like dosing schedule and food requirements must also be weighed with patient goals. He added that comorbidities are particularly important as they can predispose patients to AEs linked with specific TKIs. After initial therapy, Cortes noted that treatment responses, reported AEs, and mutation profiles all play a key role in guiding subsequent TKI selections, a process he described as ultimately more complex than the initial decision.
Evolving AI Risk-Stratification Methods in Multiple Myeloma: C. Ola Landgren, MD, PhD
C. Ola Landgren, MD, PhD, of the Sylvester Myeloma Institute and the University of Miami Miller School of Medicine, unpacks evolving risk-stratification strategies in multiple myeloma management and the development of the CORAL AI tool in honor of Multiple Myeloma Awareness Month. Researchers at the University of Miami built individualized prediction models trained on large datasets integrating disease biology, clinical characteristics, and treatment data to better estimate patient outcomes and guide dynamic clinical decision making. CORAL is a histomorphologic deep learning platform designed to extract meaningful biological insights directly from routine bone marrow biopsy images, inferring underlying molecular characteristics and genomic abnormalities typically obtained through advanced sequencing addressing the common real-world limitations of comprehensive genomic profiling. By integrating histopathology image analysis with clinical and treatment variables, CORAL enables real-time, individualized risk assessment and treatment guidance even where detailed molecular data are unavailable.
