Dr. Brian Lawenda

06/08/2026

Today I want to recognize D’Silva II, a remarkable American whose life reflects service in its fullest sense. 🇺🇸

I first met Reuben years ago when I was serving as a Navy physician at Naval Medical Center San Diego. He was recovering after being shot by a sniper in Fallujah, Iraq, an injury for which he received a Purple Heart.

As physicians, we are sometimes privileged to meet people at incredibly vulnerable moments. What stayed with me about Reuben was not only the seriousness of his injury, but his strength, humility, humor, and determination during recovery.

Since then, Reuben has continued serving in extraordinary ways. He became an educator, earned degrees from UNLV, the University of Pennsylvania, and Yale, and now serves in the Nevada State Assembly.

That is what makes his story so powerful.

Service did not end for him on the battlefield. It continued in the classroom, in his community, and now in public office.

I’m proud of Reuben and grateful that our paths crossed during my time in the Navy. His journey is a reminder that healing is not only about surviving an injury. It is also about what someone chooses to do with the life ahead.

Grateful for Reuben, and for all who have sacrificed in service to our country. 🙏🏼💜🇺🇸

See Reuben’s public post: https://www.facebook.com/share/p/1aJKXZ2ZxJ/?mibextid=WC7FNe
Assemblymember Reuben D'Silva: https://www.leg.state.nv.us/App/Legislator/A/Assembly/Current/28

06/07/2026

A major step forward for patients with kidney cancer.

A trial called FASTRACK II, published in The Lancet Oncology, looked at SABR, short for stereotactic ablative body radiotherapy. SABR is also commonly called SBRT, or stereotactic body radiation therapy.

This treatment was studied in patients with primary kidney cancer who were not good candidates for surgery, were high-risk for surgery, or declined surgery.

SABR/SBRT is not conventional radiation.

It is a highly precise, non-invasive treatment that delivers a powerful dose of radiation directly to the tumor, usually in just 1 to 5 treatments, while carefully limiting dose to the surrounding kidney, bowel, and nearby organs.

No incision.
No needle through the skin.
No freezing or heating probe.
Typically no general anesthesia.
No hospital stay.

That is what makes this so exciting.

This is a treatment I have been offering selected kidney cancer patients for years, with excellent outcomes in my own clinical experience. The FASTRACK II results add powerful long-term prospective data supporting what many of us have been seeing clinically.

In FASTRACK II, 70 patients were treated, with tumors allowed up to 10 cm. The median tumor size was about 4.6 cm, meaning many tumors were larger than the usual sweet spot for needle-based ablation.

After long-term follow-up, the results were remarkable:

✅ No local recurrences were seen in this trial
✅ Cancer-specific survival was 100%
✅ No grade 4 or 5 treatment-related side effects were reported
✅ About 10% had grade 3 side effects, mostly short-term nausea, pain, or bowel-related symptoms

SABR/SBRT is now recognized in NCCN kidney cancer guidelines as an option for selected patients with localized kidney cancer.

In my view, SABR/SBRT deserves to be discussed much more often for selected patients with localized renal cell carcinoma, especially when surgery or needle-based ablation is not ideal.

For the right patient, SABR/SBRT may offer excellent long-term tumor control without surgery, needles, or hospitalization.

Source: FASTRACK II trial, The Lancet Oncology.
https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(26)00091-4/abstract

06/06/2026

This is exactly the kind of research that gives me real hope.

Sarasota Memorial’s Kolschowsky Research and Education Institute is enrolling patients in a study evaluating LINFU, or Low-Intensity Non-Focused Ultrasound, as a potential new screening approach for people at high risk for pancreatic cancer.

This one is personal for me.

Both of my parents were diagnosed with pancreatic cancer. So when I see our local medical community investing in earlier detection, it means a lot.

Pancreatic cancer is one of the most difficult cancers to find early. Too often, it is diagnosed only after symptoms develop, when treatment becomes much more challenging. But the growing data from high-risk surveillance programs are encouraging. When pancreatic cancer is found through structured screening, it is much more likely to be detected at an earlier, potentially more treatable stage.

That is the opportunity.

Today, high-risk surveillance usually relies on MRI/MRCP and/or endoscopic ultrasound, often called EUS. These are the established tools. EUS is especially useful for detecting small solid lesions and can allow tissue sampling. MRI/MRCP is noninvasive and helpful for following pancreatic cysts and duct changes.

But one of the biggest challenges in pancreatic cancer screening is that some of the earliest precancerous ductal changes are microscopic. These are called PanIN lesions, short for pancreatic intraepithelial neoplasia. PanIN changes can range from low-grade to high-grade, and high-grade PanIN is considered one of the important precursor lesions that can eventually lead to pancreatic cancer.

The problem is that PanIN lesions are generally too small to be seen on CT, MRI, or even endoscopic ultrasound.

That is why LINFU is so interesting.

Instead of only looking for a visible mass or structural abnormality, LINFU uses low-intensity ultrasound stimulation, along with a contrast agent and secretin, to encourage the pancreas to release more ductal cells and secretions.

Those secretions can then be collected during an upper endoscopy, without directly placing a catheter into the pancreatic duct. That matters, because directly instrumenting the pancreatic duct can carry risks, including pancreatitis.

The hope is that analyzing these pancreatic cells and secretions could one day help identify concerning cellular or precancerous changes earlier, potentially before an obvious cancer is visible.

That is a very important idea.

If concerning cells are found, the next step is not automatic surgery. Management would depend on the degree of abnormality, whether anything can be localized on MRI/MRCP or EUS, and careful review by a multidisciplinary team at an experienced pancreatic center. Lower-risk or indeterminate findings may lead to closer surveillance, while high-grade dysplasia or confirmed malignant cells would usually prompt a much more aggressive evaluation and surgical consultation if a target can be localized. This is one of the key questions studies like this need to help define: how best to act on abnormal cellular findings before a visible cancer is present.

To be clear, LINFU is still investigational. We do not yet have published clinical data showing how well it performs compared with EUS, MRI/MRCP, or other screening approaches. It should not be viewed as a replacement for guideline-based surveillance at this time.

But this is exactly why research matters.

I want to especially recognize Dr. Kenneth Meredith, the local principal investigator, and the Sarasota Memorial research team for bringing this innovative study to our community. Dr. Meredith has been a strong surgical oncology leader in our region for many years, and it is encouraging to see him and the SMH team helping make this kind of forward-looking pancreatic cancer research available locally.

That kind of clinical leadership matters.

It takes vision, commitment, and a real dedication to patients to move early detection research forward, especially in a disease where the window for cure can be so narrow.

For people with a strong family history of pancreatic cancer or a known genetic risk, this is also an important reminder: talk with your physician about genetic counseling, germline testing, and appropriate high-risk surveillance.

I am genuinely encouraged to see Sarasota Memorial, Dr. Meredith, and the research team helping lead this effort here in our region.

Earlier detection could change everything.

And for pancreatic cancer, that is exactly the kind of progress we need.

Dr. Kenneth Meredith, surgical oncologist with First Physicians Group, discusses a novel screening for pancreatic cancer.

06/06/2026

The GLP-1 cancer story keeps getting more interesting.

These drugs started as diabetes medications. Then they transformed obesity treatment. Now researchers are asking a bigger question:

Could GLP-1 medications also reduce cancer risk, slow cancer progression, or even improve the effectiveness of cancer treatments?

A new Washington Post article highlights several studies presented at ASCO looking at GLP-1 drugs such as Ozempic, Wegovy, and Mounjaro in cancer prevention, progression, and survival. https://www.washingtonpost.com/health/2026/06/03/science-around-glp-1-drugs-cancer-is-suddenly-getting-lot-more-interesting/

The numbers are worth paying attention to:

* More than 40 ASCO studies, abstracts, oral presentations, and posters examined GLP-1 drugs and cancer.
* Obesity is associated with 13 different cancers.
* A University of Pennsylvania study of more than 100,000 women found GLP-1 users were about 30% less likely to develop breast cancer.
* A breast cancer analysis of more than 137,000 patients found 5-year survival of nearly 96% in GLP-1 users, compared with about 90% in similar nonusers.
* A study of 10,225 patients across seven solid tumors found GLP-1 use was associated with lower progression to stage IV disease.
* The strongest metastatic-progression signals were seen in lung, breast, colorectal, and liver cancers, with risk reductions in the range of about 31% to 50%.
* In chronic pancreatitis, GLP-1 use was associated with a more than 50% lower risk of pancreatic cancer.
* One acute myeloid leukemia analysis found a 63% lower risk among GLP-1 users.
* In metastatic colorectal cancer patients receiving immunotherapy, GLP-1 use was associated with lower mortality at 3 years, 5 years, and beyond.
* In more than 25,000 patients with metastatic non-small cell lung cancer treated with targeted therapies called TKIs, GLP-1 users had 5-year survival of 63%, compared with 40% among nonusers.
* In one lung cancer subgroup treated with ALK inhibitors, survival was reported as 85% in GLP-1 users versus 48% in nonusers.

That is a lot of signal.

But it is not proof.

Most of these studies are observational. That means they can show associations, but they cannot prove that GLP-1 drugs prevent cancer or improve cancer survival.

There is also an important caution: randomized trial data so far have not clearly proven that GLP-1 drugs reduce cancer risk. Many of those trials were not designed to study cancer outcomes and had limited follow-up, but the distinction matters.

Another nuance: some studies compare GLP-1 drugs against insulin. Since insulin itself may have cancer-promoting biology in some settings, that comparison could make GLP-1s look more favorable. When GLP-1s are compared with metformin or SGLT2 inhibitors, the advantage may be smaller or may disappear.

So no, I would not call GLP-1s cancer-prevention drugs today.

And I would not recommend them specifically to treat cancer.

But I also would not ignore this signal.

The most interesting question is whether the benefits are simply from weight loss, or whether GLP-1 drugs are doing something deeper: improving insulin resistance, lowering inflammation, altering immune signaling, changing the tumor microenvironment, or possibly making immunotherapy and targeted therapy work better.

Cancer is not only a genetic disease.

It is also influenced by metabolism, inflammation, hormones, immune function, insulin resistance, visceral fat, and the environment around the tumor.

That may be the real lesson here.

GLP-1 drugs may end up being one of the most important metabolic therapies of our time.

Not proven cancer drugs.

But absolutely worth studying.

06/06/2026

Is exercise part of your anticancer strategy?

Cancer survivors are often told to stay active, but that advice is usually too vague to be very helpful.

05/31/2026

It’s rare to see a standing ovation for a drug trial at ASCO, the world’s largest oncology meeting.

But when survival improves this much in metastatic pancreatic cancer, it deserves that kind of reaction.

This is a historic moment in the treatment of a terrible disease, and a hopeful one for patients and families who have been waiting far too long for real progress.

05/31/2026

Among patients with previously treated metastatic pancreatic ductal adenocarcinoma, treatment with daraxonrasib led to significantly longer overall survival and progression-free survival than chemotherapy. The incidence of adverse events of grade 3 or higher was higher in the chemotherapy group, which also translated into fewer patients needing to discontinue daraxonrasib.

https://www.nejm.org/doi/full/10.1056/NEJMoa2605555

05/29/2026

Clinicians know this problem too well.
Before the patient even walks into the room, we are often trying to reconstruct the story from scattered records: outside notes, pathology reports, imaging, labs, scanned PDFs, copied-forward documentation, and missing or conflicting details.
That is not just “documentation.”
That is clinical reconstruction.
And it is one of the most overlooked burdens in modern medicine.
I wrote about why the visit note often begins before the visit itself, why ambient scribes do not fully solve this problem, and why VeloNote was built to help clinicians walk in prepared.
VeloNote does not replace clinical judgment. It gives clinicians a better starting point.
Read the full post here:

The overlooked problem in clinical documentation is not just writing the note. It is reconstructing the patient story before the visit even starts.

05/25/2026

https://www.floridaweekly.com/articles/charlotte-county/dont-die-a-guide-to-optimizing-your-health/

Founding Father Benjamin Franklin famously said, “In this world, nothing is certain except death and taxes.” Nearly 250 years later, his statement still rings true. Today, though, the IRS lets taxpayers file an extension to delay paying federal income taxes beyond the deadline. What if there was...

05/22/2026

You never know the impact simple kind words may have on others…

“She stopped at a convenience store to pick up some coffee and lunch. As she shopped through the aisles, a woman approached her. Fifteen years later, Gentile still remembers what the woman said.

"She said, 'Not everybody could wear a hairstyle like that. You look fabulous.'"

Gentile was stunned. She managed to say, "Thank you," before the woman walked away. Then she went back to her car, letting the words settle.

"I sat there for a while, sort of embracing this wonderful, kind thing that this person had said to me," Gentile said.

"And it really made a turning point for me that made me feel seen, made me feel normal and gave me the courage to get to work and just get started."

When Pat Gentile began to grow out her hair after chemotherapy, she was nervous to go to work for the first time without a wig. An unexpected encounter with a convenience store stranger changed that.