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18 episodes with Alterations
Welcome to Sunday Service Wish you were here! Newsong, Colorado Springs (starts at 10:00am) Subscribe to text updates. Text the words text alert to 94000 Subscribe to emails (bottom of page on newsongcs.com) Listen to podcasts. Keywords newsong foursquare Watch services on Youtube. Keyword newsongcs Follow us on Facebook, Instagram & TikTok keyword newsongcs 3 ways to give to Missions, Disaster Relief, Tithes, or Offerings 1.. newsongcs/com/give 2. Text Giving - text the word EASY to 94000 3. Mail - P.O. Box 75818 • C.S., CO 80970
Hope you are having a lovely day! Today Ms. Caitlin has a cute kids book for you and she is very excited to read to you today! Today we have Caitlin who will be reading "The Worm Family Has its Picture Taken" by Jennifer Frank and David Ezra Stein! Do you remember getting your family photo taken?As always this book was selected from our library! Kids and Parents can read along with us, in this read aloud story time! Be sure to check out your local Library to check out what books they may have! If you prefer E-Books, sign into the Hoopla or Libby app using your Library Card and follow along from there!- Check out the Library Systems official website where you can find links to free resources, school and career guides, and news about our upcoming events! https://www.pawls.org/ -Follow us on YouTube and enjoy our backlog of digital story hours and other great content! https://www.youtube.com/@pawls365Original background track is Concerto for Two Violins by Bach.Alterations were made by us to make it fit the length of our content.Brought to you from the Pike-Amite-Walthall Library system.#library #books #pawlskids #kidsstorytime
Hello there! This idea came because I wanted to read a bit about fossils and to share how you can learn from old outdated books. So I put both ideas together, and here we are! I have planned a full six weeks of uploads EVERY DAY (except weekends) and I'm looking forward to all the dinosaur info!In my opinion, It's a little dry to be honest, but I loved this stuff as a kid and I hope someone listening enjoys it too. Plus we still have our regular content for ya'll to enjoy! - Check out the Library Systems official website where you can find links to free resources, school and career guides, and news about our upcoming events! https://www.pawls.org/ -Follow us on YouTube and enjoy our backlog of digital story hours and other great content! https://www.youtube.com/@pawls365 Original background track is The Talons Of Adventure, The Antlers Of Romance by Doctor Turtle, music from the freemusicarchive.orghttps://freemusicarchive.org/music/Doctor_Turtle/none_given_1561/Doctor_Turtle_-_You_Um_Ill_Ah1/The Talons Of Adventure, The Antlers Of Romance by Doctor Turtle is licensed under a Attribution 4.0 International License.Alterations were made by us to make it fit the length of our content.#library #books #pawlskids #kidsstorytime
Ever notice how you can respond to a bride at 11pm on a Sunday, over-deliver on every single fitting, and still feel like you're not doing enough? That's not a work ethic problem. That's a mindset problem — and this week we're digging into it.In this episode, we're talking about the thoughts that quietly run bridal alterations businesses: the "what if she doesn't book me if I raise my prices," the "I can't trust anyone else to touch my brides' gowns," the "I have to answer right now or I'll lose her." Turns out, there's data on how often those thoughts are actually true — and it's a lot less often than it feels like.In this episode, you'll learn:The 97% vs. 3% thought model for catching scarcity thinking before it runs your dayHow the "hustle loop" shows up specifically in bridal alterations and fitting businessesWhy setting clear expectations with brides (communication windows, waiting room policies, package inclusions) builds more trust, not lessThe golden rule for client communication: you're responsible for what you clearly explain, your bride is only responsible for what you told herWhy not responding instantly to an anxious bride is often the most helpful thing you can doA daily gratitude practice for shifting out of scarcity mindsetHow mindset work translates directly into pricing confidence and revenue growthMentioned in this episode:The Anxious Generation — this month's SBS Book Club pickThe Artist's Way by Julia CameronConnect with Ashley: https://theabundance.group Connect with Nadine:Check out the exclusive private podcast series, Fitting Packages 101: https://enchanting-sun-77080.myflodesk.com/privatepodcastBecome a member: https://secretsofabridalseamstresspodcast.com/membershipInstagram: https://www.instagram.com/secretsofabridalseamstress/TikTok: https://www.tiktok.com/@nadinebozemanYouTube: https://www.youtube.com/@secretsofabridalseamstress/
Glad to have you listening with us today! I wanted to continue with the discussion on the Odyssey by reading a bit from a translation of The Odyssey by Emily Wilson, but first for anyone unfamiar; There has been some interesting online discourse over The Odyssey about translation choices and such, which made me want to talk about the nature of translations and compare a few. So here we are, and this time with an actual reading! Today we will be reading one of my favorite translations of the Odyssey, with Caitlin as your reader, and reading in a simple plain prose style. Hope you enjoy.We hope you enjoy this sneak peak, and as always if you enjoy the story then we invite you to visit your local library and ask them to reserve it for you! If you can't find it at your library, then you will want to follow my Project Gutenberg guide, so please check it out to learn more!- Check out the Library Systems official website where you can find links to free resources, school and career guides, and news about our upcoming events! https://www.pawls.org/ -Follow us on YouTube and enjoy our backlog of digital story hours and other great content! https://www.youtube.com/@pawls365 Original background track is The Talons Of Adventure, The Antlers Of Romance by Doctor Turtle, music from the freemusicarchive.orghttps://freemusicarchive.org/music/Doctor_Turtle/none_given_1561/Doctor_Turtle_-_You_Um_Ill_Ah1/The Talons Of Adventure, The Antlers Of Romance by Doctor Turtle is licensed under a Attribution 4.0 International License.Alterations were made by us to make it fit the length of our content.#library #books #pawlskids #kidsstorytime
Hope you are having a lovely day! Today Ms. Caitlin has a cute kids book for you and she is very excited to read to you today! Today we have Caitlin who will be reading "It fell from the Sky" by The fan brothers! That's a big Marble! Wait..do kids know what marbles are anymore?As always this book was selected from our library! Kids and Parents can read along with us, in this read aloud story time! Be sure to check out your local Library to check out what books they may have! If you prefer E-Books, sign into the Hoopla or Libby app using your Library Card and follow along from there!- Check out the Library Systems official website where you can find links to free resources, school and career guides, and news about our upcoming events! https://www.pawls.org/ -Follow us on YouTube and enjoy our backlog of digital story hours and other great content! https://www.youtube.com/@pawls365Original background track is Concerto for Two Violins by Bach.Alterations were made by us to make it fit the length of our content.Brought to you from the Pike-Amite-Walthall Library system.#library #books #pawlskids #kidsstorytime
: In this episode of Sew & So, we're joined by Dr. Cindie Husbands, founder of the American Tailors and Sewing Association. Few people can say they've been a professional mime at SeaWorld, designed award-winning bridal veils, produced performances at Carnegie Hall, Broadway Theatre, and the Sydney Olympics, built dance studios, manufactured casino uniforms in Las Vegas, launched a company that produced antimicrobial masks during the pandemic, and then founded a national organization to transform the future of tailoring in America. But Dr. Cindie Husbands can. Every chapter of her extraordinary life has been connected by one constant—sewing. From learning to sew as a young girl to building businesses across the country, Cindie has embraced every opportunity that came her way. Today, as founder of the American Tailors and Sewing Association, she's on a mission to address the growing shortage of skilled sewists, establish professional standards for the tailoring industry, and create new pathways for people to build meaningful careers through sewing. Join us for an inspiring conversation about entrepreneurship, reinvention, and why sewing isn't just a craft—it's a skill that can truly change lives. (3:00) How did Cindie first learn to sew and who was her inspiration? (4:40) What's the first item she created and does she still have it? (4:55) Cindie takes us on a ride with her through the journey to where she is today. Hear about the now famous people she still knows from high school and why she became a mime at Sea World. Buckle-up…this is amazing! Hear about Carnage Hall, the Sydney Olympics, Alaska, Las Vegas, Casino Uniforms, Kokomo, IN, the realization that she had gone to high school with her husband and more! And in all of this…she earned her Doctorate Degree! (21:26) Hear about the performances she's produced and which are her favorites. (22:20) Cindie talks about why quilting in Alaska is so pervasive and why quilting became important to her (25:46) Her daughter Amber owns Volcano View in Homer, AK. (26:08) What sewing projects are the most meaningful to her? (28:00) Cindie talks about the disconnect in the sewing industry and why she started the American Tailors and Sewing Association. And…the dearth of standards and sewists to work for fashion companies and tailoring. (32:00) Why haven't standards and pathways been addressed until now? (34:00) There is a resurgence in the interest of tailoring…but not enough people in the workforce to do the work. She explains what can be done about it. (36:08) Have the large stores been supportive of her efforts? (37:56) What are the goals of the Association? And her vision for the future of the industry? (39:20) Learn about her plans for Mobile Sew Labs created to help people reinvent themselves. (41:00) Cindie has “sewing can be a business at almost any level”. What does she mean by this? (43:00) Americantailor.org (43:08) What's next for Cindie? (44:05) What's her dream? (44:50) Is there a question we didn't ask? (45:40) You can reach out to Cindie go to Americantailor.org. Tell her you met her on Sew & So! Be sure to subscribe to, review and rate this podcast on your favorite platform…and visit our website sewandsopodcast.com for more information about today's and all of our Guests.
Dr. Sonam Puri joins the podcast to share the update to the living guideline on stage IV NSCLC with driver alterations. Dr. Puri discusses the practice-changing evidence reviewed for both NTRK rearrangements, including the TRIDENT-1 trial, and HER2 activating mutations, including the Beamion LUNG-1 study. She shares how these results impacted the clinical practice guideline with the addition of repotrectinib and zongertinib, what these new TKIs mean for patients, and where the panel is waiting for additional randomized data to clarify the role of therapeutic options. Dr. Puri encourages listeners to stay tuned for future updates to the living guideline as new evidence is published. Read the full living guideline "Therapy for Stage IV Non-Small Cell Lung Cancer With Driver Alterations: ASCO Living Guideline, Version 2026.3.2" at www.ascopubs.org/guidelines/therapy-stage-iv-non-small-cell-lung-cancer-driver-alterations" LINK TO FULL TRANSCRIPT
Hello there! This idea came because I wanted to read a bit about fossils and to share how you can learn from old outdated books. So I put both ideas together, and here we are! I have planned a full six weeks of uploads EVERY DAY (except weekends) and I'm looking forward to all the dinosaur info!In my opinion, It's a little dry to be honest, but I loved this stuff as a kid and I hope someone listening enjoys it too. Plus we still have our regular content for ya'll to enjoy! - Check out the Library Systems official website where you can find links to free resources, school and career guides, and news about our upcoming events! https://www.pawls.org/ -Follow us on YouTube and enjoy our backlog of digital story hours and other great content! https://www.youtube.com/@pawls365 Original background track is The Talons Of Adventure, The Antlers Of Romance by Doctor Turtle, music from the freemusicarchive.orghttps://freemusicarchive.org/music/Doctor_Turtle/none_given_1561/Doctor_Turtle_-_You_Um_Ill_Ah1/The Talons Of Adventure, The Antlers Of Romance by Doctor Turtle is licensed under a Attribution 4.0 International License.Alterations were made by us to make it fit the length of our content.#library #books #pawlskids #kidsstorytime
Hello there! This idea came because I wanted to read a bit about fossils and to share how you can learn from old outdated books. So I put both ideas together, and here we are! I have planned a full six weeks of uploads EVERY DAY (except weekends) and I'm looking forward to all the dinosaur info!In my opinion, It's a little dry to be honest, but I loved this stuff as a kid and I hope someone listening enjoys it too. Plus we still have our regular content for ya'll to enjoy! - Check out the Library Systems official website where you can find links to free resources, school and career guides, and news about our upcoming events! https://www.pawls.org/ -Follow us on YouTube and enjoy our backlog of digital story hours and other great content! https://www.youtube.com/@pawls365 Original background track is The Talons Of Adventure, The Antlers Of Romance by Doctor Turtle, music from the freemusicarchive.orghttps://freemusicarchive.org/music/Doctor_Turtle/none_given_1561/Doctor_Turtle_-_You_Um_Ill_Ah1/The Talons Of Adventure, The Antlers Of Romance by Doctor Turtle is licensed under a Attribution 4.0 International License.Alterations were made by us to make it fit the length of our content.#library #books #pawlskids #kidsstorytime
Hope you are having a lovely day! Today Ms. Caitlin has a cute kids book for you and she is very excited to read to you today! Today we have Caitlin who will be reading "Waiting for Hanami" by J.P. Takahashi! The famous Sakura Bloom is beautifully illustrated in this book, you should check it out!As always this book was selected from our library! Kids and Parents can read along with us, in this read aloud story time! Be sure to check out your local Library to check out what books they may have! If you prefer E-Books, sign into the Hoopla or Libby app using your Library Card and follow along from there!- Check out the Library Systems official website where you can find links to free resources, school and career guides, and news about our upcoming events! https://www.pawls.org/ -Follow us on YouTube and enjoy our backlog of digital story hours and other great content! https://www.youtube.com/@pawls365Original background track is Concerto for Two Violins by Bach.Alterations were made by us to make it fit the length of our content.Brought to you from the Pike-Amite-Walthall Library system.#library #books #pawlskids #kidsstorytime
Hello there! This idea came because I wanted to read a bit about fossils and to share how you can learn from old outdated books. So I put both ideas together, and here we are! I have planned a full six weeks of uploads EVERY DAY (except weekends) and I'm looking forward to all the dinosaur info!In my opinion, It's a little dry to be honest, but I loved this stuff as a kid and I hope someone listening enjoys it too. Plus we still have our regular content for ya'll to enjoy! - Check out the Library Systems official website where you can find links to free resources, school and career guides, and news about our upcoming events! https://www.pawls.org/ -Follow us on YouTube and enjoy our backlog of digital story hours and other great content! https://www.youtube.com/@pawls365 Original background track is The Talons Of Adventure, The Antlers Of Romance by Doctor Turtle, music from the freemusicarchive.orghttps://freemusicarchive.org/music/Doctor_Turtle/none_given_1561/Doctor_Turtle_-_You_Um_Ill_Ah1/The Talons Of Adventure, The Antlers Of Romance by Doctor Turtle is licensed under a Attribution 4.0 International License.Alterations were made by us to make it fit the length of our content.#library #books #pawlskids #kidsstorytime
Hello there! This idea came because I wanted to read a bit about fossils and to share how you can learn from old outdated books. So I put both ideas together, and here we are! I have planned a full six weeks of uploads EVERY DAY (except weekends) and I'm looking forward to all the dinosaur info!In my opinion, It's a little dry to be honest, but I loved this stuff as a kid and I hope someone listening enjoys it too. Plus we still have our regular content for ya'll to enjoy! - Check out the Library Systems official website where you can find links to free resources, school and career guides, and news about our upcoming events! https://www.pawls.org/ -Follow us on YouTube and enjoy our backlog of digital story hours and other great content! https://www.youtube.com/@pawls365 Original background track is The Talons Of Adventure, The Antlers Of Romance by Doctor Turtle, music from the freemusicarchive.orghttps://freemusicarchive.org/music/Doctor_Turtle/none_given_1561/Doctor_Turtle_-_You_Um_Ill_Ah1/The Talons Of Adventure, The Antlers Of Romance by Doctor Turtle is licensed under a Attribution 4.0 International License.Alterations were made by us to make it fit the length of our content.#library #books #pawlskids #kidsstorytime
Glad to have you listening with us today! I wanted to continue with the discussion on the Odyssey by reading a bit from a translation of The Odyssey by Emily Wilson, but first for anyone unfamiar; There has been some interesting online discourse over The Odyssey about translation choices and such, which made me want to talk about the nature of translations and compare a few. So here we are, and this time with an actual reading! Today we will be reading one of my favorite translations of the Odyssey, with Caitlin as your reader, and reading in a simple plain prose style. Hope you enjoy.We hope you enjoy this sneak peak, and as always if you enjoy the story then we invite you to visit your local library and ask them to reserve it for you! If you can't find it at your library, then you will want to follow my Project Gutenberg guide, so please check it out to learn more!- Check out the Library Systems official website where you can find links to free resources, school and career guides, and news about our upcoming events! https://www.pawls.org/ -Follow us on YouTube and enjoy our backlog of digital story hours and other great content! https://www.youtube.com/@pawls365 Original background track is The Talons Of Adventure, The Antlers Of Romance by Doctor Turtle, music from the freemusicarchive.orghttps://freemusicarchive.org/music/Doctor_Turtle/none_given_1561/Doctor_Turtle_-_You_Um_Ill_Ah1/The Talons Of Adventure, The Antlers Of Romance by Doctor Turtle is licensed under a Attribution 4.0 International License.Alterations were made by us to make it fit the length of our content.#library #books #pawlskids #kidsstorytime
The conversation comes full circle. In the final chapter of this Sports Cards Live discussion, Jeremy Lee, David Chase, Joe Poirot, and Josh Adams reflect on the broader implications of the reconstructed T206 Honus Wagner and what it may mean for the future of sports card collecting. The panel discusses whether restoration will become more accepted, how collectors should think about exceptions, where personal collecting philosophies differ from hobby standards, and why context matters when evaluating altered or restored cards. The episode also includes a fun conversation about LeBron James, player legacies, and whether changing teams affects a superstar's long-term collectibility. In this episode: Has the hobby reached a tipping point on restoration? Can collectors make exceptions for iconic cards? Personal collecting rules vs. hobby standards Does intent matter when a card is altered? Could the FrankenWagner change collecting forever? LeBron James, team loyalty, and hobby legacy Final thoughts from the panel Looking ahead to The National Thank you for listening to Sports Cards Live. If you enjoyed this episode, please help us grow the hobby by supporting the show:
Hope you are having a lovely day! Today Ms. Caitlin has a cute kids book for you and she is very excited to read to you today! Today we have Caitlin who will be reading "Daisy Dinosaur gets lost" by Steve Smallman! Would you let Daisy hang out with you?As always this book was selected from our library! Kids and Parents can read along with us, in this read aloud story time! Be sure to check out your local Library to check out what books they may have! If you prefer E-Books, sign into the Hoopla or Libby app using your Library Card and follow along from there!- Check out the Library Systems official website where you can find links to free resources, school and career guides, and news about our upcoming events! https://www.pawls.org/ -Follow us on YouTube and enjoy our backlog of digital story hours and other great content! https://www.youtube.com/@pawls365Original background track is Concerto for Two Violins by Bach.Alterations were made by us to make it fit the length of our content.Brought to you from the Pike-Amite-Walthall Library system.#library #books #pawlskids #kidsstorytime
Hope you are having a lovely day! Today Ms. Caitlin has a cute kids book for you and she is very excited to read to you today! Today we have Caitlin who will be reading "Penelope Rex and the problem with pets" by Ryan T. Higgins! A very cute illustrated book with a little Trex and a SabercatAs always this book was selected from our library! Kids and Parents can read along with us, in this read aloud story time! Be sure to check out your local Library to check out what books they may have! If you prefer E-Books, sign into the Hoopla or Libby app using your Library Card and follow along from there!- Check out the Library Systems official website where you can find links to free resources, school and career guides, and news about our upcoming events! https://www.pawls.org/ -Follow us on YouTube and enjoy our backlog of digital story hours and other great content! https://www.youtube.com/@pawls365Original background track is Concerto for Two Violins by Bach.Alterations were made by us to make it fit the length of our content.Brought to you from the Pike-Amite-Walthall Library system.#library #books #pawlskids #kidsstorytime
Hello there! This idea came because I wanted to read a bit about fossils and to share how you can learn from old outdated books. So I put both ideas together, and here we are! I have planned a full six weeks of uploads EVERY DAY (except weekends) and I'm looking forward to all the dinosaur info!In my opinion, It's a little dry to be honest, but I loved this stuff as a kid and I hope someone listening enjoys it too. Plus we still have our regular content for ya'll to enjoy! - Check out the Library Systems official website where you can find links to free resources, school and career guides, and news about our upcoming events! https://www.pawls.org/ -Follow us on YouTube and enjoy our backlog of digital story hours and other great content! https://www.youtube.com/@pawls365 Original background track is The Talons Of Adventure, The Antlers Of Romance by Doctor Turtle, music from the freemusicarchive.orghttps://freemusicarchive.org/music/Doctor_Turtle/none_given_1561/Doctor_Turtle_-_You_Um_Ill_Ah1/The Talons Of Adventure, The Antlers Of Romance by Doctor Turtle is licensed under a Attribution 4.0 International License.Alterations were made by us to make it fit the length of our content.#library #books #pawlskids #kidsstorytime
This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME/NCPD/AAPA information, and to apply for credit, please visit us at PeerView.com/EXH865. CME/NCPD/AAPA credit will be available until June 15, 2027.Mastering the Breakthroughs in HER2-Mutant NSCLC: Decoding Alterations, Refining Treatment, and Empowering Patients In support of improving patient care, this activity has been planned and implemented by PVI, PeerView Institute for Medical Education, and LUNGevity Foundation. PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an independent medical educational grant from Boehringer Ingelheim Pharmaceuticals, Inc.Disclosure information is available at the beginning of the video presentation.
This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME/NCPD/AAPA information, and to apply for credit, please visit us at PeerView.com/EXH865. CME/NCPD/AAPA credit will be available until June 15, 2027.Mastering the Breakthroughs in HER2-Mutant NSCLC: Decoding Alterations, Refining Treatment, and Empowering Patients In support of improving patient care, this activity has been planned and implemented by PVI, PeerView Institute for Medical Education, and LUNGevity Foundation. PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an independent medical educational grant from Boehringer Ingelheim Pharmaceuticals, Inc.Disclosure information is available at the beginning of the video presentation.
This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME/NCPD/AAPA information, and to apply for credit, please visit us at PeerView.com/EXH865. CME/NCPD/AAPA credit will be available until June 15, 2027.Mastering the Breakthroughs in HER2-Mutant NSCLC: Decoding Alterations, Refining Treatment, and Empowering Patients In support of improving patient care, this activity has been planned and implemented by PVI, PeerView Institute for Medical Education, and LUNGevity Foundation. PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an independent medical educational grant from Boehringer Ingelheim Pharmaceuticals, Inc.Disclosure information is available at the beginning of the video presentation.
This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME/NCPD/AAPA information, and to apply for credit, please visit us at PeerView.com/EXH865. CME/NCPD/AAPA credit will be available until June 15, 2027.Mastering the Breakthroughs in HER2-Mutant NSCLC: Decoding Alterations, Refining Treatment, and Empowering Patients In support of improving patient care, this activity has been planned and implemented by PVI, PeerView Institute for Medical Education, and LUNGevity Foundation. PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an independent medical educational grant from Boehringer Ingelheim Pharmaceuticals, Inc.Disclosure information is available at the beginning of the video presentation.
This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME/NCPD/AAPA information, and to apply for credit, please visit us at PeerView.com/EXH865. CME/NCPD/AAPA credit will be available until June 15, 2027.Mastering the Breakthroughs in HER2-Mutant NSCLC: Decoding Alterations, Refining Treatment, and Empowering Patients In support of improving patient care, this activity has been planned and implemented by PVI, PeerView Institute for Medical Education, and LUNGevity Foundation. PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an independent medical educational grant from Boehringer Ingelheim Pharmaceuticals, Inc.Disclosure information is available at the beginning of the video presentation.
This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME/NCPD/AAPA information, and to apply for credit, please visit us at PeerView.com/EXH865. CME/NCPD/AAPA credit will be available until June 15, 2027.Mastering the Breakthroughs in HER2-Mutant NSCLC: Decoding Alterations, Refining Treatment, and Empowering Patients In support of improving patient care, this activity has been planned and implemented by PVI, PeerView Institute for Medical Education, and LUNGevity Foundation. PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an independent medical educational grant from Boehringer Ingelheim Pharmaceuticals, Inc.Disclosure information is available at the beginning of the video presentation.
Hello there! This idea came because I wanted to read a bit about fossils and to share how you can learn from old outdated books. So I put both ideas together, and here we are! I have planned a full six weeks of uploads EVERY DAY (except weekends) and I'm looking forward to all the dinosaur info!In my opinion, It's a little dry to be honest, but I loved this stuff as a kid and I hope someone listening enjoys it too. Plus we still have our regular content for ya'll to enjoy! - Check out the Library Systems official website where you can find links to free resources, school and career guides, and news about our upcoming events! https://www.pawls.org/ -Follow us on YouTube and enjoy our backlog of digital story hours and other great content! https://www.youtube.com/@pawls365 Original background track is The Talons Of Adventure, The Antlers Of Romance by Doctor Turtle, music from the freemusicarchive.orghttps://freemusicarchive.org/music/Doctor_Turtle/none_given_1561/Doctor_Turtle_-_You_Um_Ill_Ah1/The Talons Of Adventure, The Antlers Of Romance by Doctor Turtle is licensed under a Attribution 4.0 International License.Alterations were made by us to make it fit the length of our content.#library #books #pawlskids #kidsstorytime
Hello there! This idea came because I wanted to read a bit about fossils and to share how you can learn from old outdated books. So I put both ideas together, and here we are! I have planned a full six weeks of uploads EVERY DAY (except weekends) and I'm looking forward to all the dinosaur info!In my opinion, It's a little dry to be honest, but I loved this stuff as a kid and I hope someone listening enjoys it too. Plus we still have our regular content for ya'll to enjoy! - Check out the Library Systems official website where you can find links to free resources, school and career guides, and news about our upcoming events! https://www.pawls.org/ -Follow us on YouTube and enjoy our backlog of digital story hours and other great content! https://www.youtube.com/@pawls365 Original background track is The Talons Of Adventure, The Antlers Of Romance by Doctor Turtle, music from the freemusicarchive.orghttps://freemusicarchive.org/music/Doctor_Turtle/none_given_1561/Doctor_Turtle_-_You_Um_Ill_Ah1/The Talons Of Adventure, The Antlers Of Romance by Doctor Turtle is licensed under a Attribution 4.0 International License.Alterations were made by us to make it fit the length of our content.#library #books #pawlskids #kidsstorytime
Hope you are having a lovely day! Today Ms. Caitlin has a cute kids book for you and she is very excited to read to you today! Today we have Caitlin who will be reading "How dinosaurs went extinct" by Ame Dyckman! A totally real true story about the real extinction of the dinosaurs!As always this book was selected from our library! Kids and Parents can read along with us, in this read aloud story time! Be sure to check out your local Library to check out what books they may have! If you prefer E-Books, sign into the Hoopla or Libby app using your Library Card and follow along from there!- Check out the Library Systems official website where you can find links to free resources, school and career guides, and news about our upcoming events! https://www.pawls.org/ -Follow us on YouTube and enjoy our backlog of digital story hours and other great content! https://www.youtube.com/@pawls365Original background track is Concerto for Two Violins by Bach.Alterations were made by us to make it fit the length of our content.Brought to you from the Pike-Amite-Walthall Library system.#library #books #pawlskids #kidsstorytime
HER Style Podcast | Buy Less, Shop Smarter, Build a Wardrobe You Love
Have you ever walked through a store and thought, "Wait. Who is this actually for?" It can feel like everything is made for someone else. Someone taller. Younger. Trendier. Maybe someone with a completely different body type or lifestyle than yours. After a while, it's easy to start believing that fashion just isn't for you anymore, or that you'll have to settle for clothes you don't really love. But before you give up on shopping altogether, I want to offer a different perspective. Because in today's episode, we're talking about why this happens, why shopping can start to feel so discouraging, and what to do when it feels like nothing in stores reflects your style. The goal is to help you build a wardrobe you actually love without lowering your standards or settling. So don't give up, friend! We're about to make shopping way easier and more empowering than ever. FREE 5-MIN PERSONAL STYLE QUIZ: https://herstylellc.com/quiz HER STYLE ON INSTAGRAM: https://www.instagram.com/heatherriggsstyle/ JOIN THE WAITLIST FOR HER STYLE COLLECTIVE: https://herstylellc.com/collective Related Episodes: 297 – The Women's Clothing Stores I'm Loving Right Now (and How to Find Your New Favorite Brands) 118 – Struggling with Negative Self-Talk? Make This One Simple Mindset Shift to Improve Your Body Image 104 – Alterations 101: What's Possible, How Much It Costs, and Where To Find a Good Tailor 7 – How To Shop If You Hate The Current Trends
Hello there! This idea came because I wanted to read a bit about fossils and to share how you can learn from old outdated books. So I put both ideas together, and here we are! I have planned a full six weeks of uploads EVERY DAY (except weekends) and I'm looking forward to all the dinosaur info!In my opinion, It's a little dry to be honest, but I loved this stuff as a kid and I hope someone listening enjoys it too. Plus we still have our regular content for ya'll to enjoy! - Check out the Library Systems official website where you can find links to free resources, school and career guides, and news about our upcoming events! https://www.pawls.org/ -Follow us on YouTube and enjoy our backlog of digital story hours and other great content! https://www.youtube.com/@pawls365 Original background track is The Talons Of Adventure, The Antlers Of Romance by Doctor Turtle, music from the freemusicarchive.orghttps://freemusicarchive.org/music/Doctor_Turtle/none_given_1561/Doctor_Turtle_-_You_Um_Ill_Ah1/The Talons Of Adventure, The Antlers Of Romance by Doctor Turtle is licensed under a Attribution 4.0 International License.Alterations were made by us to make it fit the length of our content.#library #books #pawlskids #kidsstorytime
Hello there! This idea came because I wanted to read a bit about fossils and to share how you can learn from old outdated books. So I put both ideas together, and here we are! I have planned a full six weeks of uploads EVERY DAY (except weekends) and I'm looking forward to all the dinosaur info!In my opinion, It's a little dry to be honest, but I loved this stuff as a kid and I hope someone listening enjoys it too. Plus we still have our regular content for ya'll to enjoy! - Check out the Library Systems official website where you can find links to free resources, school and career guides, and news about our upcoming events! https://www.pawls.org/ -Follow us on YouTube and enjoy our backlog of digital story hours and other great content! https://www.youtube.com/@pawls365 Original background track is The Talons Of Adventure, The Antlers Of Romance by Doctor Turtle, music from the freemusicarchive.orghttps://freemusicarchive.org/music/Doctor_Turtle/none_given_1561/Doctor_Turtle_-_You_Um_Ill_Ah1/The Talons Of Adventure, The Antlers Of Romance by Doctor Turtle is licensed under a Attribution 4.0 International License.Alterations were made by us to make it fit the length of our content.#library #books #pawlskids #kidsstorytime
Hope you are having a lovely day! Today Ms. Caitlin has a cute kids book for you and she is very excited to read to you today! Today we have Caitlin who will be reading "Tiny TRex and the First day Oopsies" by Stuszman! A charming book with illustrations of a super cute trex and their friends!As always this book was selected from our library! Kids and Parents can read along with us, in this read aloud story time! Be sure to check out your local Library to check out what books they may have! If you prefer E-Books, sign into the Hoopla or Libby app using your Library Card and follow along from there!- Check out the Library Systems official website where you can find links to free resources, school and career guides, and news about our upcoming events! https://www.pawls.org/ -Follow us on YouTube and enjoy our backlog of digital story hours and other great content! https://www.youtube.com/@pawls365Original background track is Concerto for Two Violins by Bach.Alterations were made by us to make it fit the length of our content.Brought to you from the Pike-Amite-Walthall Library system.#library #books #pawlskids #kidsstorytime
Dr. Beckett compares grilling and steak grading to sports card grading, noting that both rely on labels and subjective “eye appeal” but can still disappoint. He explains how chefs and buyers judge ingredients by sight, how steaks are graded (prime/choice) yet may not taste like their grade, and how it's hard to “return the evidence” after eating. Comparing a cheaper USDA prime New York strip from Tom Thumb versus his usual Central Market purchase, he felt the steak tasted about a full grade lower despite looking similar. Beckett discusses trust in grading within limits, consistency, batch rhythm, pricing differences by venue, and parallels to card alteration and the need for truthful labeling, concluding that grading matters but isn't perfect and that collectors gravitate to trusted graders. 00:44 Foodie Grilling Mindset 00:57 Steak Grading Meets Cards 01:58 Sending Back Mistakes 02:48 Bargain Prime Experiment 06:23 Subjective Value and Trust 08:53 How Graders Get Rhythms 10:12 Mint to Black Label Steaks 10:50 Alterations and Disclosure
HER Style Podcast | Buy Less, Shop Smarter, Build a Wardrobe You Love
Have you ever tried something on and bought it just because it fit? Maybe part of you knew the color wasn't quite right or it wasn't the exact thing you were hoping to find. But you couldn't bring yourself to keep up the search? Or you genuinely didn't have time to keep looking? Often, those are the pieces that end up sitting in your closet for months because even though it technically fit your figure, it didn't fit your life, your style, or the way you wanted to feel. If you've ever struggled with that, then today's episode is for you. We're going to talk about why fit is only one piece of the style puzzle, the seven things that matter just as much as fit when you're evaluating clothes, why so many women settle for "good enough" pieces, and how to know whether something is truly worth bringing home. Because if your goal is to build a wardrobe you genuinely love, then you cannot let fit alone be the final say. You can do so much better than that, my friend. And in this episode, we're raising the bar and equipping you to stop settling and start making smarter buying decisions. So go refill your mug and settle in. I can't wait for you to hear this one. FREE 5-MIN PERSONAL STYLE QUIZ: https://herstylellc.com/quiz HER STYLE ON INSTAGRAM: https://www.instagram.com/heatherriggsstyle/ JOIN THE WAITLIST FOR HER STYLE COLLECTIVE: https://herstylellc.com/collective Related Episodes: 286 – Shopping for Your Real Life (Not the Fantasy One in Your Head) 129 – Which Style Foundation Is the MOST Important? The Style, Fit, and Color Debate! 104 – Alterations 101: What's Possible, How Much It Costs, and Where To Find a Good Tailor
Dr. Lyudmila Bazhenova joins the podcast to share the update to the living guideline on stage IV NSCLC without driver alterations. Dr. Bazhenova discusses the evidence reviewed for both non-squamous NSCLC, including the POD1IM-304 and BAP BRAIN trials, and squamous cell NSCLC, including the HARMONi-6 trial. She shares how these results impacted the clinical practice guideline, what they mean for patients receiving immunotherapy and chemotherapy, and where the panel is waiting for additional evidence to clarify the role of therapeutic options. Dr. Bazhenova encourages listeners to stay tuned for future updates to the living guideline after publication of data from the 2026 ASCO Annual Meeting. Read the full living guideline "Therapy for Stage IV Non-Small Cell Lung Cancer without Driver Alterations, ASCO Living Guideline Version 2026.3.1" LINK TO FULL TRANSCRIPT
Dr. Joshua Reuss returns to the podcast to discuss the update to the living guideline on stage IV NSCLC with driver alterations. The conversation focuses on new cancer treatment strategies for patients with advanced NSCLC and EGFR mutations, including classical EGFR alterations (exon 19 deletions, exon 21 L858R substitution) and rarer alterations (exon 20 insertion mutations). Dr. Reuss discusses results from clinical trials, including MARIPOSA and CHRYSALIS-2 and how these impacted first-line and subsequent line treatment recommendations. He looks to the future on what new evidence and potential updates are in the pipeline for this living guideline. Read the full living guideline "Therapy for Stage IV Non-Small Cell Lung Cancer with Driver Alterations, ASCO Living Guideline Version 2026.3.1" LINK TO FULL TRANSCRIPT
In this Supplement Ingredient Series episode, Nurse Doza breaks down glutathione — the master antioxidant your liver makes to fight inflammation, detox your body, and protect your brain. With roughly 1 in 4 people worldwide carrying a fatty liver, most are running on low reserves. Learn why glutathione is non-negotiable for energy, performance, and recovery — plus how to get your own vial to use at home. Featured Partner: SHED SHED delivers practitioner-grade glutathione in a vial you can use at home — the same master antioxidant Nurse Doza has administered through thousands of injections and IVs in clinical practice. Because the liver's ability to produce glutathione drops when it's fatty, inflamed, or overworked, supplementing directly is often the fastest way to restore energy, mental clarity, and detoxification pathways — exactly the mechanism discussed in this episode.
On this Make A Difference Minute, you'll hear a simple but powerful reminder from Cynthia Jones, who is battling cancer. In the middle of her fight, she shares what matters most now. Every day is precious. Take a moment to listen, reflect, and consider how you can support her journey. This MADM is brought to you by CoraNation Tailoring & Alterations, proudly supporting stories and the people who make our communities strong. Real stories. Real people. Real impact. News That Unites!™️
On this Monday edition of Sid & Friends in the Morning, Sid recaps yesterday's Sunday afternoon action at Augusta National Golf Club down in Georgia, where Rory McIlroy secured his second consecutive Green Jacket, winning the 2026 Masters Tournament at twelve under par. In other news of the day, Mayor Mamdani celebrates his first 100 days in office, Eric Swalwell suspends his run for California Governor after multiple sexual assault allegations get tossed his way, and President Trump announces that he'll be taking the initiative in the Strait of Hormuz with a blockade taking effect this morning. Bruce Blakeman, Craig Carton, Darryl Strawberry, Ellie Cohanim, Joe Hathaway, John Catsimatidis & Randy Fine join Sid on this Monday installment of Sid & Friends in the Morning. Learn more about your ad choices. Visit megaphone.fm/adchoices
On this Make A Difference Minute, I'm joined by Dr. George Ackerman, founder of Together for Sharon, a movement created in memory of his mother, Sharon, who lost her battle with Parkinson's disease. One of the biggest misconceptions about Parkinson's is that it only affects the elderly. The reality is, it doesn't discriminate. People are being diagnosed younger than ever, even in their 20s. George shares what families face that often goes unseen, and why awareness matters now more than ever. From personal loss to a global mission, his message is clear. The more we come together, the closer we get to stopping this disease. This MADM is brought to you by CoraNation Tailoring & Alterations, proudly supporting stories and the people who make our communities strong. Real stories. Real people. Real impact. News That Unites!™️
What does it really take to build a thriving bridal alterations business from the ground up? In this episode, Nadine sits down with Rachel Natali of Change of a Dress Alterations who shares how she went from bartending and working multiple side jobs to hitting six figures and buying her dream home—all in just a few years.Rachel opens up about the wins, the hard moments, and the mindset shifts that changed everything. If you've ever wondered when it's time to take the leap, how to charge what you're worth, or how to grow without losing yourself in the process, this episode is for you. In this episode:How Rachel discovered bridal alterations through a chance encounter What she learned from working for someone else before going solo—the good, the bad, and what NOT to doThe brave decision to start a business in a brand new state where she knew absolutely no oneHow to know when it's actually time to take the leap and quit your side jobsThe real story of hiring help when you're scared you can't afford it (spoiler: you probably can)Money mindset shifts: why being money-motivated isn't greedy—it's empoweringWhat it really took to hit six figures as a bridal seamstress Why you should never feel bad about charging what you're worthThe offer Rachel turned down (and why working in-house for a bridal shop isn't always the dream it seems)How to set boundaries with bridal shops while still maintaining great relationshipsRachel's next chapter: hiring a team, paying off debt, and living life on her own termsConnect with Rachel: Website: https://changeofadressalterations.com/Instagram: https://www.instagram.com/changeofadressalterations/ Connect with Nadine:Check out the exclusive private podcast series, Fitting Packages 101: https://enchanting-sun-77080.myflodesk.com/privatepodcastBecome a member: https://secretsofabridalseamstresspodcast.com/membershipInstagram: https://www.instagram.com/secretsofabridalseamstress/TikTok: https://www.tiktok.com/@nadinebozemanYouTube: https://www.youtube.com/@secretsofabridalseamstress
Today on the 5: The newest release of DLSS has generated a lot of discussion, and with very good reason. DLSS5 crosses an important line by opening the door to changing the nature of graphics in video games that could easily have a significant impact on how players react to them. This is exactly the thing that many people have been concerned would happen, and they're clearly not happy about it.
Our brains are engines of imagination—an “idea organ” that has transformed both our species and the planet. Genevieve Konopka, Chair of the Department of Neurobiology in the David Geffen School of Medicine at UCLA, asks how genes drive the development of the cell types that build the human brain and give rise to cognition, and how cognitive behavior emerges from evolutionarily adapted genomic programs. Because the human brain is comprised of heterogenous cell types, she examines gene expression patterns and chromatin states within specific cell types to gain insights into brain evolution and the development of cognitive disorders. Using single cell genomics to compare human and nonhuman primate brains, her work uncovers human brain innovations, including changes in the proportions of immature oligodendrocytes in the neocortex. She recapitulates this result in vitro using stem cell derived models from humans and nonhuman primates, highlighting the intersection of cellular genomics with brain evolution and function. Series: "CARTA - Center for Academic Research and Training in Anthropogeny" [Science] [Show ID: 41298]
Our brains are engines of imagination—an “idea organ” that has transformed both our species and the planet. Genevieve Konopka, Chair of the Department of Neurobiology in the David Geffen School of Medicine at UCLA, asks how genes drive the development of the cell types that build the human brain and give rise to cognition, and how cognitive behavior emerges from evolutionarily adapted genomic programs. Because the human brain is comprised of heterogenous cell types, she examines gene expression patterns and chromatin states within specific cell types to gain insights into brain evolution and the development of cognitive disorders. Using single cell genomics to compare human and nonhuman primate brains, her work uncovers human brain innovations, including changes in the proportions of immature oligodendrocytes in the neocortex. She recapitulates this result in vitro using stem cell derived models from humans and nonhuman primates, highlighting the intersection of cellular genomics with brain evolution and function. Series: "CARTA - Center for Academic Research and Training in Anthropogeny" [Science] [Show ID: 41298]
SummaryThis episode features a lively panel discussion on healthcare documentation, compliance risks, and best practices. The experts share insights on managing documentation delays, metadata analysis, contract oversight, and the impact of AI in healthcare record-keeping.key topicsRisks of documentation modificationMetadata analysis in auditsContract oversight and complianceAI in healthcare documentationTakeawaysAltering original medical records can escalate legal issues.Metadata analysis is crucial in fraud detection.Effective contract management prevents costly mistakes.AI in documentation requires careful oversight.
On this Make A Difference Minute, 17-year-old business owner Elli Tomlin of Elli Beans Coffee in Rogersville shares what entrepreneurship has taught her about leadership and self-discipline. From early mornings to real responsibility, Elli talks about the habits, mindset, and accountability it takes to run a business while still in high school. Her perspective is a reminder that leadership is not about age. It is about ownership, consistency, and showing up when it matters. Sponsor: CoraNation Tailoring & Alterations
On this MADM, Josey Trawick shares a little bit about himself as he battles chronic myelogenous leukemia, vision loss, Meniere's Disease, and multiple mental health challenges that have left him unable to work. Listen & share. Donate: gofundme.com/support-josey-trawicks-journey-to-stability Sponsor: CoraNation Tailoring & Alterations
On this Make A Difference Minute, I'm reminding listeners that one of the most meaningful things we can do is let people know they are not alone. Many carry silent burdens and feel unseen, even while surrounded by others. This segment encourages presence, compassion, and small acts of connection that can make a lasting difference. Sponsor: CoraNation Tailoring & Alterations
On this Make A Difference Minute, Chambers Ricketts shares a father's perspective after bringing his son, Ethan, home following his diagnosis of Polymicrogyria (PMG). Sponsor: CoraNation Tailoring & Alterations
Dr. Joshua Reuss is back on the podcast to discuss the full update to the living guideline on stage IV NSCLC without driver alterations. He discusses the new evidence and how this impacts the latest recommendations on first-line and subsequent therapeutic options. Dr. Reuss emphasizes the need for shared decision-making between clinicians and patients. He shares ongoing research that the panel will review in the future for further updates to this living guideline, and puts the updated recommendations into context for clinicians treating patients with stage IV NSCLC. Read the full living guideline update "Therapy for Stage IV Non-Small Cell Lung Cancer Without Driver Alterations: ASCO Living Guideline, Version 2026.3.0" at www.asco.org/thoracic-cancer-guidelines" TRANSCRIPT This guideline, clinical tools and resources are available at www.asco.org/thoracic-cancer-guidelines. Read the full text of the guideline and review authors' disclosures of potential conflicts of interest in the Journal of Clinical Oncology, https://ascopubs.org/doi/10.1200/JCO-25-02825 Brittany Harvey: Hello and welcome to the ASCO Guidelines podcast, one of ASCO's podcasts delivering timely information to keep you up to date on the latest changes, challenges, and advances in oncology. You can find all the shows, including this one, at asco.org/podcasts. My name is Brittany Harvey, and today I am interviewing Dr. Joshua Reuss from Georgetown University, co-chair on "Therapy for Stage IV Non-Small Cell Lung Cancer Without Driver Alterations: ASCO Living Guideline, Version 2026.3.0." It is great to have you back on the show today, Dr. Reuss. Dr. Joshua Reuss: Happy to be here, Brittany. Brittany Harvey: Just before we discuss this guideline, I would like to note that ASCO takes great care in the development of its guidelines and ensuring that the ASCO Conflict of Interest Policy is followed for each guideline. The disclosures of potential conflicts of interest for the guideline panel, including Dr. Reuss who has joined us here today, are available online with the publication of the guideline in the Journal of Clinical Oncology, which is linked in the show notes. Dr. Reuss, this living clinical practice guideline for systemic therapy for patients with stage IV non-small cell lung cancer without driver alterations is updated on an ongoing basis. So, what prompted this latest update to the recommendations? Dr. Joshua Reuss: Our committee is tasked with making routine updates to the living guidelines and really keeping them living, right? So, evaluating new data as it is coming in to see, is this practice changing? Is this data that should inform and potentially alter our guideline recommendations so that practitioners and other care providers could really make the best treatment decisions for their patients? So that is something that happens on a more routine basis, but periodically, we are tasked with performing a more comprehensive update of our guideline where we really evaluate every one of our point recommendations, the data associated with these recommendations, to be sure that these are up to date, these are comprehensive, and to see if we need to alter anything in the language of these updates. Brittany Harvey: Excellent. Thank you for providing that background. And yes, this is truly a comprehensive update that goes through all the latest literature. Given that, I would like to review what has changed and what is new in the recommendations. So, what are the updated recommendations on first-line therapy for patients with stage IV non-small cell lung cancer without driver alterations? Dr. Joshua Reuss: So there are two main guidelines that we recommend from this panel. One is a driver mutation-positive guideline and the other is a driver mutation-negative guideline. And I think on first blush, one might look at kind of the recent flurry of approvals and new data and say, well, all the excitement, you know, is in the driver mutation-positive guideline. But I would say that the driver mutation-negative guideline is equally as important and really has several unique challenges associated with it. You know, first and foremost is that there are really a multitude of regimens that can be considered for any one patient. And how to choose between one can be quite difficult and a stressful challenge that clinicians can have, particularly since there are really no randomized studies comparing these regimens in a head-to-head fashion. In addition, you know, these guidelines are really broken down by two key factors. One is disease histology, so namely squamous versus non-squamous histology. And the other is PD-L1 status, broken down into one of three tertiles: PD-L1 high, which is greater than or equal to 50% expression; PD-L1 low, which is 1% to 49% expression; and then PD-L1 negative or unknown. So what you are really looking at, if you do that math, is really six unique patient subpopulations where we need to make a recommendation on one of the multitude of treatment regimens that is approved. And what that means is you are oftentimes really looking at subset and sub-subset level data to help inform clinicians in their treatment decision making, which can be quite challenging because as those small subsets of data is more and more parsed, there are many confounders that can be interjected there. And so I think the committee is tasked with really quite a challenge in terms of how to really communicate and broadcast that data in a way that informs clinicians in making a decision on what is the right treatment for their patient. Brittany Harvey: Absolutely. It can be challenging to interpret that subgroup data across several different studies that are reporting on different regimens and different outcomes. And I appreciate you mentioning the driver mutation-positive guideline as well. Listeners can check out the companion episode with Dr. Puri for more information on what is changed in the driver mutation-positive guideline. Based on that primer, what is new for first-line therapy for patients with stage IV non-small cell lung cancer without driver alterations? Dr. Joshua Reuss: Even though I will say there is not a lot of new trial data that was incorporated into this guideline, there were some updates and just some meaningful long-term data that we incorporated. I think first and foremost, there is a new top-level recommendation in this guideline pertaining to molecular testing, which is absolutely critical in both the driver mutation-positive and driver mutation-negative space. I think we tend to think that, oh, well, molecular testing really only pertains to then finding a driver mutation. But the lack of a mutation is absolutely critical as well, right? Because that is what leads us down the mutation-negative pathway. We also need this molecular testing to assess PD-L1 status. We are seeing emerging data on molecular mutations that might confer resistance to certain immunotherapy-based strategies. So the committee felt strongly that a recommendation on molecular testing is critical to include in both the driver mutation-positive guideline and the driver mutation-negative guideline. I will also say that we are now seeing five and six-year updates from some of the landmark trials of immunotherapy in driver mutation-negative non-small cell lung cancer. It is really incredible to see that in some of these trials, we are seeing very impressive durability of the treatment in the patient subsets that we are commenting on. In others, perhaps that durability is less clear, and I think that leads to challenges in making a recommendation on any one particular regimen. And I think that is nowhere more clear than in the squamous subset. I think that was one perhaps subtle change that is in this guideline where, particularly in the PD-L1 negative squamous population, the committee felt that no one regimen really was worthy of standing above the others. Sometimes I think it is important to really champion one unique regimen if we feel that the data is there to support it. But I think it is equally important to list multiple regimens where the data is less clear. I think another point is that while perhaps there were no new regimens that we have added or that led to other clear changes in the prioritization of one regimen over another, there are other unique data subsets that I think come into play in making a decision and that really are important when looking at the discussion on any one recommendation from this guideline. For example, we know there is emerging data on perhaps the significance of molecular alterations in KEAP1 or STK11 and how that might influence frontline decision-making. You know, there is not a prospective phase III trial in this population, but I think we still need to use that data in certain scenarios to make recommendations for a particular patient. Another example of a trial that, again, did not change our recommendations, but I think one can incorporate in their decision making is the KEYNOTE-598 trial. Now, this is not a new study, but what it studied was pembrolizumab versus pembrolizumab plus ipilimumab in a PD-L1 high subset, and found that the addition of ipilimumab to pembrolizumab in the PD-L1 high population did not significantly improve clinical efficacy. And so while pembrolizumab plus ipilimumab is not an approved regimen, it is hard to extrapolate that to our combination treatments that are approved. I think some clinicians might find that data valuable when making a frontline treatment decision on a patient who has PD-L1 high status. So a bit of a whirlwind tour, but I think there are still multiple factors that went into this guideline that are important to review when making treatment decisions for any one patient. Brittany Harvey: Absolutely. I think what you just mentioned in having that upfront molecular testing is really key for individualized patient care. And the evidence summaries that you provide in addition to the recommendations are really important for clinicians to be able to refer to as they are making decisions in their clinic. So then beyond those changes for first-line therapy, what is updated for second-line and subsequent therapies? Dr. Joshua Reuss: For second-line and subsequent therapies, we did see one new treatment recommendation join these ranks, and that was telisotuzumab vedotin. Telisotuzumab vedotin, quite a mouthful. That is an antibody-drug conjugate. I like to think of that as smart chemotherapy, targeted chemotherapy, where you are trying to utilize some aspect of a marker that is selectively expressed or overexpressed on the cancer surface to then shepherd in the anticancer molecule, a highly potent chemotherapeutic in the case of currently approved antibody-drug conjugates, to exert antitumor killing effect. So in this case, the antibody-drug conjugate telisotuzumab vedotin targets MET overexpression. So telisotuzumab is an antibody targeting MET, and that is conjugated to an MMAE highly potent chemotherapeutic payload called vedotin. So we know MET can be selectively expressed and overexpressed in non-small cell lung cancer in both driver mutation-positive and mutation-negative subsets. The data that led to this approval was from the phase II LUMINOSITY trial which evaluated telisotuzumab vedotin, or Teliso-V, in many subsets. But the subset that really showed promise and was expanded was the EGFR wild-type, non-squamous, non-small cell lung cancer population with MET overexpression. And so in 78 patients with high levels of expression, the response rate here was 34.6%, median progression-free survival of 5.5 months, and a median overall survival of 14.6 months. With an overall acceptable safety profile; grade 3 or higher adverse events, neuropathy was perhaps the most common at 7%, also increased ALT at 3.5%, and pneumonitis at 2.9%. Now this was phase II data that led to an accelerated approval. There is an ongoing phase III study randomizing patients with high expression to Teliso-V versus docetaxel. That is the phase III TeliMET study. But it is nice that we now have another option for patients, perhaps a more biomarker-directed option with, again, this MET overexpression. And again, it further reinforces the importance of molecular testing in patients with traditionally driver mutation-negative non-small cell lung cancer, whether that is upfront or at progression, and in particular utilizing immunohistochemistry to assess MET expression in these patients. And this does join another ADC that we had previously made an update in our recommendation, which is trastuzumab deruxtecan, which is approved for those patients with HER2-overexpressing non-small cell lung cancer. So just again to reiterate the importance of molecular testing in patients both at the outset of their treatment and upon progression on frontline therapy. Brittany Harvey: Definitely. It is great to have this new antibody-drug conjugate join the treatment options, and as you mentioned, very important in this case to have that molecular testing done at the outset and at progression. So then in your view, what should clinicians know as they implement this living guideline, and how do these changes impact patients with non-small cell lung cancer? Dr. Joshua Reuss: Because there are so many different regimens that one can consider for any one patient, I think it is easy to become overwhelmed and stress on, "Am I making the right choice for my patient?" And I think one of the key take home points is that in many cases, there is no one right regimen. And I think one has to weigh several factors. It is the treatment schedule. It is the toxicity profile. It is the molecular profile of the patient. It is the patient preference. You know, there are so many factors here. And I would like to draw the reader and viewer's attention to an important section of these guidelines, particularly the Patient and Clinician Communication section, where we have a box focused on discussion points between patients and clinicians, which I think focuses on several of the high-level points that one can emphasize in making these decisions, ranging on things from: what are the goals of the treatment? What are the risks and benefits to any one approach? What are comorbidities that should be factored in? Common concerns, toxicity management, clinical trial consideration. All of these factors that I think are incredibly important in making that frontline treatment decision and implementing a regimen that both the clinician and, more importantly, the patient feels comfortable with. Brittany Harvey: It is really important that there is shared decision-making in these scenarios. And I think that patient-clinician communication section can tease out some of those preferences from the patient end and talk through the risks and benefits of different regimens as well. As we mentioned at the top of this episode, this guideline is a living guideline and updated on an ongoing basis. So what is the panel examining and keeping an eye on for future updates to this guideline? Dr. Joshua Reuss: So I think there are a lot of exciting new therapies and more up-to-date trials that we are anxiously awaiting the results of on our committee, and I think the oncology community in general is awaiting the results of. When we will have these results, I think, is a bit of an open-ended question, but I can give some insight on several of the trials that our committee is really keeping a close eye on. One that we have mentioned for several guideline iterations is the ECOG-ACRIN INSIGNA trial. This is a phase III clinical trial comparing pembrolizumab versus pembrolizumab plus carboplatin and pemetrexed chemotherapy in PD-L1 positive, non-squamous, non-small cell lung cancer. We talk about there being different regimens that can be considered in PD-L1 positive and PD-L1 high subsets, namely immunotherapy alone or immunotherapy plus chemotherapy, but there is no direct head-to-head comparison here. So this trial hopefully will answer that question. It has now finished accrual. There are other very interesting molecules and trials. I think another interesting compound is ivonescimab. This is a PD-1/VEGF bispecific antibody that is currently approved in China as monotherapy in patients with PD-L1 positive non-small cell lung cancer based off of the HARMONi-2 trial, where the progression-free survival of this bispecific antibody, ivonescimab, appeared superior to pembrolizumab. And we are looking closely at ongoing trials to see if these results will be replicated in an ex-China population. And if so, I think it could have a real impact and change on our guidelines. Still other very interesting things. There are obviously confirmatory studies for antibody-drug conjugates, such as the TeliMET study that I alluded to earlier, and many promising antibody-drug conjugates, both bispecific and trispecific antibody-drug conjugates, that hopefully can inform practice. And then there are several unique subsets of populations that I think we now are utilizing data on to make decisions, but a lot of that is retrospective in small subsets where we do not have that prospective data. And there are several trials ongoing in some of these subsets to try to gain clarity on what regimen may be the best for patients. One example is the phase III TRITON trial, which is looking at comparing CTLA-4 containing regimen, particularly the POSEIDON regimen of durvalumab plus tremelimumab and chemotherapy, versus the KEYNOTE-189 regimen, which is pembrolizumab plus carboplatin and pemetrexed, in patients with non-squamous, non-small cell lung cancer that have alterations in either KRAS, KEAP1, and/or STK11. There is a lot of both preclinical and clinical data to suggest that patients with these alterations in STK11 and KEAP1 may be more resistant to a PD-1 based treatment approach, and perhaps the incorporation of CTLA-4 can lead to a more meaningful response in this unique subset. Obviously, that data, it is retrospective, it is in small subsets. And when you add in a CTLA-4 molecule, you are also introducing greater risk for toxicity. So this trial is going to be very important in elucidating: is there a benefit in that unique subset? Does that data that we see retrospectively in this small subset hold true when evaluated in a prospective fashion? So while our guideline, our most recent comprehensive panel update, may not have had a lot of new data in it that has influenced frontline treatment decision-making, I think the future is bright and there are a lot of novel studies and novel treatments on the horizon that will hopefully improve the outcomes for our patients. Brittany Harvey: Absolutely. We will look forward to the results of those ongoing trials to provide more options and particularly clarity for patients with non-small cell lung cancer and to inform this guideline and its many updates to come. So I want to thank you so much for your work to rapidly and continuously update this guideline, and thank you for your time today, Dr. Reuss. Dr. Joshua Reuss: Thank you so much. Brittany Harvey: And finally, thank you to all of our listeners for tuning in to the ASCO Guidelines podcast. To read the full guideline, go to www.asco.org/thoracic-cancer-guidelines. You can also find many of our guidelines and interactive resources in the free ASCO Guidelines App available in the Apple App Store or the Google Play Store. If you have enjoyed what you have heard today, please rate and review the podcast and be sure to subscribe so you never miss an episode. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.
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