Podcasts about Plenary

Heather du Plessis-Allan Drive

Play Episode Listen Later Mar 13, 2025 25:50

Dr. Ebony Hoskins and Dr. Andreas Obermair discuss the surgical management of gynecologic cancers, including the role of minimally invasive surgery, approaches in fertility preservation, and the nuances of surgical debulking. TRANSCRIPT Dr. Ebony Hoskins: Hello and welcome to the ASCO Daily News Podcast, I'm Dr. Ebony Hoskins. I'm a gynecologic oncologist at MedStar Washington Hospital Center in Washington, DC, and your guest host of the ASCO Daily News Podcast. Today we'll be discussing the surgical management of gynecologic cancer, including the role of minimally invasive surgery (MIS), approaches in fertility preservation, and the nuances of surgical debulking, timing, and its impact on outcomes. I am delighted to welcome Dr. Andreas Obermair for today's discussion. Dr. Obermair is an internationally renowned gynecologic oncologist, a professor of gynecologic oncology at the University of Queensland, and the head of the Queensland Center for Gynecologic Cancer Research. Our full disclosures are available in the transcript of this episode. Dr. Obermair, it's great speaking with you today. Dr. Andreas Obermair: Thank you so much for inviting me to this podcast. Dr. Ebony Hoskins: I am very excited. I looked at your paper and I thought, gosh, is everything surgical? This is everything that I deal with daily in terms of cancer in counseling patients. What prompted this review regarding GYN cancer management? Dr. Andreas Obermair: Yes, our article was published in the ASCO Educational Book; it is volume 44 in 2024. And this article covers some key aspects of targeted precision surgical management principles in endometrial cancer, cervical cancer, and ovarian cancer. While surgery is considered the cornerstone of gynecologic cancer treatment, sometimes research doesn't necessarily reflect that. And so I think ASCO asked us to; so it was not just me, there was a team of colleagues from different parts of the United States and Australia to reflect on surgical aspects of gynecologic cancer care and I feel super passionate about that because I do believe that surgery has a lot to offer. Surgical interventions need to be defined and overall, I see the research that I'm doing as part of my daily job to go towards precision surgery. And I think that is, well, that is something that I'm increasingly passionate for. Dr. Ebony Hoskins: Well, I think we should get into it. One thing that comes to mind is the innovation of minimally invasive surgery in endometrial cancer. I always reflect on when I started my fellowship, I guess it's been about 15 years ago, all of our endometrial cancer patients had a midline vertical incision, increased risk of abscess, infections and a long hospital stay. Do you mind commenting on how you see management of endometrial cancer today? Dr. Andreas Obermair: Thank you very much for giving the historical perspective because the generation of gynecologic oncologists today, they may not even know what we dealt with, what problems we had to solve. So like you, when I was a fellow in gynecologic oncology, we did midline or lower crosswise incisions, the length of stay was, five days, seven days, but we had patients in hospital because of complications for 28 days. We took them back to the operating theaters because those are patients with a BMI of 40 plus, 45, 50 and so forth. So we really needed to solve problems. And then I was exposed to a mentor who taught minimal invasive surgery. And in Australia he was one of the first ones who embarked on that. And I can remember, I was mesmerized by this operation, like not only how logical this procedure was, but also we did rounds afterwards. And I saw these women after surgery and I saw them sitting upright, lipstick on, having had a full meal at the end of the day. And I thought, wow, this is the most rewarding experience that I have to round these patients after surgery. And so I was thinking, how could I help to establish this operation as standard? Like a standard that other people would accept this is better. And so I thought we needed to do a trial on this. And then it took a long time. It took a long time to get the support for the [LACE - Laparoscopic Approach to Cancer of the Endometrium] trial. And in this context, I just also wanted to remind us all that there were concerns about minimal invasive surgery in endometrial cancer at the time. So for example, one of the concerns was when I submitted my grant funding applications, people said, “Well, even if we fund you, wouldn't be able to do this trial because there are actually no surgeons who actually do minimally invasive surgery.” And at the time, for example, in Australia, there were maybe five people, a handful of people who were able to do this operation, right? This was about 20 years ago. The other concern people had was they were saying, could minimally invasive surgery for endometrial cancer, could that cause port side metastasis because there were case reports. So there were a lot of things that we didn't know anyway. We did this trial and I'm super happy we did this trial. We started in 2005, and it took five years to enroll. At the same time, GOG LAP2 was ramping up and the LACE trial and GOG LAP2 then got published and provided the foundations for minimally invasive surgery in endometrial cancer. I'm super happy that we have randomized data about that because now when we go back and now when people have concerns about this, should we do minimally invasive surgery in P53 mutant tumors, I'm saying, well, we actually have data on that. We could go back, we could actually do more research on that if we wanted to, but our treatment recommendations are standing on solid feet. Dr. Ebony Hoskins: Well, my patients are thankful. I see patients all the time and they have high risk and morbidly obese, lots of medical issues and actually I send them home most the same day. And I think, you know, I'm very appreciative of that research, because we obviously practice evidence-based and it's certainly a game changer. Let's go along the lines of MIS and cervical cancer. And this is going back to the LACC [Laparoscopic Approach to Cervical Cancer] trial. I remember, again, one of these early adopters of use of robotic surgery and laparoscopic surgery for radical hysterectomy and thought it was so cool. You know, we can see all the anatomy well and then have the data to show that we actually had a decreased survival. And I even see that most recent updated data just showing it still continued. Can you talk a little bit about why you think there is a difference? I know there's ongoing trials, but still interested in kind of why do you think there's a survival difference? Dr. Andreas Obermair: So Ebony, I hope you don't mind me going back a step. So the LACC study was developed from the LACE trial. So we thought we wanted to reproduce the LACE data/LAP2 data. We wanted to reproduce that in cervix cancer. And people were saying, why do you do that? Like, why would that be different in any way? We recognize that minimally invasive radical hysterectomy is not a standard. We're not going to enroll patients in a randomized trial where we open and do a laparotomy on half the patients. So I think the lesson that really needs to be learned here is that any surgical intervention that we do, we should put on good evidence footing because otherwise we're really running the risk of jeopardizing patients' outcomes. So, that was number one and LACC started two years after LACE started. So LACC started in 2007, and I just wanted to acknowledge the LACC principal investigator, Dr. Pedro Ramirez, who at the time worked at MD Anderson. And we incidentally realized that we had a common interest. The findings came totally unexpected and came as an utter shock to both of us. We did not expect this. We expected to see very similar disease-free and overall survival data as we saw in the endometrial cancer cohort. Now LACC was not designed to check why there was a difference in disease-free survival. So this is very important to understand. We did not expect it. Like, so there was no point checking why that is the case. My personal idea, and I think it is fair enough if we share personal ideas, and this is not even a hypothesis I want to say, this is just a personal idea is that in endometrial cancer, we're dealing with a tumor where most of the time the cancer is surrounded by a myometrial shell. And most of the time the cancer would not get into outside contact with the peritoneal cavity. Whereas in cervix cancer, this is very different because in cervix cancer, we need to manipulate the cervix and the tumor is right at the outside there. So I personally don't use a uterine manipulator. I believe in the United States, uterine manipulators are used all the time. My experience is not in this area, so I can't comment on that. But I would think that the manipulation of the cervix and the contact of the cervix to the free peritoneal cavity could be one of the reasons. But again, this is simply a personal opinion. Dr. Ebony Hoskins: Well, I appreciate it. Dr. Andreas Obermair: Ebony at the end of the day, right, medicine is empirical science, and empirical science means that we just make observations, we make observations, we measure them, and we pass them on. And we made an observation. And, and while we're saying that, and yes, you're absolutely right, the final [LACC] reports were published in JCO recently. And I'm very grateful to the JCO editorial team that they accepted the paper, and they communicated the results because this is obviously very important. At the same time, I would like to say that there are now three or four RCTs that challenge the LACC data. These RCTs are ongoing, and a lot of people will be looking forward to having these results available. Dr. Ebony Hoskins: Very good. In early-stage cervical cancer, the SHAPE trial looked at simple versus radical hysterectomy in low-risk cervical cancer patients. And as well all know, simple hysterectomy was not inferior to radical hysterectomy with respect to the pelvic recurrence rate and any complications related to surgery such as urinary incontinence and retention. My question for you is have you changed your practice in early-stage cervical cancer, say a patient with stage 1B1 adenocarcinoma with a positive margin on conization, would you still offer this patient a radical hysterectomy or would you consider a simple hysterectomy? Dr. Andreas Obermair: I think this is a very important topic, right? Because I think the challenge of SHAPE is to understand the inclusion criteria. That's the main challenge. And most people simplify it to 2 cm, which is one of the inclusion criteria but there are two others and that includes the depth of invasion. Dr. Marie Plante has been very clear. Marie Plante is the first author of the SHAPE trial that's been published in the New England Journal of Medicine only recently and Marie has been very clear upfront that we need to consider all three inclusion criteria and only then the inclusion criteria of SHAPE apply. So at the end of the day, I think what the SHAPE trial is telling us that small tumors that would strictly fulfill the criteria of a 1B or 1B1 cancer of the cervix can be considered for a standard type 1 or PIVA type 1 or whatever classification we're trying to use will be eligible. And that makes a lot of sense. I personally not only look at the size, I also look at the location of the tumor. I would be very keen that I avoid going through tumor tissue because for example, if you have a tumor that is, you know, located very much in one corner of the cervix and then you do a standard hysterectomy and then you have a positive tumor margin that would be obviously, most people would agree it would be an unwanted outcome. So I'd be very keen checking the location, the size of the tumor, the depths of invasion and maybe then if the tumor for example is on one side of the cervix you can do a standard approach on the contralateral side but maybe do a little bit more of a margin, a parametrial margin on the other side. Or if a tumor is maybe on the posterior cervical lip, then you don't need to worry so much about the anterior cervical margin, maybe take the rectum down and maybe try to get a little bit of a vaginal margin and the margin on the uterus saccals. Just really to make sure that you do have margins because typically if we get it right, survival outcomes of clinical stage 1 early cervix cancer 1B1 1B 2 are actually really good. It is a very important thing that we get the treatment right. In my practice, I use a software to record my treatment outcomes and my margins. And I would encourage all colleagues to be cognizant and to be responsible and accountable to introduce accountable clinical practice, to check on the margins and check on the number on the percentage of patients who require postoperative radiation treatment or chemo radiation. Dr. Ebony Hoskins: Very good. I have so many questions for you. I don't know the statistics in Australia, but here, there's increased rising of endometrial cancer and certainly we're seeing it in younger women. And fertility always comes up in terms of kind of what to do. And I look at the guidelines and, see if I can help some of the women if they have early-stage endometrial cancer. Your thoughts on what your practice is on use of someone who may meet criteria, if you will. The criteria I use is grade 1 endometrioid adenocarcinoma. No myometria invasion. I try to get MRI'd and make sure that there's no disease outside the endometrium. And then if they make criteria, I typically would do an IUD. Can you tell me what your practice is and where you've had success? Dr. Andreas Obermair: So, we initiated the feMMe clinical trial that was published in 2021 and it was presented in a Plenary at one of the SGO meetings. I think it was in 2021, and we've shown complete pathological response rates after levonorgestrel intrauterine device treatment. And so in brief, we enrolled patients with endometrial hyperplasia with atypia, but also patients with grade 1 endometrial adenocarcinoma. Patients with endometrial hyperplasia with atypia had, in our series, had an 85 % chance of developing a complete pathological response. And that was defined as the complete absence of any atypia or cancer. So endometrial hyperplasia with atypia responded in about 85%. In endometrial cancer, it was about half, it was about 45, 50%. In my clinical practice, like as you, I see patients, you know, five days a week. So I'm looking after many patients who are now five years down from conservative treatment of endometrial cancer. There are a lot of young women who want to get pregnant, and we had babies, and we celebrate the babies obviously because as gynecologist obstetricians it couldn't get better than that, right, if our cancer patients have babies afterwards. But we're also treating women who are really unfit for surgery and who are frail and where a laparoscopic hysterectomy would be unsafe. So this phase is concluded, and I think that was very successful. At least we're looking to validate our data. So we're having collaborations, we're having collaborations in the United States and outside the United States to validate these data. And the next phase is obviously to identify predictive factors, to identify predictors of response. Because as you can imagine, there is no point treating patients with a levonorgestrel intrauterine joint device where we know in advance that she's not going to respond. So this is a very, very fascinating story and we got our first set of data already, but now we just really need to validate this data. And then once the validation is done, my unit is keen to do a prospective validation trial. And that also needs to involve international collaborators. Dr. Ebony Hoskins: Very good. Moving on to ovarian cancer, we see patients with ovarian cancer with, say, at least stage 3C or higher who started neoadjuvant chemotherapy. Now, some of these patients are hearing different things from their medical oncologist versus their gynecologic oncologist regarding the number of cycles of neoadjuvant chemotherapy after getting diagnosed with ovarian cancer. I know that this can be confusing for our patients coming from a medical oncologist versus a gynecologic oncologist. What do you say to a patient who is asking about the ideal number of chemotherapy cycles prior to surgery? Dr. Andreas Obermair: So this is obviously a very, very important topic to talk about. We won't be able to provide a simple off the shelf answer for that, but I think data are emerging. The ASCO guidelines should also be worthwhile considering because there are actually new ASCO Guidelines [on neoadjuvant chemotherapy for newly diagnosed, advanced ovarian cancer] that just came out a few weeks ago and they would suggest that we should be aiming for R0 in surgery. If we can maybe take that as the pivot point and then go back and say, okay, so what do need to do to get the patient to zero? I'm not an ovarian cancer researcher; I'm obviously a practicing gynecologic oncologist. I think about things a lot and things like that. In my practice, I would want a patient to develop a response after neoadjuvant chemotherapy. So, if a patient doesn't have a response after two or three cycles, then I don't see the point for me to offer her an operation. In my circle with the medical oncologists that I work with, I have a very, very good understanding. So, they send the patient to me, I take them to the theater. I take a good chunk of tissue from the peritoneum. We have a histopathologic diagnosis, we have a genomic diagnosis, they go home the same day. So obviously there is no hospital stay involved with that. They can start the chemotherapy after a few days. There is no hold up because the chances of surgical complication in a setting like this is very, very low. So I use laparoscopy to determine whether the patient responds or not. And for many of my patients, it seems to work. It's obviously a bit of an effort and it takes operating time. But I think I'm increasing my chances to make the right decision. So, coming back to your question about whether we should give three or six cycles, I think the current recommendations are three cycles pending the patient's response to neoadjuvant chemotherapy because my aim is to get a patient to R0 or at least minimal residual disease. Surgery is really, in this case, I think surgery is the adjunct to systemic treatment. Dr. Ebony Hoskins: Definitely. I think you make a great point, and I think the guideline just came out, like you mentioned, regarding neoadjuvant. And I think the biggest thing that we need to come across is the involvement of a gynecologic oncologist in patients with ovarian cancer. And we know that that survival increases with that involvement. And I think the involvement is the surgery, right? So, maybe we've gotten away from the primary tumor debulking and now using more neoadjuvant, but surgery is still needed. And so, I definitely want to have a take home that GYN oncology is involved in the care of these patients upfront. Dr. Andreas Obermair: I totally support that. This is a very important statement. So when I'm saying surgery is the adjunct to medical treatment, I don't mean that surgery is not important. Surgery is very important. And the timing is important. And that means that the surgeons and the med oncs need to be pulling on the same string. The med oncs just want to get the cytotoxic into the patients, but that's not the point, right? We want to get the cytotoxic into the patients at the right time because if we are working under this precision surgery, precision treatment mantra, it's not only important what we do, but also doing it at the right time. And ideally, I I would like to give surgery after three cycles of neoadjuvant chemotherapy, if that makes sense. But sometimes for me as a surgeon, I talk to my med onc colleagues and I say, “Look, she doesn't have a good enough response to her treatment and I want her to receive six cycles and then we re-evaluate or change medical treatment,” because that's an alternative that we can swap out drugs and treat upfront with a different drug and then sometimes they do respond. Dr. Ebony Hoskins: I have maybe one more topic. In the area I'm in, in the Washington D.C. area, we see lots of endometrial cancer and they're not grade 1, right? They're high-risk endometrial cancer and advanced. So a number of patients with stage 3 disease, some just kind of based off staging and then some who come in with disease based off of the CT scan, sometimes omental caking, ascites. And the real question is we have extrapolated the use of neoadjuvant chemotherapy to endometrial cancer. It's similar, but not the same. So my question is in an advanced endometrial cancer, do you think there's still a role, when I say advanced, I mean, maybe stage 4, a role for surgery? Dr. Andreas Obermair: Most definitely. But the question is when do you want to give this surgery? Similar to ovarian cancer, in my experience, I want to get to R0. What am I trying to achieve here? So, I reckon we should do a trial on this. And I reckon we have, as you say, the number of patients in this setting is increasing, we could do a trial. I think if we collaborate, we would have enough patients to do a proper trial. Obviously, we would start maybe with a feasibility trial and things like that. But I reckon a trial would be needed in this setting because I find that the incidence that you described, that other people would come across, they're becoming more and more common. I totally agree with you, and we have very little data on that. Dr. Ebony Hoskins: Very little and we're doing what we can. Dr. Obermair, thank you for sharing your fantastic insights with us today on the ASCO Daily News Podcast and for all the work you do to advance care for patients with gynecologic cancer. Dr. Andreas Obermair: Thank you, Dr. Hoskins, for hosting this and it's been an absolute pleasure speaking with you today. Dr. Ebony Hoskins: Definitely a pleasure and thank you to our listeners for your time today. Again, Dr. Obermair's article is titled, “Controversies in the Surgical Management of Gynecologic Cancer: Balancing the Decision to Operate or Hesitate,” and was published in the 2024 ASCO Educational Book. And you'll find a link to the article in the transcript of this episode. Finally, if you value the insights that you hear on the ASCO Daily News Podcast, please take a moment to rate, review and subscribe wherever you get your podcasts. Disclaimer: 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. Find out more about today's speakers: Dr. Ebony Hoskins @drebonyhoskins Dr. Andreas Obermair @andreasobermair Follow ASCO on social media:      @ASCO on Twitter      ASCO on Bluesky  ASCO on Facebook      ASCO on LinkedIn      Disclosures: Dr. Ebony Hoskins: No relationships to disclose. Dr. Andreas Obermair: Leadership: SurgicalPerformance Pty Ltd. Stock and Ownership Interests: SurgicalPerformance Pty Ltd. Honoraria: Baxter Healthcare Consulting or Advisory Role: Stryker/Novadaq Patents, Royalties, and Other Intellectual Property: Shares in SurgicalPerformance Pty Ltd. Travel, Accommodation, Expenses: Stryker

Chris Bishop: Infrastructure Minister on the Government's first Infrastructure Investment Summit

Play Episode Listen Later Mar 13, 2025 2:32 Transcription Available

The Minister in charge of the Government's Infrastructure Investment Summit says deals will mostly be done in the coming weeks, months and years ahead. More than a hundred companies, managing about six trillion dollars in capital, are at the Government's two day summit in Auckland. But Chris Bishop says there's already been one tangible commitment from Australian investor Plenary group. "They've promised to set up a New Zealand office here and they've promised to bid on the next five PPP opportunities that come up - that is a commitment that they have just made, I think, in the last 24 hours, on the basis of what they heard at the summit and in the leadup to it. So that's good." LISTEN ABOVESee omnystudio.com/listener for privacy information.

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Chris Bishop: Infrastructure Minister on the Government's first Infrastructure Investment Summit

Best of Business

Play Episode Listen Later Mar 13, 2025 2:41 Transcription Available

business politics government australian new zealand minister infrastructure auckland ppp plenary chris bishop investment summit listen abovesee

DT #546 Recap and Review of the 2025 IEDC Leadership Summit

Develop This: Economic and Community Development

Play Episode Listen Later Mar 12, 2025 25:03

Summary In this episode of the Develop This Podcast, host Dennis Fraise is joined by contributing correspondents Joy Austin, Angee Shaker, and Sean Maguire to discuss their experiences at the recent IEDC Leadership Summit held in Washington, DC. They reflect on the conference's location, programming, and the importance of networking and collaboration among economic developers. The group shares insights on various sessions, including data utilization, personal branding, and the impact of plenary speakers. They conclude with thoughts on the overall experience and future conferences. Takeaways The conference location in DC allowed for advocacy opportunities. Networking with colleagues was a highlight of the conference. Sessions focused on collaboration rather than traditional presentations. Data utilization is crucial for effective economic development. Personal branding is important for professional growth. Plenary sessions featured inspiring speakers from various fields. The conference emphasized learning from peers and sharing experiences. The hotel location facilitated easy access to key sites in DC. Future conferences will continue to explore innovative formats. Staying hydrated and comfortable is essential during conferences. Upcoming IEDC conferences Rural Retreat June 23rd - 25th Great Falls Montana Annual Conference - September 14th - 17th Detroit, MI Leadership Summit March 1st - 3rd 2026

Paul Newfield: Morrison CEO on the Government's Infrastructure Investment Summit

The Mike Hosking Breakfast

Play Episode Listen Later Mar 12, 2025 3:31 Transcription Available

A lot's riding on the Government as it opens the country up to more offshore investment. Representatives of more than 100 foreign entities are in Auckland to eye up potential opportunities at the Infrastructure Investment Summit. The Government's hoping for more project funding and public-private partnerships. Chief Executive with infrastructure investor Morrison, Paul Newfield told Mike Hosking New Zealand needs to be painted as a great place to invest. He says the Government needs to present a multi-decade pipeline, a vision for what infrastructure could be, and a commitment to maintain work over successive governments. Meanwhile, Australian investor Plenary's already confirmed to BusinessDesk it intends to bid on the first stage of the multibillion-dollar Northland Expressway. LISTEN ABOVE See omnystudio.com/listener for privacy information.

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Embracing AI to Transform Risk Management in Construction with Luigi La Corte

Navigating Major Programmes

Play Episode Listen Later Mar 10, 2025 43:24

Host Riccardo Cosentino sits down with Luigi La Corte, CEO and Co-Founder of Provision, a Toronto-based AI construction technology company. Luigi recounts his journey from working alongside his father's contracting business to a role in P3 (Public-Private Partnerships) at Plenary, where he observed firsthand the mounting costs of construction disputes and claims. Driven by a desire to create positive change, Luigi launched Provision in 2022, evolving the venture through several pivots to its current mission—helping contractors and subcontractors identify and mitigate contractual risks early and effectively. Together, Riccardo and Luigi discuss the promise of AI in reducing disputes, optimizing processes, and ultimately aiming to put more profit into contractors' pockets, thereby fueling a more innovative and rewarding construction industry for all." I do think the industry is very receptive. They want to solve problems. And I don't think AI is a lot of hype. I think what it's done, especially in construction, is it's helped people standardize. One of the biggest problems in construction is that a lot of the information is contained within PDFs and unstructured documents. But now you can create a taxonomy for each of those things and plug them into, you know, the respective workflow. That's magic. And then also, LLMs can emulate some level of human thought and exercise some discretion in a very specific sense." – Luigi La CorteKey TakeawaysWhy construction claims are costly: they consume 2–4% of project budgets, making early risk identification essential to save time and money.How AI can streamline error-prone document reviews, improving accuracy and project efficiency How market feedback drives product evolution: Iterating based on real-world pain points leads to solutions that better meet user needs.Why AI won't solve every dispute is because its strength lies in reducing errors, identifying risks, and augmenting human expertise for higher-level tasks.How contractor profitability fuels industry transformation: reinvesting gains in technology sparks innovationThe conversation doesn't stop here—connect and converse with our community via LinkedIn:Follow Navigating Major ProgrammesFollow Riccardo CosentinoFollow Luigi La CorteExplore Provision, Luigi's AI-driven solution to reduce risk in construction.Read Riccardo's latest at www.riccardocosentino.com Music: "A New Tomorrow" by Chordial Music. Licensed through PremiumBeat.

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FATF Plenary, GAO Reports, EU & UK Russia Sanctions, and a BOI Update

AML Conversations

Play Episode Listen Later Feb 26, 2025 15:14

This week, John and Elliot discuss the results of the February FATF Plenary, GAO reports on BOI, and Assessing Progress on Countering Criminal Activity, new sanctions issued by the UK and EU against Russia, the latest on the requirement to file BOI with FinCEN, priorities of the Acting Comptroller of the Currency, and other items impacting the financial crime prevention community.

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Ep. 155 Plenary Inspiration

Think This Way

Play Episode Listen Later Feb 25, 2025

inspiration plenary

M25 Plenary 1: Stan Reeder preaches on Begin

lifelong learning preaches reeder plenary

Play Episode Listen Later Feb 19, 2025 48:03

Dr. Reeder preaches from Luke 15 on the three types of "lost" February 10 2025 To watch: click here Lifelong Learning Code: 80890 Click here to learn about Lifelong Learning.

M25 Plenary 2: Carla Sunberg preaches on Relate

relate lifelong learning preaches plenary

Play Episode Listen Later Feb 19, 2025 50:49

This sermon was preached on February 11, 2025 To watch: click here Lifelong Learning Code: 80890 Click here to learn about Lifelong Learning.

M25 Plenary 3: LaMorris Crawford preaches on the theme of Imagine

Play Episode Listen Later Feb 19, 2025 60:35

This sermon was preached on February 11, 2025 To watch: click here Lifelong Learning Code: 80890 Click here to learn about Lifelong Learning.

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M25 Plenary 4: Kevin Jack preaches on Next

lifelong learning preaches plenary

Play Episode Listen Later Feb 19, 2025 63:28

This sermon was preached on February 12, 2025 To watch: click here Lifelong Learning Code: 80890 Click here to learn about Lifelong Learning.

Catechesis That Raises Up Multiethnic Leaders for the Kingdom

The Coffee Hour from KFUO Radio

Play Episode Listen Later Feb 18, 2025 29:36

How does the Church raise up multiethnic leaders for the kingdom through catechesis? The Rev. Dr. Ely Prieto, Associate Professor of Practical Theology and Director of the Center for Hispanic Studies at Concordia Seminary in St. Louis, joins Andy and Sarah to talk about the Concordia Seminary Multiethnic Symposium happening May 6-7. They discuss how catechesis is part of the Lord's command in Matthew 28:19, what is meant by "all nations" in this command, what a multiethnic church is and where we see examples of the beauty of multiethnic churches, how catechesis is a powerful tool in the context of a multiethnic church, and the exciting topics to be covered at this year's Multiethnic Symposium. Learn more and register at csl.edu/multiethnic, and read on for the official press release with more details. --------------------------------------------------- ST. LOUIS, Feb. 12, 2025— Registration is open for the 2025 Multiethnic Symposium, “Learning From Each Other: Catechesis That Raises Up Multiethnic Leaders for the Kingdom,” set for May 6-7 on the campus of Concordia Seminary, St. Louis. The symposium brings together individuals from varied cultural backgrounds to share their unique perspectives and experiences to help equip future leaders with knowledge, stills and spiritual maturity to serve God's kingdom faithfully. “Raising up the next generation of multiethnic leaders within The Lutheran Church—Missouri Synod (LCMS) presents a significant challenge, but it also represents a tremendous responsibility and a unique opportunity that the Lord has graciously bestowed upon us,” said Dr. Ely Prieto, the Lutheran Foundation Professor of Urban and Cross-Cultural Ministry. “In a multiethnic church context, catechesis serves as a vital and powerful tool for cultivating leaders who are equipped to effectively minister among diverse communities. This symposium will provide an invaluable opportunity to learn from esteemed scholars, experienced pastors and dedicated missionaries who have studied this crucial area and have played a pivotal role in raising up the next generation of immigrant leaders.” Plenary speakers include: Dr. Kent Burreson, Professor of Systematic Theology, Concordia Seminary, St. Louis Dr. Rhoda Schuler, Professor Emeritus, Concordia University, St. Paul, St. Paul, Minn. Rev. Jeff Cloeter, Senior Pastor, Christ Memorial Lutheran Church, St. Louis Dr. Stanish Stanley, Executive Director, Christian Friends of New Americans, St. Louis Jessica Bordeleau, Coordinator, Digital Publishing, Concordia Seminary, St. Louis The 19th Annual Lecture in Hispanic/Latino Theology and Mission also will be held during the symposium. Dr. Hosffman Ospino, professor of Hispanic Ministry and Religious Education and chair of the Department of Religious Education and Pastoral Ministry at Boston College, in Boston, Mass., will present, “How the Roman Catholic Church is Cultivating and Mentoring a New Generation of Hispanic-Ecclesial Leaders.” The response will be given by Rev. Stephen Heimer, manager of All Nations Ministry for the LCMS Office of National Mission (ONM) in St. Louis, Mo. The lecture, sponsored by the Seminary's Center for Hispanic Studies, is free and open to the public. Participants are encouraged to extend their stay and attend the 2025 Multi Asian Gathering, set for May 7-8 on the Seminary campus. The admission fee for the Multi Asian Gathering is $25. Registration closes April 21. The admission fee for the Multiethnic Symposium is $85, but free for Concordia Seminary students and faculty. For more information, visit csl.edu/multiethnic or contact Continuing Education at 314-505-7286 or ce@csl.edu. As you grab your morning coffee (and pastry, let's be honest), join hosts Andy Bates and Sarah Gulseth as they bring you stories of the intersection of Lutheran life and a secular world. Catch real-life stories of mercy work of the LCMS and partners, updates from missionaries across the ocean, and practical talk about how to live boldly Lutheran. Have a topic you'd like to hear about on The Coffee Hour? Contact us at: listener@kfuo.org.

Plenary Abstracts at AAHPM/HPNA: Yael Schenker, Na Ouyang, Marie Bakitas

GeriPal - A Geriatrics and Palliative Care Podcast

Play Episode Listen Later Feb 13, 2025 47:19

In today's podcast we were delighted to be joined by the presenters of the top scientific abstracts for the Annual Assembly of the American Academy of Hospice and Palliative Medicine (AAHPM) and the Hospice and Palliative Medicine Nurses Association (HPNA). Eric and I interviewed these presenters at the meeting on Thursday (before the pub crawl, thankfully). On Saturday, they formally presented their abstracts during the plenary session, followed by a wonderful question and answer session with Hillary Lum doing a terrific job in the role of podcast host moderator. Our three guests were Marie Bakitas, who conducted a trial of tele/video palliative care for Black and White inpatients with serious illness hospitalized in the rural south; Yael Shenker, for a trial of patient-directed Prepare-for-your-care vs. facilitated Respecting Choices style advance care planning interventions; and, Na Ouyang, who studied the relationship between prognostic communication and prolonged grief among the parents of children who died from cancer. From just the abstracts we had so many questions. We covered some of our questions on the podcast, others you can ponder on your own or in your journal clubs, including: Marie's tele/video palliative care intervention was tailored/refined with the help of a community advisory board. Does every institution need to get a community advisory board to tailor their rural tele-palliative care initiative (or geriatrics intervention) to the local communities served? Who would/should be on that board? How to be sensitive to the risks of stereotyping based on recommendations from the few members of the board to the many heterogeneous patients served? Advance care planning has taken a beating. For the purposes of a thought exercise, no matter what you believe, let's assume that there are clear important benefits. Based on the results of Yael's study, should resources be allocated to resource intensive nurse facilitated sessions (Respecting Choices), which had significantly better engagement, or to low resource intensive patient-facing materials (Prepare), which had significantly less engagement but still plenty of engagement (e.g. 75% vs 61% advance directive completion)? One interpretation of Na's study is that clinicians can lean on the high levels of trust and high ratings of communication to engage with parents of children with cancer about prognosis. Another interpretation is that clinicians avoided telling the parents prognosis in order to bolster their ratings of trust and communication quality. Which is it? Bonus: Simon says he composed the song Sounds of Silence in a dark echoing bathroom about his concerns that people had stopped listening to each other in the 1960s (still resonates, right?). Garfunkel says Simon was writing about Garfunklel's friend and college roomate Sandy, who was blind. Who's got the right of it? Enjoy! -Alex Smith

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No Rome, No Problem! How to Get a Plenary Indulgence Right Where You Are (Special Podcast Highlight)

The Patrick Madrid Show

Play Episode Listen Later Jan 28, 2025 4:05

Patrick Madrid gets into a question from Emily in Maine, who’s wondering if she has to pack her bags for Rome to receive a plenary indulgence during the Jubilee Year. Here's the Explanation: Patrick explains that while Rome’s Holy Doors are a major focus during the Jubilee Year, you don’t actually need to fly to the Eternal City to participate. Many dioceses around the world designate their own churches: usually cathedrals or significant shrines, with Holy Doors. So, you can check out your diocesan website to see which local church has been designated. Once you know where the doors are, you can receive the same plenary indulgence as if you were in St. Peter’s Basilica. So, What’s a Plenary Indulgence Anyway? Patrick gives a quick theology lesson: A plenary indulgence is the "complete remission of the punishment due to sins that have already been forgiven." It’s like hitting the reset button on your soul’s "penance odometer." To receive it, you need to: Be in a state of grace (go to Confession if needed!). Renounce all attachment to sin: even those sneaky past sins you might secretly still take pride or enjoyment in. Perform the prescribed act (in this case, passing through a Holy Door). Receive Communion and pray for the Pope’s intentions (like an Our Father and a Hail Mary). Patrick makes it clear that detachment from sin doesn’t mean you need to feel it emotionally. It’s an act of the will: a firm decision to reject sin out of true love for God. What About Rome? Emily mentions she’d love to go to Rome (don’t we all?), but it’s just not possible. Patrick assures her that the indulgence she gets at her local Holy Door is just as “full” as the one you’d get in Rome. There’s no "extra holy" indulgence for jetsetters: it’s the same grace whether you’re at St. Peter’s or in Portland, Maine. Final Thought: If you’re dreaming of Rome but stuck at home, don’t sweat it. Holy Doors are popping up all over the world, and the grace is universal. So, grab your diocesan map, check out your nearest Holy Door, and step into the incredible mercy God is offering you this Jubilee Year. Hey, maybe pray for a miracle trip to Rome while you’re at it. You never know what door God might open for you, literally!

How to Advance Cancer Care for Native Americans

university australia phd professor md melbourne netherlands consultants southampton critical care world congress plenary uhs surgical oncologist perioperative medicine prehabilitation

Play Episode Listen Later Jan 9, 2025 18:23

Native American oncologist Dr. Amanda Bruegl and Dr. Noelle LoConte discuss culturally tailored interventions and the importance of community engagement to advance cancer prevention, diagnosis, and treatment for Native communities. TRANSCRIPT ASCO Daily News: Hello and welcome to the ASCO Daily News Podcast. I'm Geraldine Carroll, a reporter for the ASCO Daily News. On today's episode, we'll be discussing cancer care for Native American communities who face unique challenges and disparities in accessing and receiving cancer care. I'm delighted to be joined by two oncologists who will be sharing their insights on ways to advance cancer prevention, diagnosis, and treatment through culturally tailored interventions and community-based programs for high-risk Native Americans whose issues are chronically overlooked in the healthcare system, according to experts. Dr. Amanda Bruegl is an associate professor of obstetrics and gynecology at the Oregon Health and Science University School of Medicine. She is a gynecologic oncologist at the OHSU Knight Cancer Institute and a citizen of the Oneida Nation and descendant of Stockbridge-Munsee. Dr. Noelle LoConte is an associate professor of medicine at the University of Wisconsin Madison Carbone Cancer Center where she also serves as a GI medical oncologist, geriatrician and leads community outreach. Full disclosures are available in the transcript of this episode. Dr. LoConte and Dr. Bruegl, it's great to have you on the podcast today. Dr. Noelle LoConte: Thanks so much for having me. Dr. Amanda Bruegl: Thank you for having us. ASCO Daily News: Dr. Bruegl, I'd like to start by asking you to tell us a bit about your background and how it has influenced your career and interests as a gynecologic oncologist. Dr. Amanda Bruegl: I grew up in Wisconsin and I have a Native parent and a non-Native parent. And so having an awareness of both cultural influences in my life has really shaped my interest in cancer prevention. Seeing the high rates of preventable death in cancer among Native populations in gynecologic cancers, in particular, has really driven me to dedicate my research career toward decreasing the morbidity and mortality of cervical cancer among Native women. ASCO Daily News: Well, can you tell us about your work in cancer prevention, specifically cervical cancer? The data shows that Native Americans in Oregon get cervical cancer one and a half times more than the general state population and die from it two times more often. What are the factors, the barriers, that are contributing to these high rates of cervical cancer? Dr. Amanda Bruegl: The data in Oregon is actually not just limited to Oregon. Our group did some work in collaboration with the Northwest Portland Area Indian Health Board Tribal Epidemiology Center, and we found that, as you stated, the rates of cervical cancer are one and a half times that of non-Hispanic Whites and the rate of death is about twice. And that's true for the Pacific Northwest. And if you dig deeper into the literature, you see that these rates are true across Indian Country, sometimes worse. When we looked at the age groups, we found that older women had three times the rate of mortality. So looking at like 45 to 65. As I was looking through the literature to figure out, well, why is this, we found that there are very, very few funded studies that even look at this. We have a known persistent disparity that is chronically understudied and underfunded. And so I'm trying to do work in this arena to explore this further. A follow up study that we did was looking at whether we are using the prevention tools. So it's common across the United States that we have two very powerful prevention tools. So participation in cervical cancer screening doesn't necessarily prevent cervical cancer, but you can have early detection of pre-invasive disease or detection of early-stage disease, which is highly curable. And then we also have HPV vaccination, something geared towards the youth in our communities across the U.S. HPV vaccination starting at age 9 with a goal of complete vaccination by the age of 12. So we looked at: Are we using these two tools in Indian Country? And what we found was that participation in cervical cancer screening, looking at who is up-to- date among Natives, and we found that overall the population had about 60% rates of up-to- date on cervical cancer screening compared to general US rates, which are in like the high 70s or low 80s. And then when we looked at that age group that has higher rates of mortality, we actually found that there's only about a 50% rate of up-to-date screening. So we know in one arena people aren't participating in screening. And there's a variety of different contributors to that. There's access to care. How far do you have to travel to get to a provider who will provide cervical cancer screening? Among Native women, there's an over 50% rate of history of sexual trauma, sexual violence, pelvic exam trauma. It's a huge barrier to coming in for this very sensitive exam. There is also mistrust with the medical system in general. There's high turnover of providers at Indian Health Service Clinics. The clinic that I'm currently working at now, so I do outreach at a clinic one day a month and I'm the longest standing doc at that clinic and I'm a consultant who comes one day a month. I've been there since 2016. And so when you can't develop a relationship with a provider and develop trust and there's just this churn of new people every three to six months, developing a relationship to allow someone to feel comfortable with a very personal and private examination can be a huge barrier. On the HPV vaccination side, we found that the numbers for HPV vaccination were pretty optimistic. So the numbers have been going up since our study period started in 2015. The clinics in the Pacific Northwest that are serving Native populations are doing a great job with education, outreach and increasing the numbers. The group with the greatest rates of HPV vaccination are for people assigned female at birth in the 13-18 age group. They are the only group that is approaching the Healthy People 2030 goal. But there's still work to be done in this arena. Those are some big drivers of why this persistent disparity continues. ASCO Daily News: Absolutely. You mentioned some very serious barriers. Sexual trauma, mistrust, long distance to travel to clinics. Looking ahead, can you tell us about potential screening tools that could improve screening? And I also wanted to ask you about innovations you're excited about that could be potentially incorporated into practice to increase the ability and comfort of your patients to screening and access to HPV vaccination. Dr. Amanda Bruegl: So, in terms of cervical cancer screening and how to increase the rates, there are a number of different things in the literature broadly across populations that really show that knowledge and awareness of cervical cancer and cervical cancer screening guidelines is associated with guideline concordant care. And so ensuring that our patients in our communities know and understand what the recommendations are is very important. Efforts to provide education to women in the community, community stakeholders, and culturally tailored content can all be important for increasing the rates of cervical cancer participation. Another thing that has the potential to really help improve screening rates is HPV self-collection. The FDA just recently approved HPV self-collection which can help empower an individual to do their own testing on their own body and not have someone else place a speculum in a private personal area where they're not comfortable. Some of the tribes in our region are starting to adopt this practice. And I just gave a talk to the regional Indian Health Service medical directors and have had really positive feedback about clinics working towards bringing this into their practice. I hope that the FDA can move forward with allowing patients to do this in the comfort of their own home. Sadly, the FDA in their evaluations decided it had to be a clinic administered test. So someone still has to go through the barrier of finding time to, if they have caregiver responsibilities or work, to have these responsibilities taken care of for someone else so they can drive to a clinic. So these barriers of transportation and caregiving are not addressed by this. It addresses some of the trauma, that barrier. And so I think in the US, we can do better about bringing this like FIT testing to our patients. I really hope and challenge our country to move forward with that a bit more. Geraldine Carroll: Thanks, Dr. Bruegl. I'll come back to you in a moment, but first I'd like to switch gears and address some of the challenges faced by Native communities in Wisconsin that were featured in a fascinating study presented by our guest, Dr. Noelle LoConte, at the recent ASCO Quality Care Symposium. The study found that radon levels in Native lands in Wisconsin were much higher than anticipated and may explain higher rates of lung cancer among Native communities in the state. Radon is the second leading cause of lung cancer in the U.S. So, Dr. LoConte, can you tell us more about this study and your incredible partnership with the Stockbridge-Munsee Band of the Mohican Nation Health Center in this work? Dr. Noelle LoConte: You bet. Thanks for the interest. First of all, I think it's just an incredible privilege to work with all of these communities. So, I wanted to say at the jump that this was a joint project led by the cancer center that I'm affiliated with, but also with the Stockbridge-Munsee community. They approved the project and they designed it with us, and they retain ownership of the data. Data sovereignty is an important issue when you're doing this work. But we came to them wanting to work on something around cancer. I actually thought maybe colorectal cancer screening. But in meeting with the health center and the tribal community members, it became clear that they were more concerned that they had intergenerational rates of cancer, and they felt that they were being poisoned by their land. And that brought me to the state Environmental Health Program. And we looked at some data and realized, one, their lung cancer rates were quite high, but two, their radon testing rates were quite low. And that that was a place where we thought we couldn't make some forward momentum. So, we designed a program to educate around radon and radon testing and mitigation and then tested all the homes on the reservation. And we successfully tested all homes for radon and then successfully mitigated all the homes that tested over four picocuries per liter, which is the recommended level at which you should mitigate per the EPA, the Environmental Protection Agency. The statewide average for Wisconsin is 10% positive. And amongst homes that had a basement, which is thought to be the highest risk kind of dwelling in the Stockbridge-Munsee Reservation community, the positive rate was 77%. And when you take all the homes together because we had some homes with crawl spaces or slab foundation, it was around, I believe, 55% positive, so much higher than 10%. ASCO Daily News: Well, that data is just striking. Your study certainly illustrates the vital role that cancer centers can play in mitigating structural determinants of health among Native communities, such as with housing quality. Do you think this will inspire a similar approach in other regions of the country? Dr. Noelle LoConte: Yeah, I think this work was possible because of philanthropy. It is very, very hard to get grant funding for mitigation, in particular. Mitigation is usually done once in the life of the dwelling, but it is very, very expensive. A cheap mitigation is $750, and many are many thousands of dollars especially when you're looking at very rural communities where there's not really a mitigator within hundreds of miles and you have to really negotiate to get somebody to come out there. Every cancer center that's designated by the National Cancer Institute has to have a community outreach and engagement unit or program. I would argue that rather than us generating reports describing disparities, that this kind of work to actually dismantle these determinants of health and move power back into the community is an ideal role for a cancer center. But the funding was definitely a tricky piece of it. And I would hope that we could either envision funding mechanisms that allow for this kind of direct service to communities, or we can continue to work with philanthropic agencies to fund this. ASCO Daily News: Well, looking through a wider lens at the experience of Native communities navigating cancer care, I'd like to ask each of you to comment on how you think the oncology community can better support and serve high-risk Native populations. What message would you like oncologists to take away from this discussion today? Dr. Bruegl, would you like to respond first? Dr. Amanda Bruegl: There's so many layers to needs in our communities. First and foremost, it's important to understand that American Indians and Alaska Natives are sovereign people, sovereign nations. We've been written into the US Constitution as citizens of our own tribes. And it's important to remember that when working with our populations. I think it's also really important to remember that there's treaty law that promised healthcare to our communities. And you see that we are underfunded in all aspects of healthcare, and it's a driver. And people on the healthcare side of things need to remember we represent the failures of the healthcare system to care for our Native communities. Whether or not you wake up in the morning with a goal to help, you have to remember that you represent the institution and the history of this country and are going to be asked to prove yourself in a genuine fashion. And that takes time. I think for people who are in research, it's really important to think about how do you engage and partner with tribal communities so that we're not chronically left behind and left out of study? We seldom show up in the data, and we have to find our own data. Tribal epidemiology centers have been really paramount in helping tribes get access to their data and analyze their data. But you can see in trial after trial after trial, we're sort of shoved into the other box. And so it's so difficult to understand how the cancer story relates to us and how do we improve it? ASCO Daily News: Thank you, Dr. Bruegl. Dr. LoConte, would you like to comment on this as well? Dr. Noelle LoConte: Yeah. I had jotted down a few points. Many are going to be a little bit of a repetition here, but I think the overarching theme is that the goals for academic medicine often are not the goals of the community that you may be seeking to work in, and so being able to pivot was key to the success of my project, I think. Can't underestimate the importance of trust. And trust takes a lot of time and a lot of showing up and a lot of being consistent and delivering on what you say you're going to do. And there's a lot of turnover in academic medicine. People leave institutions, move on for promotions. None of that is going to help strengthen these relationships. So I think institutions would be wise to invest in people that stay. I think there should be things like retention bonuses for those of us that stay in places and do community work. It's certainly not the sexy stuff. It's not what gets you in the Plenary at the ASCO Annual Meeting, for example, but I was beyond delighted that I was on the podium for the ASCO Quality Care Symposium. And I think continuing to elevate this work as meaningful and important work, just as important as clinical trials and new drugs, is really important. I would like to second the motion or the thought that we need to support full funding for the Indian Health Services. It is a promise we made that we continue to underdeliver on that continues to harm patients every day, particularly in the latter half of the year when they run out of funding pretty consistently. For those of us that are non-Native doing this work, to know the history of the community that you're working in and be really mindful of that but also know the role that your institution played in propagating some of these harms. And I think we need more Native physicians that really will help to have concordance with patients and physicians. And so as much as we can support getting more Native folks starting really early – high school, middle school, interested in medicine and biomedical research, all the way through medical school residency fellowship would be really, really impactful. We have a program here founded by Amanda's husband called the Native American Center for Health Professions, or NACHP. It's really a feather in our cap here and I would love to see all medical schools have some sort of pathway program like that. We won't get out of this hole until we start to really take that seriously. ASCO Daily News: Well, thank you so much, Dr. LoConte and Dr. Bruegl for taking the time and showing up for Native communities, and all your work to advance cancer care. We are certainly very grateful for your time today and we will embed links to all of the studies discussed in the transcript of this episode. So thank you again, Dr. LoConte and Dr. Bruegl. Dr. Noelle LoConte: You're welcome. Dr. Amanda Bruegl: Thank you for having us. ASCO Daily News: And thank you to our listeners for your time today. Again, you'll find links to the studies we discussed today in the transcript of this episode. Finally, if you value the insights that you hear on the ASCO Daily News Podcast, please take a moment to rate, review and subscribe wherever you get your podcasts. Disclaimer: 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. Follow today's speakers: Dr. Amanda Bruegl  Dr. Noelle LoConte @noelleloconte.bsky.social Follow ASCO on social media:  @ASCO on Twitter  ASCO on Facebook  ASCO on LinkedIn  Disclosures:  Dr. Amanda Bruegl – No relationships to disclose Dr. Noelle LoConte: Consulting or Advisory Role: Abbvie, PDGx Research Funding: Exact Sciences

World Congress of Prehabilitation and Perioperative Medicine plenary | TMT Down Under

TopMedTalk

Play Episode Listen Later Dec 23, 2024 28:34

This piece comes from Melbourne, Australia, at the World Congress of Prehabilitation and Perioperative Medicine, held alongside the Australian ERAS+ Conference. Recorded on the conference stage before an audience of guests and delegates, hear how the World Congress came to be where it is today. Presented by Mike Grocott, and Kate Leslie with Denny Levett, Professor in Perioperative Medicine and Critical Care at the University of Southampton and a Consultant in Perioperative Medicine at Southampton University Hospital NHS Foundation trust (UHS), and Gerrit Slooter, MD, PhD, Surgical Oncologist, Maxima Medical Centre, The Netherlands.

Clare PPN's Winter Plenary Offers Networking Opportunity For Community Groups

Clare FM - Podcasts

Play Episode Listen Later Dec 12, 2024 5:29

Clare PPN's Winter Plenary will take place in the new De Valera Library in Ennis on the 17th of December. For more on this, Alan Morrissey was joined by Clare PPN Coordinator,Sarah Clancy. Photo (c): https://clareppn.ie/clareppn-winter-plenary-2024/

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EVJ in Conversation Podcast, No. 83, November 2024, John Hickman Plenary Lecture at BEVA Congress 2024: Dean Richardson

Equine Veterinary Journal Podcasts

Play Episode Listen Later Nov 25, 2024 53:20

In this podcast recorded at BEVA Congress 2024, Dean Richardson delivers the John Hickman Plenary Lecture, "They Shoot Horses, Don't They? The Past, Present, and Future of Fracture Management."

conversations future congress richardson lecture plenary john hickman beva

Jubilee Year - "Hope Does Not Disappoint" We are Pilgrims of Hope - 11/21/2024

Catholic Women Now

Play Episode Listen Later Nov 21, 2024 24:42

Iowa Catholic Radio Network Shows: - Be Not Afraid with Fr. PJ McManus - Catholic Women Now with Chris Magruder and Julie Nelson - Faith of Trial with Deacon Mike Manno and Gina Noll - Making It Personal with Bishop William Joensen - Man Up! with Joe Stopulus - The Catholic Morning Show - The Uncommon Good with Bo Bonner and Dr. Bud Marr - Faith and Family Finance with Gregory Waddle

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Final Day of the Bishops' Fall Plenary Assembly in Baltimore

Play Episode Listen Later Nov 13, 2024 6:07

The United States Conference of Catholic Bishops (USCCB) gathered for the 2024 Fall Plenary Assembly in Baltimore, November 11-14. Among the speakers were Archbishop Borys Gudziak on the celebration of the 10th anniversary of Laudato Si', Bishop Timothy Senior on the Catholic Campaign for Human Development, Bishop Seitz on the Church's support for migrants and refugees, and Bishop Robert Baron, Bishop Thomas Daly, and Bishop Michael Burbidge on the teaching of Dignitas Infinita .

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Bishops Gather for Fall Plenary Assembly in Baltimore_1

united states president baltimore assembly bishops synod plenary usccb synodality united states conference

Play Episode Listen Later Nov 13, 2024 6:28

The United States Conference of Catholic Bishops (USCCB) gathered for the 2024 Fall Plenary Assembly in Baltimore, November 11-14. Among the speakers were Apostolic Nuncio to the United States, Cardinal Christophe Pierre, and President of the USCCB, Archbishop Timothy P. Broglio. Watch the livestream and read related materials at www.usccb.org/plenary-assembly-november-11-14-2024 Catholic Current also spoke with Ukrainian Bishop Stepan Sus, delegates to the Synod on Synodality, and Bishop Roy Campbell, who shared the history of the National Black Catholic Congress.

Celebrating 50+2 years of Scholarship: Department of the History and Sociology of Science - Plenary Presentations: Past, Present, Future

Historical Perspectives on STEM

Play Episode Listen Later Nov 7, 2024 44:04

Celebrating 50+2 years of Scholarship: Department of the History and Sociology of Science - Plenary Presentations: Past, Present, Future by Consortium for History of Science, Technology and Medicine

history science technology future medicine sociology scholarships presentations consortium past present future plenary

FATF Plenary, Influence and Sanctions, Financial Inclusion, and FINTRAC on Lawyers

AML Conversations

Play Episode Listen Later Nov 1, 2024 14:57

This week, John and Elliot discuss the outcomes of the October FATF Plenary, a recent investigative report about former government officials giving advice on sanctions compliance, the US Treasury's National Strategy on Financial Inclusion, FINTRAC's recent bulletin on the risks of Canadian lawyers not having to comply with AML rules, and several other items impacting the financial crime prevention community.

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3.118 Fall and Rise of China: Chinese Civil War Draws First Blood

Kings and Generals: History for our Future

Play Episode Listen Later Sep 23, 2024 32:48

Last time we spoke about the finale of the Northern Expedition, the reunification of China. In May the NRA advanced from the Yellow River bridgehead despite losing access to the Tianjin-Pukou railway, forcing a 60-mile march. General Chen Tiaoyuan captured Tehzhou on the 13th, as the NRA cleared northern Shandong. They then converged on Beijing, with Feng Yuxiang's 2nd Collective Army and Yan Xishan's 3rd Collective Army advancing from different directions. Yan Xishan fought the NPA, recapturing territories and capturing Nankou, which led to speculation he would enter Beijing first. Despite NPA counterattacks, the NRA forces continued their advance. By late May, the NRA's combined efforts and internal NPA issues led to a general retreat of the NPA forces. On June 6, Yan Xishan's troops entered Beijing. The NPA's Zhang Zuolin was assassinated by Japanese officers, leading to a power shift to his son Zhang Xueliang, who later aligned with Chiang Kai-Shek. By December 1928, China was unified under the KMT. #118 The Chinese Civil War Draws First Blood Welcome to the Fall and Rise of China Podcast, I am your dutiful host Craig Watson. But, before we start I want to also remind you this podcast is only made possible through the efforts of Kings and Generals over at Youtube. Perhaps you want to learn more about the history of Asia? Kings and Generals have an assortment of episodes on history of asia and much more so go give them a look over on Youtube. So please subscribe to Kings and Generals over at Youtube and to continue helping us produce this content please check out www.patreon.com/kingsandgenerals. If you are still hungry for some more history related content, over on my channel, the Pacific War Channel where I cover the history of China and Japan from the 19th century until the end of the Pacific War. So I said a few times during the northern expedition that I wanted to push aside the emerging Chinese civil war. Although we loosely covered a lot of the major events, this episode is going to try and narrow and focus it down. Now please note, up until this point I have to admit I had been using sources that were either skewed towards the Chinese nationalist views or were trying to be non biased. For some of these episodes I intentionally am using some CCP aligned sources, I will try my best to balance things out. Also a large part of this is going to be a retelling of the Shanghai Massacre, but more from the point of view of the CCP. All the way back in 1926, Chiang Kai-Shek had managed to seize power over the Kuomintang. He exerted control over the party and army as he unleashed the Northern Expedition. By November 9th Chiang Kai-Shek set up a new headquarters in Nanchang. Chiang Kai-Shek was determined to purge the party of communists and began to do so here. He began by recruiting a large number of right-wing Kuomintang members such as Dai Jitao and Wu Tiecheng. Dai Jitao was a member of the Kuomintang Central Executive Committee and had served as the Minister of the KMT's propaganda department. After the death of Sun Yat-Sen, Dai Jitao had actively promoted an anti-communist movement, drawing support from warlords, right wingers and those the CCP would describe as “imperialists”. In May of 1925 with the support of Chiang Kai-Shek, Dai Jitao began an anti-communist campaign in Shanghai. He ran two successful pamphlets loosely translated in English as "The Philosophical Foundation of Sun Yat-senism" and "National Revolution and the Chinese Kuomintang”. Both worked to promote the teachings of Confucius and Mencius while distorting Sun Yat-sen's thoughts. Dai Jitao was arguing that Sun Yat-Sen's ideology chiefly came from Confucianism instead of western philosophy and that in fact the man was a traditionalist. He twisted Sun Yat-Sen's three principles, castrating them of revolutionary content. All of this quickly became a "banner" for the Kuomintang right-winger to carry out anti-communist activities. After Chiang Kai-Shek arrived in Nanchang, he immediately invited him to go north to jointly plan the purge of the party and anti-communism. Wu Tiecheng joined Dai Jitao, he was the director of the Guangzhou Public security Bureau and a well known KMT right-winger. Prior to the Zhongshan ship incident, Wu Tiecheng stated he had suggested to Chiang Kai-Shek that they impose sanctions on the CCP. In his words “with the registration materials of the special household registration of our Public Security Bureau, we can immediately arrest a dozen of the main Communist Party members, and then use a ship to transport them to a small island near Zhongshan County , or send them to Shanghai. As for the minor members, they will be temporarily detained." Chiang Kai-Shek said "I will think about it first." After the Zhongshan incident, Chiang Kai-Shek pretended to dismiss him from his post, but specially invited him later to Nanchang and dispatched him to Japan as a liaison. Another large figure who was invited over was Huang Fu, who had served as the Minister of Foreign affairs and Education for the Beiyang Government and as its Prime Minister. When Chiang Kai-Shek came to Nanchang he wrote to Huang Fu twice inviting him to come south. On December 31st, Zhang Jingjiang and Chen Guofu were also invited to Nanchang. Zhang Jingjiang was a member of the KMT's Central Supervisory Committee. After the secondary Plenary session of the second central committee, he became chairman of it. He used his authority and colluded with Chen Guofu, the Minister of Organization to dissolve the Guangzhou Municipal Party committee, which at the time was being led by left winger KMT. They did this by placing confidants in various positions to steal power. Simultaneously, they suppressed worker and peasant movements in Guangdong, even dispatching gangsters to kill their leaders and burn down the provincial and Hong Kong strike committee HQ. All of these people gathered at Nanchang formed a anti-communist cabal backing Chiang Kai-Shek. In January of 1927 these men went up Mount Lushan to a famous hotel called Xianyan where they plotted. After several days of meetings, as my source argues, mostly based on the advice of Huang Fu, these following decisions were obtained. Number 1, they would enact a policy of separating from the USSR and purging the party of CCP. Number 2, the NRA must settle the southeast by forming an alliance with the gentry and merchant class there. Number 3 in their diplomatic efforts they had to abandon the USSR and ally themselves to Japan. Number 4, to increase their military power they had to unite with Feng Yuxiangs Guominjun and Yan Xishan. Upon returning to Nanchang, Chiang Kai-Shek took action, first by attacking Borodin. He sent a telegram to Xu Qian, the chairman of the Wuhan joint conference, stating Borodin had insulted him in public at Wuhan and demanded he be removed from his advisory position. He also recomended expell Borodin back to the USSR. The source I am reading states Chiang Kai-Shek had two rationales for going after Borodin. "Chiang Kai-Shek felt that except for Borodin, the Kuomintang leaders in Wuhan were all politically incompetent. ... As long as Borodin was there, he could not gain a dominant position. Secondly, he was using Borodin like a scape goat to hide his real anti-Soviet purpose'. At this time Chiang Kai-Shek was being labeled a USSR stooge by the NPA and a Japanese stooge by the CCP. In response, Chiang Kai-Shek stated publicly "Our alliance with Russia was left by the Prime Minister. Although its representatives have been arrogant for a long time and oppressed our party leaders in many ways, I believe that this has nothing to do with the Soviet Union's spirit of treating us equally. No matter what their personal attitudes are, we will never change our relationship with the Soviet Union towards Japan. Why should we unite with the Soviet Union? It is because the Soviet Union can treat China equally. Since the Soviet Union has not given up treating us equally, how can we give up the policy of alliance with Russia. ... Not only Japan, but any country, if it can treat China equally, then we will treat them the same way as we treat the Soviet Union. It is not impossible to unite with them. We unite with the Soviet Union to seek freedom and equality for China. It is completely based on the meaning of treating our nation equally, so we must unite with the Soviet Union. If the Soviet Union does not treat us equally and oppresses us in the same way, we will also oppose them in the same way. I have said for a long time." In regards to the CCP Chiang Kai-Shek stated to his close confidants “When I was in Guangzhou, I was always paying attention to the actions of the CCP. I wanted to implement my proposal to overthrow the CCP in Guangzhou, however I did not do so. I was unable to do so because it could mean the end of the Kuomintang”. After the success of the Northern Expedition, Chiang Kai-Shek lamented to his confidants “although our army has won a great victory, I still worry the enemy is not at our front but at our rear. The CCP is causing much trouble within, we must make sure it does not split out party or even collapse our army. There are thorns everywhere”. Publically Chiang Kai-Shek stated "Now there is a rumor that I distrust and alienate my Communist comrades and have a tendency to oppose them. In fact, it cannot be said that I will not oppose the Communist Party. I has always supported the Communist Party... But that is to say, if the Communist Party becomes strong in the future and its members are arrogant and tyrannical, I will definitely correct them and punish them. ... Now many Communist Party members are actually oppressing the Kuomintang members, showing an overbearing attitude, and tend to exclude Kuomintang members, making Kuomintang members embarrassed. In this way, I can no longer treat Communist Party members with the same preferential treatment as before. If I still have the same attitude as before, then I am not in the position of a Kuomintang member, and I cannot be a Kuomintang member. Although I am not a Communist Party member, from a revolutionary perspective, I have to take some responsibility for the success or failure of the Communist Party! I am the leader of the Chinese revolution, not just the leader of the Kuomintang. The Communist Party is a part of the Chinese revolutionary forces. Therefore, if Communist Party members do something wrong or act tyrannically, I have the responsibility and power to intervene and punish them." As you can see, publicly Chiang Kai-Shek was always walking on eggshells when attacking the CCP. If you know the old boiling frog analogy, it's more or less like Chiang Kai-Shek gradually getting the public to attack the CCP. At the ceremony where Li Liejun was appointed chairman of Jiangxi, Chiang Kai-shek once again gave a speech, saying that communism was only a method of economic development, which might be applicable in some countries, but if China adopted communism, it would be a great harm and would only lead to the overthrow and revolution of China. In late January, Chiang Kai-Shek met with Momuro Keijiro, a representative sent by Japan's minister of Finance and Navy at Lushan. Chiang Kai-Shek explained to Keijiro that he understood the importance of the political and economic relationship between Manchuria and Japan. He understood the Japanese had spilt a lot of blood there during the Russo-Japanese War. He believed Manchuria required special consideration and hoped the Japanese would correctly evaluate the KMT's struggle to reunify China. Chiang Kai-Shek then met with the Japanese consul General in Jiujiang, Edo Sentaro, explaining he did not only intend to abolish the unequal treaties but would try to respect the existing conditions as much as possible, such as guaranteeing the recognition of foreign loans and repayments and respecting foreign owned enterprises. After these meetings Chiang Kai-Shek met with representatives of the Imperial Japanese Military such as Nagami Masuki and Matsumuro Takayoshi. It was Dai Jitao who set up these meetings. Chiang Kai-Shek began the talks by making it clear the KMT would not work with the CCP and was willing to work with Japan to prevent the spread of Communism in China. Chiang Kai-Shek also met with the Japanese politician Yamamoto Jotario who would go on to say in Beijing that he believed the Generalissimo was an outstanding military leader. Needless to say, as my source would put it “Chiang Kai-Shek was closely colluding with Japanese imperialism”. He was also establishing contacts with the US. He dispatched Wang Zhengting to Shanghai to meet the American consul general there. Wang Zhengting told him the KMT had washed their hands of the communists and that there would be nor more incidents such as the one that befell Hankou. The American consul general in Guangzhou was likewise contacted through the finance minister of Guangdong, Kong Xiangxi. What the American consuls told their government was “if the powers want to drive the Soviets out of China, they should establish direct contact with Chiang Kai-Shek”. Chiang Kai-Shek also publicly expressed regret to numerous nations for incidents such as the one in Nanjing. He was gaining a reputation as being the only leader in China capable of restoring order amongst the chaos. Many of these foreign diplomats privately told Chiang Kai-Shek that if he wanted to really brush shoulders with them he had to purge the communists and soon. To truly purge the communists Chiang Kai-Shek reaches a deal with the bourgeoisie of Jiangsu and Zhejiang. They will support him economically if he helps suppress the worker movements in Shanghai. They fund Chiang Kai-Shek some 500,000 Yuan in early March, then on the 29th the Shanghai Commercial Federation pledges 5 million Yuan, with another 3 million on April 1st. Around this time Chiang Kai-Shek secretly send Wang Boling, the deputy commander of the 1st army; Yang Hu, chief of the special affairs department of the general HQ and Chen Qun the director of the political department of the eastern route army to Shanghai in disguise to meet Huang Jinrong. Huang Jinrong was a chief detective working in the French concession of Shanghai. He also happened to be one of the top three gangsters working under Du Yuesheng of the Green Gang. Huang Jinrong summoned Du Yuesheng and the other Green Gang leader Zhang Xiaolin, as they all discussed how to purge the communists. The Green Gang leaders seized the opportunity to help the KMT. They began monitoring the CCP, armed their gang members and began to attack anyone who was picketing. They formed the “China Progress Association”, which in reality was just Green Gang members. This association proceeded to attack the Shanghai General Labor Union, providing the perfect pretext for Chiang Kai-Shek to act. On April 1st Wang Jingwei returns to Shanghai from aboard. By the 3rd Chiang Kai-Shek telegrams that Wang Jingwei is reinstated and holds secret talks with him. On the 8th Chiang Kai-Shek organizes a Shanghai Provisional Political Committee, stipulating it will decide all military, political and financial decisions and will replace the Shanghai special municipality provincial government that was established after the third Shanghai worker uprising. On the 9th he unleashes martial law prohibiting assemblies, strikes and marches, and established the Songhu Martial Law Command, with Bai Chongxi and Zhou Fengqi as the commander and deputy commander. Chiang Kai-Shek then takes his leave for Nanjing, leaving the job to Bai Chongxi who will supervise a coup in Shanghai. In a vain attempt Chen Duxiu tells the CCP to ease up on the Anti-Chiang Kai-Shek stuff. Then its announced to them that Chen Duxiu had managed to form a deal with Wang Jingwei. Chiang Kai-Shek send word from Nanjing to carry out the purge, in a very “execute order 66 fashion”. April the 12th takes a wild turn in Shanghai. In the early morning a signal is raised over a warship anchored near the Gaochang temple. Hundreds of well armed Green Gang, Triads and some secret agents wearing blue shorts and white cloth armbands with a black gongs on them, dispersed from the French concession in several cars. From 1 to 5am they attacked the picketing workers in Zhabei, Nanshi, Huxi, Wusong, Hongkou and other districts. The workers resisted immediately causing fierce street battles to break out. The 26th Army of the NRA, an old Sun Chuanfang unit that recently defected, came to forcibly confiscate guns while stating they were “mediating an internal strife amongst the workers”. Over 2700 armed workers in Shanghai were disarmed. More than 120 were killed with another 180 injured. The Shanghai General Labor Union club and all their associated pickets in the districts were occupied. Within the foreign concessions, foreign military and police forces arrested more than 1000 CCP members and workers who were immediately handed over to Chiang Kai-Shek's men. On the morning of the 13th, the workers from Shanghai's tobacco, silk factories, trams, municipal administration, postal services, sailors and various other industries went on strike. Over 200,000 workers took to the streets and the Shanghai General Labor Union held a mass rally in Qingyun Road Square in Zhabei with over 100,000 participants. They held a quick conference calling for resolutions. The first resolution was to hand over their weapons. Secondly those who destroyed their unions should be severely punished. Third the families of those killed needed to be compensated. Fourth protests should be made against the imperialists within the concessions. Fifth a telegram needed to be sent to the central government, then whole nation and world to demand assistance. Lastly the military authorities should be responsible for protecting the Shanghai trade unions. After the conference, the masses marched upon the headquarters of the 2nd division of the 26th army along Baoshan road to petition for the release of their comrades and for their weapons to be returned to them. They marched for a kilometer and upon reaching the Sandeli area of Baoshan road, soldiers of the 2nd division rushed out and opened fire upon them killing more than 100 on the spot. It was said Baoshan road was flooded with blood. That afternoon Chiang Kai-Sheks forces occupied the Shanghai General Labor Union and General Command of the Shanghai workers. They closed down and disbanded numerous revolutionary organizations and carried out searches and murders. Within 3 days after the Shanghai incident, more than 300 Shanghai CCP members were killed, another 500 were arrested and 5000 went “missing”. Like I said in the previous podcast on this very subject, I will leave it to you as to what missing meant. On the 15th of april the Kuomintang in Guangzhou launched their own coup. On that day more than 2000 CCP members and their supporters were arrested, 200 trade unions were closed. This all would b followed by similar activities in Jiangsu, Zhejiang, Anhui, Fujian and Guangxi where CCP members were purged. The NPA in the north would likewise crack down on communists. Li Dazhao had been placed on the Beiyang governments list of most wanted back in 1926 following the March 18th massacre. Since then he was hiding in the Soviet Embassy in Beijing, continuing to lead political maneuvers against the warlords. When the first united front collapsed as a result of Chiang Kai-Sheks purges, Zhang Zuolin ordered troops to raid the Soviet embassy. Li Dazhao, his wife and daughter were all arrested. Among 19 other communists, Li Dazhao was executed on April 28th of 1927 by strangulation. One of the behemoths who ushered in the New Culture Movement and was a founder of the CCP had become one of its greatest martyrs. The first united front was no more and in response to this the CCP declared "Chiang Kai-shek has become an open enemy of the national revolution, a tool of imperialism, and the culprit of the white terror of massacring workers, peasants and revolutionary masses”. This was followed by a call to mobilize, unite and form a solid front to fight the warlords and KMT. In May of 1927 the Communist International issued “the May Emergency Directive” to the CCP. (1) Without land revolution, victory is impossible; without land revolution, the Kuomintang Central Committee will become a pitiful plaything in the hands of unreliable generals. Excessive behavior must be opposed, but not by the army, but through the peasant associations. (2) It is necessary to make concessions to artisans, merchants and small landowners, and to unite with these strata. Only the land of large and medium-sized landowners should be confiscated; the land of officers and soldiers should not be touched. (3) Some old leaders of the KMT Central Committee will waver and compromise. We should recruit more new leaders of workers and peasants from below to join the KMT Central Committee and renew the KMT's upper echelons. (4) Mobilize 20,000 Communist Party members and 50,000 revolutionary workers and peasants in Hunan and Hubei to form several new armies and build our own reliable army. (5) A revolutionary military tribunal headed by prominent Kuomintang and non-Communists should be established to punish those officers who persecute workers and peasants. Wang Jingwei obtained this document from Luo Yi, the representative of the Communist International. The high-ranking officials of the Kuomintang believed that this was the Communist International's armed seizure of power and they were determined to purge the party. Thus began the Wuhan-Nanjing war. However as we saw, Wang Jingwei would perform his own purge of the communists on May 21st as he found out the Soviets were pushing the CCP to seize control over his regime. In order to resist the KMT's massacres, or as the CCP put it “the white terror”, the CCP Central Committee reorganized itself on July 12th of 1927. Chen Duxiu and other early CCP leaders who had insisted on compromising with the KMT were dismissed from their posts and labeled right-wing capitulationists. The CCP formed an alliance with left wing KMT members forming a quasi second front where they planned an armed uprising in Nanchang hoping it would spark a large peasant uprising. They were led by He Long and Zhou Enlai. He Long a ethnic Tujia and Hunanese native was born to a poor peasant family. He received no formal education and worked as a cowherder during his youth. When he was 20 he killed a local Qing tax assessor who had killed his uncle for defaulting on his taxes. From this point he fled and became an outlaw, apparently his signature weapon was a butcher knife. In 1918 he raised a volunteer revolutionary army aligned with an emerging Hunanese warlord. By 1920 he joined the NRA and began brushing shoulders with CCP members. During the northern expedition he commanded the 1st division, 9th corps and served under Zhang Fakui. By late 1926 he joined the CCP. When the first united front collapsed he joined up with the CCP and took command of the 20th corps, 1st column of the Red Army. Zhou Enlai was born in Huai'an of Jiangsu in 1898. He was born to a scholarly family, many of them officials, but like many during the late 19th century in China suffered tremendously. Zhou Enlai was adopted by his fathers youngest brother Zhou Yigan who was also ill with tuberculosis. The adoption was more of a way to cover Zhou Yigans lack of an heir. Zhou Yigan died soon after and Zhou Enlai was raised by his widow Chen. He received a traditional literacy education. Zhou Enlai's biological mother died when he was 9 and Chen when he was 10. He then fell into the care of his uncle Zho Yigeng in Fengtian. Zhou Enlai continued his education at Nankai Middle School who were adopting an educational model used at the Philipps academy in the US. Zhou Enlai excelled at debate, acting, drama the sort of skill sets needed for public service. Like many students of his day he went to Japan in 1917 for further studies. He tried to learn Japanese to enter Japanese schools but failed to do so. He also faced a lot of racism in Japan, prompting him to become quite anti japanese. While in Japan he became very interested in news about the Russian Revolution. This led him to read works from Chen Duxiu. In 1919 he returned to Tianjin where it is said he led student protests during the May Fourth movement, though a lot of modern scholars don't believe he did. Zhou Enlai then became a university student at Nankai and an activist. He led the Awakening Society and would find himself arrested. During this time he became familiar with Li Dazhao and Chen Duxiu. Then in 1920 he went to study in Marseille. In 1921 he joined a Chinese Communist Cell while in Paris. By 1922 he helped found a European branch of the CCP. When the first United Front began he joined the KMT and in 1924 was summoned back to China. He joined the Political department of the Whampoa military academy. He was made Whampoa's chief political officer, but he also took the post as secretary of the CCP of Guangdong, Guangxi and served as a Major-General. Soon he became the secretary of the CCP's Guangdong Provincial committee. In 1925 he got his first taste of military command against Chen Jiongming, accompanying the Whampoa cadets as a political officer. When Chen Jiongming regrouped and attacked Guangzhou again that year, Chiang Kai-Shek personally appointed Zhou Enlai as director of the 1st corps political department. Soon after he was appointed a KMT party representative as chief commissar of the 1st corps. With the newfound position he began appointing communists as commissars in 4 out of the 5 corps divisions. However his work at Whampoa came to an end during the Zhongshan Warship incident as Chiang Kai-Shek began purging communists from high ranking positions. Whampoa was a significant part of his career providing him with skills and a network. Until the first united fronts collapse he worked to form numerous armed CPP groups. He was sent to Shanghai where he was part of the effort to stage an uprising there. During the massacre he was arrested and nearly killed if not for the work of Zhao Shu, a representative of the 26th army who released him. From there he fled to Hankou where he participated in the CCP's 5th national congress. When Wang Jingwei unleashed his purge, Zhou Enlai went into hiding. When the CCP called for an uprising in Nanchang, Zhou Enlai as a CCP secretary was in a unique position to lead it. The CCP designated Zhou Enlai, Li Lisan, Yun Daiying and Peng Pai to form a Front Committee. The troops available to them were the 24th and 10th divisions of the 11th army of the 2nd front army, the entire 20th army, 73rd and 75th regiment of the 25th division of the 4th army and part of the officer training corps of the 3rd army of the 5th front army led by Zhu De. He Long was the commander in chief of the 2nd front army, Ye Ting was his deputy and acting front line commander. Zhou Enlai was the chief of staff with Liu Bocheng as director of the political directorate. At this time, the main force of the 3rd Army of the 5th Front Army of the Kuomintang Wuhan Government was located in Zhangshu, Ji'an; the main force of the 9th Army was located in Jinxian and Linchuan; and the main force of the 6th Army was advancing to Nanchang via Pingxiang; the rest of the 2md Front Army was located in Jiujiang; only the 5th Front Army Guard Regiment and parts of the 3rd, 6th, and 9th Armies, totaling more than 3,000 people, were stationed in Nanchang and its suburbs. The CCP Front Committee decided to launch an uprising on August 1 before the arrival of reinforcements. At 2:00am on August 1st the Nanchang uprising began. The 1st and 2nd division of the 20th army launched attacks against the defenders of the Old Fantai Yamen, Dashiyuan street and the Niuxing railway station. Meanwhile the 24th division of the 11th army attacked the Songbaixiang catholic church, Xinyingfang and Baihuazhou. The bloody battle lasted until dawn inflicting 3000 casualties and capturing more than 5000 small arms of various types, 700,000 rounds of ammunition and a few cannons. During the afternoon the 73rd regiment of the 25th division station at Mahuiling, 3 battalions of the 75th regiment and a machine gun company of the 74th regiment led by Nie Rongzhen and Zhou Shidi revolted and came to Nanchang by the 2nd of august. For the moment it seemed the CCP had achieved a grand success at Nanchang. The CCP then began proclaiming Chiang Kai-Shek and Wang Jingwei had betrayed the revolution and that of Sun Yat-Sens three principles by choosing to side with the imperialists and warlords. Meanwhile the CCP aligned military units began to gather in Nanchang requiring a reorganization. It was decided the uprising army would continue to use the designation of 2nd front army of the NRA with He Long serving as its commander in chief and Ye Ting as his deputy. Ye Ting would also command the 11th army consisting of the 24th, 25th and 10th divisions, Nie Rongzhen would be his CCP party representative; He Long would command the 20th Army consisting of the 1st and 2nd divisions with Liao Qianwu as his CCP party representative. Zhou Enlai with Zhu De as his deputy would lead the 9th army with Zhu Kejing as his CCP party representative. Altogether they were 20,000 strong and now very well armed. There was to be a great celebration, it seemed this was the grand moment the CCP would take the center stage. I would like to take this time to remind you all that this podcast is only made possible through the efforts of Kings and Generals over at Youtube. Please go subscribe to Kings and Generals over at Youtube and to continue helping us produce this content please check out www.patreon.com/kingsandgenerals. If you are still hungry after that, give my personal channel a look over at The Pacific War Channel at Youtube, it would mean a lot to me. The Chinese Civil War had officially just begun. Chiang Kai-Shek and Wang Jingwei purged their respective regimes of communists unleashing a white terror. In a scramble to survive the CCP reorganized itself and sought revenge with their first target being Nanchang. From here until 1949, the CCP and KMT would fight for the future of China.

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Challenging the Truthfulness of Scripture

Good Theological Thursday

Play Episode Listen Later Sep 19, 2024 59:11

Send us a textW3: We are back! We discuss all that has been happening in our lives over the past few months.Main Topic: Can the Bible be infallible but not inerrant? Does the Bible claim inerrancy? Does human involvement mean Scripture must have errors? We discuss 6 challenges to the truthfulness of Scripture.

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131. ESMO 2024 - Plenary Special

Oncology for the Inquisitive Mind

Play Episode Listen Later Sep 18, 2024 37:07

We have finally come to the end of ESMO 2024, and as is now tradition, Michael and Josh conclude their epic journey with a special episode highlighting their absolute favourite practice-changing selections from the Plenary Sessions. As always, ESMO brought a selection of wonderful studies that truly deserve the title "practice changing." As always, a huge thanks to everyone who joined us on this amazing journey. It has been a wonderful experience to attend a major international conference for the first time, and we are so privileged to be able to bring these results to you.Stay tuned to Oncology for the Inquisitive Mind in the coming weeks as we will be starting our ESMO 2024: Retrospective miniseries, where we speak to experts in the areas of breast, lung, GI, GU and skin cancers and get their opinions on the goings on in Barcelona.PEACE-3PODIUMKEYNOTE-A18KEYNOTE-522 OS DataNIAGRANote: this episode was recorded over two days at two separate locations.For more episodes, resources and blog posts, visit www.inquisitiveonc.comPlease find us on Twitter @InquisitiveOnc!If you want us to look at a specific trial or subject, email us at inquisitiveonc@gmail.comOncology for the Inquisitive Mind is recorded with the support of education grants from Pfizer, Gilead Pharmaceuticals and Merck Pharmaceuticals. Our partners have no editorial rights or early previews, and they have access to the episode at the same time you do.Art courtesy of Taryn SilverMusic courtesy of AlisiaBeats: https://pixabay.com/users/alisiabeats-39461785/Disclaimer: This podcast is for educational purposes only. If you are unwell, seek medical advice. Hosted on Acast. See acast.com/privacy for more information.

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S11 Ep2: ASCO 2024 Plenary: NADINA Trial Neoadjuvant Ipi/Nivo vs Adjuvant Nivo for Resectable Stage III Melanoma

OncLive® On Air

Play Episode Listen Later Aug 12, 2024 10:09

Drs Armstrong and Tawagi discuss the NADINA trial of neoadjuvant nivolumab/ipilimumab vs adjuvant nivolumab in resectable, macroscopic, stage III melanoma.

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ASCO 2024 Plenary: NADINA Trial Neoadjuvant Ipi/Nivo vs Adjuvant Nivo for Resectable Stage III Melanoma

Two Onc Docs

Play Episode Listen Later Aug 12, 2024 10:09

This week's episode will be discussing updates from ASCO 2024 next with the practice changing NADINA trial presented on the Sunday of ASCO by Dr. Christian Blank during the plenary sessions: A multicenter, randomized, phase 3 trial comparing the efficacy of neoadjuvant ipilimumab plus nivolumab with standard adjuvant nivolumab in macroscopic resectable stage III melanoma. We discuss the staging and prior standard of treatment for locally advanced melanoma, key findings from NADINA, and how these data may impact clinical practice.

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#11754 Ask Me Anything - Jim Blackburn

Catholic Answers Live

Play Episode Listen Later Jul 10, 2024

Questions Covered: 04:38 – Was the material universe always supposed to be temporary? 16:28 – What does the verse that says Jesus is first born of all creation mean? 19:35 – What qualities do women lack that disqualifies them from being priests? 22:54 – Why in some places do they stand after the consecration before the great amen. What do bishops have to do to get those changes approved? 39:57 – Does God still chastise people for their sins on this earth like He did in the old Testament? 45:47 – What’s the difference between a Plenary indulgence earned during the day and one which is earned at the moment of death? 49:51 – What is a general confession? …

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S10 Ep41: ASCO 2024 Plenary: ADRIATIC Trial in Limited-Stage Small Cell Lung Cancer

OncLive® On Air

Play Episode Listen Later Jul 8, 2024 12:26

OncLive On Air partners with Two Onc Docs to bring insights on the ADRIATIC trial, data from which were presented at the 2024 ASCO Annual Meeting.

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ASCO 2024 Plenary: ADRIATIC Trial in Limited Stage Small Cell Lung Cancer

Two Onc Docs

Play Episode Listen Later Jul 8, 2024 12:26

This week's episode will discuss updates from ASCO 2024 next with the practice changing ADRIATIC trial presented by Dr. Spigel during the plenary: Durvalumab as consolidation treatment for patients with limited-stage small-cell lung cancer (LS-SCLC).

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FATF June Plenary, Wolfsberg Group, FinCEN Proposed Rule, and More

AML Conversations

Play Episode Listen Later Jul 5, 2024 18:08

This week, John and Elliot discuss several developments impacting the financial crime community. These include the results of the recent FATF Plenary, a new statement from the Wolfsberg Group on effective monitoring for suspicious activity, the proposed rule from FinCEN to strengthen and modernize AML/CFT programs, and other items.

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Top ASCO24 Abstracts That Could Revolutionize Oncology

Play Episode Listen Later Jun 26, 2024 27:33

Drs. John Sweetenham and Angela DeMichele discuss potentially ground-breaking abstracts in breast and lung cancer as well as notable research on artificial intelligence and its impact on cancer care, all of which were featured at the 2024 ASCO Annual Meeting. TRANSCRIPT Dr. John Sweetenham: Hello, I'm Dr. John Sweetenham from UT Southwestern's Harold C. Simmons Comprehensive Cancer Center and host of the ASCO Daily News Podcast. My guest today is Dr. Angela DeMichele, the Marianne and Robert McDonald Professor in Breast Cancer Research and co-leader of the Breast Cancer Program at the University of Pennsylvania's Abramson Cancer Center. Dr. DeMichele also served as the chair of the 2024 ASCO Annual Meeting Scientific Program. Today, she'll be sharing her reflections on the Annual Meeting and we'll be highlighting some advances and innovations that are addressing unmet needs and accelerating progress in oncology. Our full disclosures are available in the transcript of this episode. Dr. DeMichele, congratulations on a very robust and highly successful program at ASCO24, and thanks for joining us on the podcast today. Dr. Angela DeMichele: Well, thanks so much for having me, Dr. Sweetenham. It's a pleasure to be here. Dr. John Sweetenham: The presidential theme of the Annual Meeting this year was the "The Art and Science of Cancer Care: From Comfort to Cure." And this was certainly reflected throughout the meeting in Chicago that welcomed more than 40,000 attendees from across the globe. I know our listeners will be interested to hear some of your own reflections from the meeting now that we're on the other side of it, so to spea Dr. Angela DeMichele: Yes. Well, I will say that playing this role in the annual meeting really was a highlight of my career, and I feel so fortunate to have had the opportunity to do it. We had over 200 sessions, and in many, if not all of these sessions, we really tried to make sure that there was a case that really sort of grounded the session to really help people understand: you're going to hear about science, but how are you going to apply that? Who is the patient for whom this science really is important? We had over 7,000 abstracts submitted, and our 25 tracks and their chairs really pulled through to find really the best science that we could present this year. I think what you saw really was a representation of that across the board: incredible advances in lung cancer, breast cancer, melanoma, GI cancers; also really cutting-edge technologies: AI, as we'll talk about in a little while circulating markers like ctDNA, new drug development, new classes of drugs. So it was really an exciting meeting. I mean, some highlights for me, I would say, were certainly the Plenary, and we can talk a little bit about that. Also, we had a fantastic ASCO/AACR Joint Session on “Drugging the “Undruggable Target: Successes, Challenges, and the Road Ahead.” And, if any of the listeners have not had a chance to hear this, it's really worth going in and watching this because it really brought together three amazing speakers who talked about the successes in KRAS, and then really, how are we using that success in learning how to target KRAS to now targeting a variety of other previously thought to be undruggable targets. I learned so much. And there's really both the academic and the pharma perspective there. So I'd really encourage watching this session. The other session that I really thought was terrific was one that I was honored to chair, which was a fireside chat (“How and Where Will Public Investment Accelerate Progress in Oncology? A Discussion with the NIH and NCI Directors”) with both Dr. Monica Bertagnolli, who is the director of the NIH, and Dr. Kim Rathmell, who's now the director of the NCI. And boy, I'll tell you, these two incredibly smart, thoughtful, insightful women; it was a great conversation. They were really understanding of the challenges we face conducting research, practicing medicine. And maybe different from leadership at the NIH in the past, they've really taken the approach to say that everything they do is focused on the patient, and they don't limit themselves to just research or just science, that everything that the NIH does, and particularly the NCI does, really has to be focused on making sure we can give patients the best possible care. And I think they're being very thoughtful about building important infrastructure that's going to take us into the future, incorporating AI, incorporating new clinical trial approaches that are going to make it faster and easier to conduct clinical trials and to get the results that we need sooner. So just a few of the highlights, I think, from some really interesting sessions. Dr. John Sweetenham: It certainly was an extremely enriching and impactful ASCO24. And I think that the overall theme of the meeting was extremely well reflected in the content with this amazing mix of really, truly impactful science, along with a great deal of patient-centered healthcare delivery science to accompany it. So, I completely agree with you about that. There was a lot, of course, to take in over the five days of the meeting, but I'm sure that our listeners would be very interested to hear about one or two abstracts that really stood out for you this year. Dr. Angela DeMichele: Sure. I'm a breast cancer specialist, so I can't help but feel that the late breaking abstract, the DESTINY-Breast06 trial, was really important for the field of breast cancer. So just briefly, this is a study of the antibody drug conjugate T-DxD, trastuzumab deruxtecan. This is a drug that is actually now approved in metastatic breast cancer, really effective in HER2-positive disease. But the question that this trial was trying to answer is, can this drug, which is built with the herceptin antibody against HER2, then linked to a chemotherapeutic molecule, can this work even in the setting of very, very low HER2 expression on a tumor? I think this is an incredibly important question in the field of antibody drug conjugates, of which there are now many across diseases, is how much of the target do you really need to have on the surface of the tumor? We had seen previously HER2 overexpressing tumors respond really well to this drug. HER2 tumors that have an intermediate level of expression were tested in the DP04 trial, and we saw that even those 2+ intermediate tumors responded well to this drug. The DP06 trial that was presented at ASCO was looking at this group of patients that have even less HER2 on the surface. So we typically measure HER2 by immunohistochemistry as 0, 1+, 2+, or 3+. And this was looking at patients whose tumors were over 0, but were at 1+ or below, so low and ultra-low. And it turned out that compared to treatment of physician's choice, the drug really had quite a lot of activity, even in these patients who have very little HER2 on their tumors, really showing progression-free survival benefits in the HER2-low and HER2-ultra-low groups that were appreciable on the order of about 5 months, additional progression free survival hazard ratios around 0.6, so really demonstrating that utilizing an antibody drug conjugate, where you've got very little target, can still be a way to get that drug to a tumor. And I think it'll remain to be seen whether other ADCs can have activity at very low levels of IHC expression of whatever target they're designed against. I think one of the tricky things here for implementing this in breast cancer will be how do pathologists actually identify the tumors that are ultra-low because it's not something that we typically do. And so we'll go through a period, I think, of adjustment here of really trying to understand how to measure this. And there are a bunch of new technologies that I think will do a better job of detecting low levels of the protein on the surface of the tumor because the current IHC test really isn't designed to do that. It was only designed to be focused on finding the tumors that had high levels. So we have some newer technologies with immunofluorescence, for example, that can really get down to very low levels. And I think this is going to be a whole new area of ADCs, target detection – how low can you go to still see activity? So I thought that this was an important abstract for many reasons. I will just say the second area that I was really particularly impressed with and had a big impact on me were the two lung cancer abstracts that were presented in the Plenary, the LAURA trial (LBA4) and the ADRIATIC trial (LBA5). And I think, I've been in the field of oncology for 30 years now, and when I started in the late ‘90s, lung cancer was a disease for which we had very few treatments. If we didn't catch it early and surgery wasn't possible for non-small cell lung cancer, really, it was a horrible prognosis. So we knew this year was the 20th anniversary of the discovery of EGFR as a subtype of lung cancer. That was really, I think, a turning point in the field of non-small cell lung cancer – finding a target. And now seeing the LAURA trial show that osimertinib really had such an enormous impact on progression-free survival amongst these patients who had EGFR-positive non-small cell lung cancer, progression-free survival hazard ratio of 0.16; there was a standing ovation. And one of the really big privileges of being the Scientific Program Chair is getting to moderate the Plenary Session, and it's a really amazing experience to be standing up there or sitting there while the presenter is getting a standing ovation. But this was well deserved because of the impact this is having on patients with EGFR positive lung cancer. And it was similar with the ADRIATIC trial, which looked at the benefits of adding immunotherapy in limited-stage small-cell lung cancer. Again, a disease that treatment has not changed in 30 years, and so the addition of durvalumab to the standard backbone of chemotherapy for small cell lung cancer had its survival advantage. These patients are living longer and it was really an impressive improvement. And I think it really underscores just the revolution that has happened in lung cancer between targeted therapy and immunotherapy has completely changed the prognosis for patients with this disease. So to me, these were really landmark reports that came out at ASCO that really showed us how far we've come in oncology. Dr. John Sweetenham: Yeah, absolutely. I think that, as you mentioned, those results are truly remarkable, and they reflect extraordinary advances in science. I think we see that both in terms of the therapeutic arena, but also, I think we've started to see it in other areas as well, like symptom control, remote patient monitoring, and so on and so forth, where some of the newer virtual technologies are really having major impacts as well. Dr. Angela DeMichele: Yes, we really wanted to have a focus on artificial intelligence in this meeting, because it's having such an enormous impact on our field in everything from care delivery to diagnostics. I'd love to hear what you thought was the most interesting, because there really was just new data across the board presented. Dr. John Sweetenham: I've actually chosen 3 abstracts which I thought were particularly interesting for a couple of reasons, really. They're all based on virtual health interventions, and I think they're interesting in really reflecting the theme of the meeting, in that they are extremely advanced technology involved in the virtual platforms, a couple of which are artificial intelligence, but very impactful to patients at the same time in terms of remote symptom control, in terms of addressing disparities, and in one case, even influencing survival. So I thought these were three really interesting abstracts that I'll walk the listeners through very quickly. The first of these was a study, Abstract 1500 (“National implementation of an AI-based virtual dietician for patients with cancer”) which looked at an artificial intelligence-based virtual dietitian for patients with cancer. This is based on the fact that we know nutritional status to be a key driver of patient experience and of cancer outcomes. And as the authors of the presentation noted, 80% of patients look for nutritional support, but many of them don't get it. And that's primarily a workforce issue. And I think that's an important thematic point as well, that these new technologies can help us to address some of the workforce issues we have in oncology. So this was an AI-based platform developed by experts in nutrition and cancer patients, based on peer reviewed literature, and a major effort in terms of getting all of these data up together. And they developed an artificial intelligence platform, which was predominantly text message based. And this platform was called INA. And as this is developing as a platform, there's a machine learning component to it as well. So in theory, it's going to get better and better and better over time. And what they did in their study was they looked at little over 3,000 patients across the entire country who were suffering from various types of cancer, GU, breast, gynecological malignancy, GI and lung. And most of them had advanced-stage disease, and many of them had nutritional challenges. For example, almost 60% of them were either overweight or obese by BMI. And the patients were entered into a text exchange with the AI platform, which would give them advice on what they should eat, what they shouldn't eat. It would push various guidance and tips to them, it would develop personalized recipes for them, and it would even develop menu plans for the patients. And what's really interesting about this is that the level of engagement from the patients was very high, with almost 70% of patients actually texting questions to this platform. About 80% of the patients completed all of the surveys, and the average time that patients interacted with the platform was almost nine months, so this was remarkable levels of engagement, high levels of patient satisfaction. And although at this point, I think it's very early and somewhat subjective, there was certainly a very positive kind of vibe from patients. Nearly 50% have used the recommended recipes. More than 80% of them thought that their symptoms improved while they were using this platform. So I think as a kind of an assistant for remote management of patients, it's really remarkable. And the fact that the level of engagement was so high also means that for those patients, it's been very impactful. The second one, this was Abstract 100 (“AI virtual patient navigation to promote re-engagement of U.S. inner city patients nonadherent with colonoscopy appointments: A quality improvement initiative”) looked again at an AI-based platform, which in this case was used in an underserved population to address healthcare disparities. This is a study from New York which was looking at colorectal cancer screening disparities amongst an underserved population, where historically they've used skilled patient navigators to address compliance with screening programs, in this case specifically for colorectal cancer. And they noticed in the background to this study that in their previous experience in 2022, almost 60% of patients either canceled or no-showed for colonoscopy appointments. And because of this and because of the high burden of patients that this group has, they decided to take an AI-based virtual patient navigator called MyEleanor and introduce this into their colorectal cancer screening quality improvement. And so they introduced this platform in April of 2023 through to the end of the year, and their plan was to target reengagements of around 2,500 patients who had been non adherent with colonoscopy appointments in a previous year. And so the platform MyEleanor would call the patients to discuss rescheduling, it would assess their barriers to uptake, it would offer live transfer to somebody to schedule for them, and then it would go on closer to the point of the colonoscopy to call the patients and give them advice about their prep. And it was very nuanced. The platform would speak in both English and Spanish versions. It could detect nuances in the patient's voice, which might then trigger it to refer the patient to a live agent rather than the AI platform. So, very sophisticated technology. And what was most interesting about this, I think, was that over the eight months of the study, around 60% of patients actually engaged with this platform, with almost 60% of that group, or 33% overall, accepting a live transfer and then going on to scheduling, so that the completion rate for the no show patients went from 10% prior to the introduction of this platform to 19% after it was introduced. So [this is] another example, I think, of something which addresses a workforce problem and also addresses a major disparity within cancer care at the moment by harnessing these new technologies. And I think, again, a great interaction of very, very high-level science with things that make a real difference to our patients. So, Dr. DeMichele, those are a couple of examples, I think, of early data which really are beginning to show us the potential and signal the impact that artificial intelligence is going to have for our patients in oncology. I wonder, do you have any thoughts right now of where you see the biggest impact of artificial intelligence; let's say not in 20 years from now, but maybe in the next year or two? Dr. Angela DeMichele: Well, I think that those were two excellent examples. A really important feature of AI is really easing the workload on physicians. And what I hope will happen is that we'll be able to use AI in the very near future as a partner to really offload some of the quite time-consuming tasks, like charting, documentation, that really take us away from face-to-face interaction with patients. I think this has been a very difficult period where we move to electronic medical records, which are great for many reasons, but have really added to the burden to physicians in all of the extra documentation. So that's one way, I think, that we will hope to really be able to harness this. I think the other thing these abstracts indicate is that patients are very willing to interact with these AI chatbots in a way that I think, as you pointed out, the engagement was so high. I think that's because they trust us to make sure that what we're doing is still going to be overseen by physicians, that the information is going to get to us, and that they're going to be guided. And so I think that in areas where we can do outreach to patients, reminders, this is already happening with mammograms and other sorts of screening, where it's automated to make sure you're giving reminders to patients about things that they need to do for some of their basic health maintenance. But here, really providing important information – counseling that can be done by one of these chatbots in a way that is compassionate, informative and does not feel robotic to patients. And then I was really impressed with, in the abstract on the screening colonoscopy, the ability of the AI instrument to really hear nuances in the patient's responses that could direct them directly to a care provider, to a clinician, if they thought that there might be some problem the patient was experiencing. So again, this could be something that could be useful in triaging phone calls that are coming in from patients or our portals that just feel like they are full of messages, no matter how hard you try to clear them all out, to get to them all. Could we begin to use AI to triage some of the more mundane questions that don't require a clinician to answer so that we can really focus on the things that are important, the things that are life threatening or severe, and make sure that we're getting to patients sooner? So there's just a few ways I really hope it'll help us. Dr. John Sweetenham: Yeah, absolutely. I think we're just scratching the surface. And interestingly enough, in my newsfeed this morning through email, I have an email that reads, “Should AI pick immunotherapy combinations?” So we'll see where that goes, and maybe one day it will. Who knows? Dr. Angela DeMichele There was a great study presented at ASCO about that very thing, and I think that is still early, but I could envision a situation where I could ask an AI instrument to tell me all of the data around something that I want to know about for a patient that could deliver all of the data to me in real time in the clinic to be able to help me make decisions, help me quote data to patients. I think in that way it could be very, very helpful. But it'll still need the physicians to be putting the data into context and thinking about how to apply it to the individual person. Dr. John Sweetenham: Absolutely, yes. And so just to round off, the final abstract that caught my eye, which I think kind of expands on a theme that we saw at an ASCO meeting two or three years ago around the impact of [oncology] care at home, and this was Abstract 1503 (“Acute care and overall survival results of a randomized trial of a virtual health intervention during routine cancer treatment”). So, a virtual platform but not AI in this case. And this was a study that looked at the use of an Integrative Medicine at Home virtual mind-body fitness program. And this was a platform that was used to look at hospital admission and acute care of patients who used it, and also looked at survival, interestingly enough. So what was done in this study was a small, randomized study which looked at the use of virtual live mind, body and fitness classes, and compared this in a randomized fashion to what they called enhanced usual care, which essentially consisted of giving the patients, making available to the patients, some pre-recorded online meditation resources that they could use. And this was applied to a number of patients with various malignancies, including melanoma, lung, gynecologic, head and neck cancers, all of whom were on systemic therapy and all of whom were reporting significant fatigue. This was a small study; 128 patients were randomized in this study. And what was very interesting, to cut to the chase here, is that the patients who had the virtual mind-body program, compared with the control group, actually were less likely to be hospitalized, the difference there being 6.3% versus 19.1%, respectively. They spent fewer days in the hospital. And remarkably, the overall survival was 24.3 months median for patients in the usual care arm and wasn't reached in those patients who were on the virtual mind-body fitness class platform. So very preliminary data, certainly are going to need more confirmation, but another example of how it appears that many of these non-pharmacological interventions have the potential to improve meaningful endpoints, including hospital stays and, remarkably, even survival. So again, I think that that is very consistent with the theme of this year's meeting, and I found that particularly interesting, too. I think our time is up, so I want to thank you, Dr. DeMichele, for sharing your insights with us today on the ASCO Daily News Podcast. We really appreciate it. And once again, I want to congratulate you on what was really a truly remarkable ASCO this year. Dr. Angela DeMichele: Well, thanks so much for having me. It's been a tremendous pleasure to be with you today. Dr. John Sweetenham: And thank you to our listeners for joining us today. You'll find links to the abstracts discussed today in a transcript of this episode. Finally, if you value the insights that you hear on the ASCO Daily News Podcast, please take a moment to rate, review, and subscribe wherever you get your podcasts. Disclaimer: 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. Follow ASCO on social media:   @ASCO on Twitter   ASCO on Facebook   ASCO on LinkedIn   Disclosures:  Dr. John Sweetenham:  Consulting or Advisory Role: EMA Wellness  Dr. Angela DeMichele: Consulting or Advisory Role (an immediate family member): Pfizer Research Funding (Inst.): Pfizer, Genentech, Novartis, Inviata/NeoGenomics

new york university chicago art english ai science challenges home spanish pennsylvania national cure pfizer gi drs gu bmi nih abstract integrative medicine acute oncology revolutionize road ahead annual meetings novartis asco genentech plenary adriatic her2 egfr kras nci drugging abstracts ut southwestern adcs breast cancer research ihc plenary session asco annual meeting ctdna abramson cancer center t dxd breast cancer program transcript dr angela demichele

ASCO24: Transforming the Lung Cancer Treatment Landscape

Play Episode Listen Later Jun 21, 2024 33:17

Drs. Vamsi Velcheti and Nathan Pennell discuss novel approaches and key studies in lung cancer that were showcased at the 2024 ASCO Annual Meeting, including the Plenary abstracts LAURA and ADRIATIC. TRANSCRIPT Dr. Vamsi Velcheti: Hello, I am Dr. Vamsi Velcheti, your guest host for the ASCO Daily News Podcast today. I'm a professor of medicine and director of thoracic medical oncology at the Perlmutter Cancer Center at NYU Langone Health. Today, I'm joined by Dr. Nate Pennell, the co-director of the Cleveland Clinic Lung Cancer Program and the vice chair of clinical research at the Taussig Cancer Center in Cleveland Clinic. Dr. Pennell is also the editor-in-chief of the ASCO Educational Book. Today, we will be discussing practice-changing abstracts and the exciting advances in lung cancer that were featured at the ASCO 2024 Annual Meeting. You'll find our full disclosures in the transcript of the episode. Nate, we're delighted to have you back on the podcast today. Thanks for being here. It was an exciting Annual Meeting with a lot of important updates in lung cancer. Dr. Nate Pennell: Thanks, Vamsi. I'm glad to be back. And yes, it was a huge year for lung. So I'm glad that we got a chance to discuss all of these late-breaking abstracts that we didn't get to talk about during the prelim podcast. Dr. Vamsi Velcheti: Let's dive in. Nate, it was wonderful to see all the exciting data, and one of the abstracts in the Plenary Session caught my attention, LBA3. In this study, the investigators did a comparative large-scale effectiveness trial of early palliative care delivered via telehealth versus in-person among patients with advanced non-small cell lung cancer. And the study is very promising. Could you tell us a little bit more about the study and your take-home messages? Dr. Nate Pennell: Yes, I think this was a very important study. So just to put things in perspective, it's now been more than a decade since Dr. Jennifer Temel and her group at Massachusetts General Hospital did a randomized study that showed that early interventions with palliative medicine consultation in patients with advanced non-small cell lung cancer significantly improves quality of life and in her initial study, perhaps even overall survival. And since then, there have been numerous studies that have basically reproduced this effect, showing that getting palliative medicine involved in people with advanced cancer, multiple different cancer types, really, has benefits. The difficulty in applying this has been that palliative care-trained specialists are few and far between, and many people simply don't have easy access to palliative medicine-trained physicians and providers. So with that in mind, Dr. Temel and her group designed a randomized study called the REACH PC trial, where 1,250 patients were randomized with advanced non-small cell lung cancer to either in-person palliative medicine visits which is sort of the standard, or one in-person assessment followed by monthly telemedicine video visits with palliative medicine. Primary endpoint was essentially to show that it was equivalent in terms of quality of life and patient satisfaction. And what was exciting about this was that it absolutely was. I mean, pretty much across the board in all the metrics that were measured, the quality-of-life, the patient satisfaction, the anxiety and depression scores, all were equivalent between doing telemedicine visits and in-person visits. And this hopefully will now extend the ability to get this kind of benefit to a much larger group of people who don't have to geographically be located near a palliative medicine program. Dr. Vamsi Velcheti: Yeah, I think it's a great abstract, Nate and I actually was very impressed by the ASCO committee for selecting this for the Plenary. We typically don't see supportive care studies highlighted in such a way at ASCO. This really highlights the need for true interdisciplinary care for our patients. And as you said, this study will clearly address that unmet need in terms of providing access to palliative care for a lot of patients who otherwise wouldn't have access. I'm really glad to see those results. Dr. Nate Pennell: It was. And that really went along with Dr. Schuchter's theme this year of bringing care to patients incorporating supportive care. So I agree with you. Now, moving to some of the other exciting abstracts in the Plenary Session. So we were talking about how this was a big year for lung cancer. There were actually 3 lung cancer studies in the Plenary Session at the Annual Meeting. And let's move on to the second one, LBA4, the LAURA study. This was the first phase 3 study to assess osimertinib, an EGFR tyrosine kinase inhibitor, in patients with EGFR mutant, unresectable stage III non-small cell lung cancer. What are your takeaways from this study? Dr. Vamsi Velcheti: This is certainly an exciting study, and all of us in the lung community have been kind of eagerly awaiting the results of the study. As you know, for stage III non-small cell lung cancer patients who are unresectable, the standard of care has been really established by the PACIFIC study with the consolidation durvalumab after definitive concurrent chemoradiation. The problem with that study is it doesn't really answer the question of the role of immunotherapy in patients who are never-smokers, and especially in patients who are EGFR positive tumors, where the role of immunotherapy in a metastatic setting has always been questioned. And in fact, there have been several studies as you know, in patients with EGFR mutation positive metastatic lung cancer where immunotherapy has not been that effective. In fact, in the subgroup analysis in the PACIFIC study, patients with EGFR mutation did not really benefit from adding immunotherapy. So this is an interesting study where they looked at patients with locally advanced, unresectable stage III patients and they randomized the patients 2:1 to osimertinib versus placebo following concurrent or sequential tumor radiation. The primary endpoint for the study was progression free survival, and a total of 216 patients were enrolled and 143 patients received a study treatment, which is osimertinib, and 73 received placebo. And 80% of the patients on the placebo arm crossed over to getting treatment at the time of progression. So most of us in the lung cancer community were kind of suspecting this would be a positive trial for PFS. But however, I think the magnitude of the difference was truly remarkable. The median PFS in the osimertinib arm was 39.1 months and placebo was 5.6 months and the hazard ratio of 0.16. So it was a pretty striking difference in terms of DFS benefit with the osimertinib consolidation following chemoradiation. So it was truly a positive study for the primary endpoint and the benefit was seen across all the subgroups and the safety was no unexpected safety signals other than a slight increase in the radiation pneumonitis rates in patients receiving osimertinib and other GI and skin tox were kind of as expected. In my opinion, it's truly practice changing and I think patients with EGFR mutation should not be getting immunotherapy consolidation post chemoradiation. Dr. Nate Pennell: I completely agree with you. I think that this really just continues the understanding of the use of osimertinib in EGFR-mutant lung cancer in earlier stages of disease. We know from the ADAURA trial, presented twice in the Plenary at the ASCO Annual Meeting, that for IB, stage II and resectable IIIA, that you prolong progression free or disease free survival. So this is a very similar, comparable situation, but at an even higher risk population or the unresectable stage III patients. I think that the most discussion about this was the fact that the osimertinib is indefinite and that it is distinct from the adjuvant setting where it's being given for three years and then stopped. But I think all of us had some pause when we saw that after three years, especially in the stage III patients from ADAURA, that there were clearly an increase in recurrences after stopping the drug, suggesting that there are patients who are not cured with a time limited treatment, or at least with 3 years of treatment. The other thing that is sobering from the study, and was pointed out by the discussant, Dr. Lecia Sequist, is if you look at the two-year disease-free survival in the placebo arm, it was only 13%, meaning almost no one was really cured with chemo radiation alone. And that really suggests that this is not that different from a very early stage IV population where indefinite treatment really is the standard of care. I wonder whether you think that's a reasonable approach. Dr. Vamsi Velcheti: I completely agree with you, Nate, and I don't think we cure a majority of our patients with stage III, and less so in patients who have EGFR-mutant, stage III locally advanced. As you just pointed out, I think very few patients actually make it that far along. And I think there's a very high rate of CNS micrometastatic disease or just systemic micrometastatic disease in this population that an effective systemic therapy of osimertinib can potentially have long term outcomes. But again, we perhaps don't cure a vast majority of them. I think that the next wave of studies should incorporate ctDNA and MRD-based assays to potentially identify those patients who could potentially go off osimertinib at some point. But, again, outside of a trial, I would not be doing that. But I think it's definitely an important question to ask to identify de-escalation strategies with osimertinib. And even immunotherapy for that matter, I think we all know that not all patients really require years and years of immunotherapy. They're still trying to figure out how to use immunotherapy in these post-surgical settings, using the MRD to de-escalate adjuvant therapies. So I think we have to have some sort of strategy here. But outside of a clinical trial, I will not be using those assays here to cite treatments, but certainly an important question to ask. Moving on to the other exciting late-breaking abstracts, LBA5, the ADRIATIC study. This is another study which was also in the plenary session. This study was designed to address this question of consolidation immunotherapy, post chemo radiation for limited-stage small cell cancer, the treatment arms being durvalumab tremelimumab, and durvalumab observation. So what do you think about the study? This study also received a lot of applause and a lot of attention at the ASCO meeting. Dr. Nate Pennell: It was. It was remarkable to be there and actually watch this study as well as the LAURA study live, because when the disease free survival curves and in the ADRIATIC study, the overall survival curves were shown, the speakers were both interrupted by standing ovation of applause just because there was a recognition that the treatment was changing kind of before our eyes. I thought that was really neat. So in this case, I think this is truly a historic study, not necessarily because it's going to necessarily be an earth shakingly positive study. I mean, it was clearly a positive study, but more simply because of the disease in which it was done, and that is limited-stage small cell lung cancer. We really have not had a change in the way we've treated limited-stage small cell lung cancer, probably 25 years. Maybe the last significant advances in that were the advent of concurrent chemotherapy and radiation and then the use of PCI with a very modest improvement in survival. Both of those, I would say, are still relatively modest advances. In this case, the addition of immunotherapy, which we know helps patients with small cell lung cancer - it's of course the standard of care in combination chemotherapy for extensive stage small cell lung cancer - in this case, patients who completed concurrent chemo radiation were then randomized to either placebo or durvalumab, as well as the third arm of durvalumab tremelimumab, which is not yet been recorded, and co primary endpoints were overall survival and progression free survival. And extraordinarily, there was an improvement in overall survival seen at the first analysis, with a median overall survival of 55.9 months compared to 33.4 months, hazard ratio of 0.73. So highly clinically and statistically significant, that translates at three years to a difference in overall survival of 56.5%, compared to 47.6%, or almost 10% improvement in survival at three years. There was also a nearly identical improvement in progression-free survival, also with a hazard ratio of 0.76, suggesting that there's a modest number of patients who benefit. But it seems to be a clear improvement with the curves plateauing out. In my opinion, this is very comparable to what we saw with the PACIFIC study in stage III, unresectable non-small cell lung cancer, which immediately changed practice back when that first was reported. And I expect that this will change practice pretty much immediately for small cell as well. Dr. Vamsi Velcheti: Yeah, I completely agree, Nate. I think it's an exciting advance in patients with limited-stage small cell lung cancer. For sure, it's practice-changing, and I think the results were exciting. So one thing that really intrigued me was in the extensive-stage setting, the benefit was very mediocre with one-to-two month overall survival benefit in both the PACIFIC and in IMpower trial. Here we are seeing almost two-year of median OS benefit. I was kind of puzzled by that, and I thought it may have to do with patients receiving radiation. And we've seen that with the PACIFIC, and makes you wonder if both the CASPIAN and the IMpower studies actually did not allow consolidation thoracic radiation. Hypothetically, if they had allowed consolidation thoracic radiation, perhaps we would have seen better outcomes. Any thoughts on that? Dr. Nate Pennell: We've been trying to prove that radiation and immunotherapy somehow go together better for a long time. Going back to the first description of the abscopal effect, and I'm not sure if I necessarily believe that to be the case, but in this setting where we truly are trying to cure people rather than merely prolong their survival, maybe this is the situation where it truly is more beneficial. I think what we're seeing is something very similar to what we're seen in PACIFIC, where in the stage IV setting, some people have long term survival with immunotherapy, but it's relatively modest. But perhaps in the curative setting, you're seeing more of an impact. Certainly, looking at these curves, we'll have to see with another couple of years to follow up. But a three-year survival of 56% is pretty extraordinary, and I look forward to seeing if this really maintains over the next couple of years follow up. Moving beyond the Plenary, there were actually lots of really exciting presentations, even outside the Plenary section. One that I think probably got at least as much attention as the ones that we've already discussed today was actually an update of an old trial that's been presented for several prior years. And I'm curious to get your take on why you thought this was such a remarkable study. And we're talking about the LBA8503, which was the 5-year update from the CROWN study, which looked at previously untreated ALK-positive advanced non-small cell in cancer patients randomly assigned to lorlatinib, the third generation ALK inhibitor, versus crizotinib, the first generation ALK inhibitor. What was so exciting about this study, and why were people talking about it? Dr. Vamsi Velcheti: Yeah, I agree, Nate. We've seen the data in the past, right? Like on the CROWN data, just first like a quick recap. This is the CROWN study, like the phase 3 study of third generation ALK inhibitor lorlatinib. So global randomized phase 3 study in patients with metastatic disease randomized to lorlatinib versus crizotinib, which is a controller. So the primary endpoint was PFS, and we've seen the results in the past of the CROWN readout quoted, with a positive study and the lorlatinib received FDA approval in the frontline setting. But the current study that was presented at the ASCO annual meeting is a kind of a postdoc analysis of five years. The endpoint for the study with central review stopped at three years, and this is actually a follow up beyond that last readout. Interestingly, in this study, when they looked at the median PFS at five years, the lorlatinib arm did not reach a median PFS even at five years and the hazard ratio is 0.19, which is kind of phenomenal in some ways. At 5 years, the majority of the patients were still on the drug. So that's quite incredible. And the benefit was more profound in patients with brain mets with a hazard ratio of 0.08. And again, speaking to the importance of brain penetrant, small molecule inhibitors, and target therapy, the safety profile, there were no additional safety signals noted in the study. We kind of know about the side effects of lorlatinib already from previous studies readouts. No unusual long-term toxicities. I should note though, about 40% of patients did have CNS, AEs grade 1, 2 CNS toxicities on the lorlatinib arm. And the other interesting thing that was also reported in the trial was dose reduction of lorlatinib did not have an impact on the PFS, which is interesting in my opinion. They also did some subgroup analysis, biomarker testing, biomarker populations. Patients who had P53 cooperation did much better with lorlatinib versus crizotinib. So overall, the other thing that they also had shown on the trial was the resistance mechanisms that were seen with lorlatinib were very different than what we are used to seeing with the earlier generation ALK inhibitors. The majority of the patients who develop resistance have bypass mechanisms and alterations in MAP kinase pathway PI3K/MTOR/PTEN pathway, suggesting that lorlatinib is a very potent ALK inhibitor and on target ALK mutations don't happen as frequently as we see with the earlier generation ALK inhibitors. So I think this really begs the question, should we offer lorlatinib to all our patients with metastatic ALK-positive tumors? I think looking at the long-term data, it's quite tempting to say ‘yes', but I think at the same time we have to take into consideration patient safety tolerability. And again, the competitor arm here is crizotinib. So lorlatinib suddenly seems to be, again, cross trial comparisons, but I think the long-term outcomes here are really phenomenal. But at the same time, I think we've got to kind of think about patient because these patients are on these drugs for years, they have to live with all the toxicities. And I think the patient preferences and safety profile matters in terms of what drug we recommend to patients. Dr. Nate Pennell: I completely agree with you. I think the right answer, is that this has to be an individual discussion with patients. The results are incredibly exciting. I mean, the two-year progression free survival was 70%, and the five-year, three years later is still 60%. Only 10% of people are failing over the subsequent three years. And the line is pretty flat. And as you said, even with brain metastases, the median survival is in reach. It's really extraordinary. Moreover, while we do talk about the significant toxicities of lorlatinib, I thought it was really interesting that only 5% of people were supposedly discontinued the drug because of treatment related AEs, which meant that with dose reduction and management, it seems as though most patients were able to continue on the drug, even though they, as you mentioned, were taking it for several years. That being said, all of us who've had experience with the second-generation drugs like alectinib and brigatinib, compared to the third-generation drug lorlatinib, can speak to the challenges of some of the unique toxicities that go along with it. I don't think this is going to be a drug for everyone, but I do think it is now worth bringing it up and discussing it with the patients most of the time now. And I do think that there will be many people for whom this is going to be a good choice, which is exciting. Dr. Vamsi Velcheti: Absolutely, completely agree. And I think there are newer ALK inhibitors in clinical development which have cleaner and better safety profiles. So we'll have to kind of wait and see how those pan out. Moving on to the other exciting abstract, LBA8509, the KRYSTAL-12 study. LBA8509 is a phase 3 study looking at adagrasib versus docetaxel in patients with previously treated advanced metastatic non-small cell cancer with KRASG12C mutation. Nate, there's been a lot of hype around this trial. You've seen the data. Do you think it's practice-changing? How does it differentiate with the other drug that's already FDA approved, sotorasib? Dr. Nate Pennell: Yeah, this is an interesting one. I think we've all been very excited in recent years about the identification of KRASG12C mutations as targetable mutations. We know that this represents about half of KRAS mutations in patients with non-small cell lung cancer, adenocarcinoma, and there are two FDA-approved drugs. Sotorasib was the first and adagrasib shortly thereafter. We already had seen the CodeBreaK 200 study, which was a phase 3 study of sotorasib versus docetaxel that did modestly prolong progression free survival compared to docetaxel, although did not seem to necessarily translate to an improvement in overall survival. And so now, coming on the heels of that study, the KRYSTAL-12 study compared adagrasib, also the KRASG12C inhibitor versus docetaxel and those with previously treated non-small cell with KRASG12C. And it did significantly improve progression free survival with a hazard ratio of 0.58. Although when you look at the median numbers, the median PFS was only 5.5 months with the adagrasib arm compared to 3.8 months with docetaxel. So while it is a significant and potentially clinically significant difference, it is still, I would say a modest improvement. And there were some pretty broad improvements across all the different subgroups, including those with brain metastases. It did improve response rate significantly. So 32% response rate without adagrasib, compared to only 9% with docetaxel. It's about what you would expect with chemotherapy. And very importantly, in this patient population, there was activity in the brain with an intracranial overall response rate among those who had measurable brain metastases of 40%. So certainly important and probably that would distinguish it from drugs like docetaxel, which we don't expect to have a lot of intracranial toxicity. There is certainly a pattern of side effects that go along with that adagrasib, so it does cause especially GI toxicity, like diarrhea, nausea, vomiting, transaminitis. All of these were actually, at least numerically, somewhat higher in the adagrasib arm than in docetaxel, a lot more hematologic toxicity with the docetaxel. But overall, the number of serious adverse events were actually pretty well matched between the two groups. So it wasn't really a home run in terms of favorable toxicity with that adagrasib. So the question is: “In the absence of any data yet on overall survival, should this change practice?” And I'm not sure it's going to change practice, because I do think that based on the accelerated approval, most physicians are already offering the G12C inhibitors like sotorasib and adagrasib, probably more often than chemotherapy, I think based on perceived improvement in side effects and higher response rates, modestly longer progression-free survival, so I think most people think that represents a modest improvement over chemotherapy. And so I think that will continue. It will be very interesting, however, when the overall survival report is out, if it is not significantly better, what the FDA is going to do when they look at these drugs. Dr. Vamsi Velcheti: Thanks so much. Very well summarized. And I do agree they look more similar than dissimilar. I think CodeBreaK-200 and the KRYSTAL-12, they kind of are very identical. I should say, though I was a little surprised with the toxicity profile of adagrasib. It seemed, I mean, not significantly, but definitely seemed worse than the earlier readouts that we've seen. The GI tox especially seems much worse on this trial. I'm kind of curious why, but if I recall correctly, I think 5% of the patients had grade 3 diarrhea. A significant proportion of patients had grade 3 nausea and vomiting. And the other complicating thing here is you can't use a lot of the antiemetics because of the QT issues. So that's another problem. But I think it's more comparable to sotorasib, in my opinion. Dr. Nate Pennell: While this is exciting, I like to think of this as the early days of EGFR, when we were using gefitinib and erlotinib. They were certainly advances, but we now have drugs that are much more effective and long lasting in these patients. And I think that the first-generation inhibitors like sotorasib and adagrasib, while they certainly benefit patients, now is just the beginning. There's a lot of research going on, and we're not going to talk about some of the other abstracts presented, but some of the next generation G12C inhibitors, for example, olomorasib, which did have also in the same session, a presentation in combination with pembrolizumab that had a very impressive response rate with potentially fewer side effects, may end up replacing the first generation drugs when they get a little bit farther along. And then moving on to another one, which I think potentially could change practice. I am curious to hear your take on it, was the LBA8505, which was the PALOMA-3 study. This was interesting in that it compared two different versions of the same drug. So amivantamab, the bispecific, EGFR and MET, which is already approved for EGFR exon 20 non-small cell lung cancer, in this case, in more typical EGFR-mutated non-small cell lung cancer in combination with osimertinib with the intravenous amivantamab, compared to the subcutaneous formulation of amivantamab. Why would this be an important study? Dr. Vamsi Velcheti: I found this study really interesting as well, Nate. And as you know, amivantamab has been FDA approved for patients with exon 20 mutation. And also, we've had, like two positive readouts in patients with classical EGFR mutations. One, the MARIPOSA study in the frontline setting and the MARIPOSA-2, in the second-line post osimertinib setting. For those studies, the intravenous amivantamab was used as a treatment arm, and the intravenous amivantamab had a lot of baggage to go along with it, like the infusion reactions and VTEs and other classic EGFR related toxicity, skin toxicities. So the idea behind developing the subcutaneous formulation of amivantamab was mainly to reduce the burden of infusion, infusion time and most importantly, the infusion related reactions associated with IV formulation. In a smaller phase 2 study, the PALOMA study, they had looked at various dosing schemas like, subcutaneous formulation, and they found that the infusion related reactions were very, very low with the subcutaneous formulation. So that led to the design of this current study that was presented, the PALOMA-3 study. This was for patients who had classical EGFR mutations like exon 19, L858R. The patients were randomized 1:1 to subcutaneous amivantamab with lazertinib versus IV amivantamab plus lazertinib. The endpoints for the study, it's a non-inferiority study with co primary endpoints of C trough and C2 AUC, Cycle 2 AUC. They were looking at those pharmacological endpoints to kind of demonstrate comparability to the IV formulation. So in this study, they looked at these pharmacokinetic endpoints and they were essentially identical. Both subcutaneous and IV formulations were compatible. And in terms of clinical efficacy as well, the response rate was identical, no significant differences. Duration of response was also identical. The PFS also was comparable to the IV formulation. In fact, numerically, the subcutaneous arm was a little better, though not significant. But it appears like, you know, the overall clinical and pharmacological profile of the subcutaneous amivantamab was comparable. And most interestingly, the AE profile, the skin toxicity was not much different. However, the infusion reactions were substantially lower, 13% with the subcutaneous amivantamab and 66% with IV amivantamab. And also, interestingly, the VTE rates were lower with the subcutaneous version of amivantamab. There was still a substantial proportion of patients, especially those who didn't have prophylactic anticoagulation. 17% of the patients with the subcutaneous amivantamab had VTE versus 26% with IV amivantamab. With prophylaxis, which is lower in both IV and subcutaneous, but still subcutaneous formulation at a lower 7% versus 12% with the IV amivantamab. So overall, I think this is an interesting study, and also the authors had actually presented some interesting data on administration time. I've never seen this before. Patients reported convenience using a modified score of patient convenience, essentially like patients having to spend a lot of time in the infusion site and convenience of the patient getting the treatment. And it turns out, and no surprise, that subcutaneous amivantamab was found to be more convenient for patients. So, Nate, I want to ask you your take on this. In a lot of our busy infusion centers, the time it takes for those patients to get the infusion does matter, right? And I think in our clinic where we are kind of fully booked for the infusion, I think having the patients come in and leave in 15, 20 minutes, I think it adds a lot of value to the cancer center operation. Dr. Nate Pennell: Oh, I completely agree. I think the efficacy results were reassuring. I think the infusion related reaction difference, I think is a huge difference. I mean, I have given a fair amount of amivantamab, and I would say the published IRR rate of 66%, 67% I would say, is maybe even underestimates how many patients get some kind of reaction from that, although it really is a first dose phenomenon. And I think that taking that down to 13% is a tremendous advance. I think fusion share time is not trivial as we get busier and busier. I know our cancer center is also very full and it becomes challenging to schedule people, and being able to do a five-minute treatment versus a five-hour treatment makes a big difference for patients. It's interesting, there was one slide that was presented from an efficacy standpoint. I'm curious about your take on this. They showed that the overall survival was actually better in the subcu amivantamab arm, hazard ratio of 0.62. Now, this was only an exploratory endpoint. They sort of talk about perhaps some rationale for why this might be the case. But at the very least, I think we can be reassured that it's not less effective to give it and does seem to be more tolerable and so I would expect that this hopefully will be fairly widely adopted. Dr. Vamsi Velcheti: Yeah, I agree. I think this is a welcome change. Like, I think the infusion reactions and the resources it takes to get patients through treatments. I think it's definitely a win-win for patients and also the providers. And with that, we come to the conclusion of the podcast. Nate, thank you so much for the fantastic insights today. Our listeners will find all the abstracts discussed today in the transcripts of the episode. Thank you so much for joining us today, Dr. Pennell. Dr. Nate Pennell: Oh, thanks for inviting me. It's always fun to talk about all these exciting advances for our patients. Dr. Vamsi Velcheti: Thanks to our listeners for your time today. You will find links to all the abstracts discussed today in the transcript of the episode. Finally, if you value the insights that you hear from ASCO Daily News Podcast, please take a moment to rate, review, and subscribe wherever you get your podcast. Disclaimer: 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. Find out more about today's speakers: Dr. Vamsi Velcheti @VamsiVelcheti Dr. Nathan Pennell @n8pennell Follow ASCO on social media:   @ASCO on Twitter   ASCO on Facebook   ASCO on LinkedIn   Disclosures: Dr. Vamsi Velcheti: Honoraria: ITeos Therapeutics Consulting or Advisory Role: Bristol-Myers Squibb, Merck, Foundation Medicine, AstraZeneca/MedImmune, Novartis, Lilly, EMD Serono, GSK, Amgen, Elevation Oncology, Taiho Oncology, Merus Research Funding (Inst.): Genentech, Trovagene, Eisai, OncoPlex Diagnostics, Alkermes, NantOmics, Genoptix, Altor BioScience, Merck, Bristol-Myers Squibb, Atreca, Heat Biologics, Leap Therapeutics, RSIP Vision, GlaxoSmithKline Dr. Nathan Pennell:   Consulting or Advisory Role: AstraZeneca, Lilly, Cota Healthcare, Merck, Bristol-Myers Squibb, Genentech, Amgen, G1 Therapeutics, Pfizer, Boehringer Ingelheim, Viosera, Xencor, Mirati Therapeutics, Janssen Oncology, Sanofi/Regeneron  Research Funding (Inst): Genentech, AstraZeneca, Merck, Loxo, Altor BioScience, Spectrum Pharmaceuticals, Bristol-Myers Squibb, Jounce Therapeutics, Mirati Therapeutics, Heat Biologics, WindMIL, Sanofi

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Spring Plenary Assembly - Day Two

spring indigenous native assembly day two plenary keeping christ eucharistic congress

Play Episode Listen Later Jun 14, 2024 8:38

The USCCB Spring 2024 plenary assembly concludes with a report on the upcoming Eucharistic Congress, discussion about religious workers' visas, an outgoing address from Suzanne Healy, the chair of the National Review Board, and approval of the new pastoral framework for Native and Indigenous people, “Keeping Christ's Sacred Promise.”

Spring Plenary Assembly—Day One