Dr. Chino talks with Dr. Navneet Majhail and patient advocate Laurie Adami about CAR-T therapy, an advance cancer treatment that biologically engineers a patient's own T-cells to recognize and kill cancer cells. This discussion will be based off the JCO OP article, "Outpatient Administration of Chimeric Antigen Receptor T-Cell Therapy Using Remote Patient Monitoring," on which Dr. Majhail served as lead author.
TRANSCRIPT
Dr. Fumiko Chino: Hello, and welcome to Put into Practice, the podcast for the JCO Oncology Practice. I'm Dr. Fumiko Chino, an associate professor in radiation oncology at MD Anderson Cancer Center with a research focus on access, affordability, and equity.
CAR T-therapy is an advanced cancer treatment that biologically engineers a patient's own T cells to recognize and kill cancer cells. It has shown remarkable benefits, leading to long-term remission or even cure for select patients with hematological cancers that have not responded to other treatments. Primary trials were exclusively conducted in the inpatient setting due to high risk of quick onset and life-threatening toxicities requiring close monitoring and immediate treatment. Advances in symptom monitoring and care delivery have allowed the introduction of outpatient CAR T, which is cost saving and more patient centered. I'm happy to welcome two guests today to discuss this promising operational shift.
Dr. Navneet Majhail, MD, MS, serves as the Physician-in-Chief of Blood Cancers at the Sarah Cannon Cancer Network, where he oversees 10 transplant and cellular therapy programs that collectively perform over 1500 transplants and cellular therapies each year. He is the first author of the JCO OP manuscript, "Outpatient Administration of Chimeric Antigen Receptor T-Cell Therapy Using Remote Patient Monitoring," which was published earlier this year.
Ms. Laurie Adami was President of the LA-based Interactive Data's Fixed Income Analytics Division when she was diagnosed with stage four follicular lymphoma at age 46. From 2006 to 2018, she was in continuous treatment and received multiple lines of therapy, including three clinical trials. In 2018, she received treatment number seven, a clinical trial of Kite CAR T-therapy. Thirty days later, she was in complete remission, where she remains today. She is an active patient advocate and legislative policy advocate for several not-for-profits.
Our full disclosures are available in the transcript of this episode, and we have already agreed to go by our first names for the podcast today.
Navneet and Laurie, it's so wonderful to speak to you today.
Dr. Navneet Majhail: Thank you. Looking forward to this conversation.
Laurie Adami: Thank you, Dr. Chino. I guess I'm supposed to call you Fumiko. Great to be here today. Great to be alive, first of all, and great to be here on this call. Thank you for having me.
Dr. Fumiko Chino: I think with everything you've gone through, Laurie, we all go on a first name basis.
Now, Navneet, do you mind starting us out with a short history of CAR T in the US, including the side effects and the precise care delivery needs that were the initial reasons why care was limited to the hospital?
Dr. Navneet Majhail: So, Fumiko, you laid an excellent background as to why these therapies are done in the inpatient side and what they are. I mean, it's really exciting, right? These are what we call transformative therapies in oncology or medicine as a whole. You're taking patients with very, very advanced diseases who traditionally would have gone on to hospice, where you can potentially put around half of these patients into very deep remissions, and maybe some of them might be cured of their underlying malignancies.
Now, having said that, as you alluded to in the introductions, most of the trials early on were focused entirely on the inpatient space for a few reasons. One was the unknowns. These were early therapies, unknown side effects, you needed to have that monitoring. The second, some of the very early work that was done with these therapies, it was clear you can have some potentially severe and fatal side effects, like cytokine release syndrome, what we now call ICANS, or immune effector cell-associated neurotoxicity syndrome. You have issues such as HLH, hemo-phagocytic lymphohistiocytosis. These are some really fatal, potentially fatal and severe side effects, which really needed close monitoring on the inpatient side.
As things have evolved, obviously we've gotten smarter at selecting patients. The constructs have improved as well, where the incidence and the severity of these toxicities has gone down. And as we become smarter overall, both from a supportive care, patient selection and technology perspective, certainly there are opportunities now for us to look at delivering these care where patients can access these therapies better.
Dr. Fumiko Chino: That's a wonderful summary, and I know at this point, I believe over 300 sites are Foundation for the Accreditation of Cellular Therapy accredited to deliver CAR T-cell therapy. So, we really have gone very much into the space where we're trying to expand access to these therapies.
Now, Laurie, I know that your CAR T was in 2018 on a phase two trial at UCLA, but your treatment started in 2006. Do you mind walking us through what that was like for you? How did it go? What was required in terms of travel, time, for, I know, again, just not just yourself, but also your family, and it's through the treatment and then also the recovery? I'm presuming that you had to be in the hospital, for example, for your CAR T for at least a week, if not longer.
Laurie Adami: Yeah, I was diagnosed in 2006 and spent 12 years in continuous treatment, all in Los Angeles where I live. When I did my CAR T, I was also in Los Angeles, so that made it easier for me, as well as my family, because when I went in for CAR T, I was just at the UCLA main hospital, which is about 20 minutes drive from my home.
The process for 12 years was difficult at every level, both physically as well as emotionally and mentally. My son was only in kindergarten when I was diagnosed, and I was given horrible statistics up front in terms of my survival likelihood, but I was determined to stay alive, and thankfully for me, I was able to get into CAR T really at the end. And like Navneet said, I would have been going to hospice if the CAR T trial hadn't opened because I had literally burned through six other treatments, none of which worked.
Dr. Fumiko Chino: It's truly a transformative treatment, and I can only imagine that for you yourself, the burdens must have been immense. I know that you were an executive flying, it sounds like around the world. How did that change your life?
Laurie Adami: So I lost my career as a result of my illness because it was clear after my first relapse, after the only treatment that existed at the time, which was 19 years ago, that this was going to be a battle that wasn't just going to go away. And so, I was really seeking things constantly, and I would do a treatment, it would fail right away. It was really, really difficult at every level. So I had to go out on disability from my work, and then I was never able to go back, because by the time I finally got CAR T, then COVID hit, I couldn't start traveling around the world with my special immune system. Yeah, it was costly at so many levels, but thankfully, thanks to science and all of you doctors on this call for administering these therapies, I am so grateful to be alive.
Dr. Fumiko Chino: Well, that segues really nicely in terms of the next advancement of science, which is to take CAR T out of the hospital. Now, Navneet, do you mind giving us an overview of your JCO OP article, outlining key considerations for outpatient administration of CAR T, so discussing things like remote patient monitoring and what is really required in terms of the investments from the cancer center?
Dr. Navneet Majhail: Certainly, Fumiko. At the end of the day, as we considered moving these therapies to the outpatient setting, there were two big problems we were trying to solve. One was the capacity issues. I mean, again, we've had increase in the utilization of these therapies, at least across our network, at the rate of like 15 to 20% per year, right? So that's your trajectory where it's heading, and there's a lot more indications coming down the road, and there's no way our health system or any other health system in the US has enough beds on the inpatient side to accommodate this, right? So one was, how do we address the capacity issues that are happening today and that we foresee happening in the future in an innovative way? And the second was, how do we make this therapy more financially sustainable? These are expensive therapies, just by the cost of the product and the care that's given around it. And the more we can do this in the outpatient setting, the less we use inpatient resources, everything that comes with the hospital stay, and would certainly make this more financially sustainable.
And I think as we think about moving this to the outpatient side, of course, across our network and for any other place that's considering it, a big component is patient experience and patient safety, right? Because as we discussed early on, there are some potentially really lethal toxicities that are associated with these products. They've gotten better. They are seen less often, and it's not very often that we see those severe toxicities, but they can come up very suddenly. We've got to make sure that you've got the pathways and everything else in place to manage those patients in a safe way.
So, we have a multi-site network. We currently have 10 centers that are a part of the Sarah Cannon Transplant and Cell Therapy Network. It's physician driven, and what we do is we like to standardize things as much as possible, so all sites can do the same thing, and we can monitor outcomes, data, and what's happening to patients in that context. So, where we ended up with is using a remote patient monitoring platform to essentially care for these patients in the outpatient setting. It's actually a pretty cool technology and a cool thing our teams came up with. I'm talking about this, but to be honest, I cannot take any credit for what our teams have done.
At the end of the day, we currently have a contract with an organization called Current Health. So, they have these kits, which include a remote patient monitoring device. It's an FDA cleared device, and it's essentially something that you slip onto your arm. It's a small, round, an inch-wide monitor. And what it does is it sends data on your vitals, your temperature, your pulse ox, your pulse rate, a whole variety of things, through Bluetooth technology to a central command center that's manned by trained nurses. And what we did was we worked with Current Health to essentially come up with the algorithms for what is a true indicator, potentially true indicator for complications like CRS, right? So if you're sleeping at night, guess what? Your pulse rate goes down, right? If you've just come back from a run, you'll be tachycardic, right? So if you're sleeping with three blankets on you, your temperature will go up, right? So how do we come up with these algorithms which take out the noise and really help us focus on what might be potential CRS? And I'll confess, we are always working to refine these algorithms, make them better as we go forward.
Once the nurse sitting in that central command center identifies a potentially true alarm, then we work with them to come up with the triage pathways and the clinical pathways for management so that the patient is triaged to the right care at the right time. So if they end up in the ER, what are the pathways for the ER to give tocilizumab very promptly, right, within 60 minutes of showing up there and so forth.
So that is what we have developed across our network from an outpatient care platform, and what we've seen in this context is that we still have around two-thirds of our patients who end up getting admitted in the outpatient setting. So we typically start as a start with the lymphodepleting chemo, and we'll keep it going through at least day 14 after the infusion of the CAR T-cells. And during this time period, around two-thirds of our patients will still end up getting admitted because with the slightest fever, we don't want to take a chance. We'll triage them quickly to the ER or the hospital. But then the median length of stay was only four days compared to our historical data where, as you can imagine, we would keep these patients in for a median of 16 days. So that's how we are managing these patients as we go forward. And like I said, we are doing a lot of research to see how can we make things better, how can we manage some very, very early CRS in the outpatient setting, for instance, and how can we keep refining the alarms and so forth?
Dr. Fumiko Chino: That sounds amazing, and it sounds like it's truly something that would not have been capable without some more advanced technologies in terms of remote patient monitoring. So we're truly galvanized by our technologies, telemedicine has really revolutionized, at least during COVID. So I'm assuming you're capitalizing on some of those advancements.
Dr. Navneet Majhail: We certainly are, and one of the interesting things I'd like to share, and maybe Laurie can comment on this or may validate this, right? So we collect the survey data, and we talk to the patients about their experience. And one interesting thing that came across these conversations was the fact that many patients and their caregivers felt more secure that there was someone potentially watching them 24/7 for these alarming signs. As you can imagine, as these patients come in, we scare them, right? "Hey, this is very, you know, innovative therapy. This might fix your lymphoma or myeloma, but hey, what, I mean, you got this bad CRS, you know, X number of people will die because of CRS and severe ICANS where you may get seizures and whatnot. But yeah, go home and sleep over it, right? So you can go home, you can stay in the outpatient setting, and come back tomorrow to see us, right?" So it was very interesting to us, that theme where patients felt that, okay, they had a level of reassurance that there was someone watching them. And that to me was very interesting as we collected that data together.
Dr. Fumiko Chino: Laurie, is that something that you've heard of from other patients, at least treated in the outpatient setting?
Laurie Adami: So I have not actually spoken to a patient who's had the monitoring on them. I've spoken to numerous patients who've done it outpatient and have been very scared, and their caregivers have been even more scared, because you know, not all caregivers are created equal. Some of these patient populations are older, and you know, there can be confusion. So, you know, I think the fact that these monitoring devices are going to become available will be immensely helpful, not only for the patient's well-being, but for their caregiver who's right now on the hook. If they fall asleep and miss the patient spiking a fever, I mean, this is the scary stuff. So, I think this is fantastic. I do wonder how you manage, how you figure out the ICANS part of it, because I know the symptoms you're talking about are primarily CRS. So does the monitor do anything that can gauge the mental activity or no?
Dr. Navneet Majhail: We are spot on that the monitoring is mostly focused around CRS. Now, for example, our program here in Nashville, the process we've set up is, so the kit that the patients use also has a tablet, through which you can have a video conference capability, right? So the process that we've set up here at the Nashville program where I practice is that one of our nurses will do a video call at 8:00 p.m. And again, I mean, you can imagine, I emphasize the team effort because you've got the outpatient clinic team, they'll have patients, as you know, there's a whole assessment that patients do, where they write their name, you know, a sentence and, you know, everything else. And at the end of the day, all that is basically passed on to the nurse who's on at night to do those assessments for patients. And around 8:00 p.m. or so, she'll or he'll connect with the patient through that video conference capability. They'll have them write that sentence and then show it on that video to see what it looks like. And then he or she can compare as to what it was 12 hours earlier at 8:00 in the morning. So it is not around the clock ICANS monitoring, but at least patients don't go 24 hours or more before getting that assessed.
Dr. Fumiko Chino: No, that's so helpful to kind of have that clarity. And I love what Laurie said that patients and patient caregivers actually kind of want this, the idea that there's more eyes on them and they're getting this sort of continuous monitoring. So, it sort of meets the brief in terms of optimizing time at home, but also reassurance for patients and caregivers.
Dr. Fumiko Chino: Now, Laurie, I had watched your interview on The Patient Story, and you had said something I thought was quite striking. You had gone to four different large cancer centers for various treatments, that ultimately led to your cure with CAR T. Do you mind speaking about how access to specialty care can be really a barrier for patients? I know that you had said previously that you felt lucky to live in LA. And I'm assuming that's not just for the nice weather.
Laurie Adami: No, it's not. I'm from the Northeast, and I'm still a Northeasterner, but being in LA where I could get to so many care centers so easily within an hour was a real bonus for me. The other thing that I was lucky to have was good insurance. So I had PPO insurance when I was employed, and that allowed me to see specialists. And I talked to many, many patients now, you know, probably over 50% of patients get diagnosed in community oncology settings and/or community hospitals, and oftentimes those settings don't have specialists. So I speak to patients being treated at Kaiser where they don't even have a lymphoma specialist. And so they're not being given necessarily the best information about the available treatments, and they may never even hear of CAR T.
So, it's a real problem for a lot of patients to get to specialists, and unless you're seeing a specialist, you're unlikely to hear about these newer modalities of treatment, immunotherapies, small molecule drugs, CAR Ts, much less likely if you're seeing a general oncologist. They're not going to know about it. And what do they know about chemotherapy, auto stem cell transplant, and allo stem cell transplant, which is being done for over 50 years? And so I'm still speaking to many patients who can't get CAR T because their insurance either won't pay for it, or they live in a state where there are no CAR T centers, which believe it or not is still the case in the United States today. There's still a small number of states where you have to travel two or three states to get to a CAR T center, and you have to get a referral from your community oncologist, and there's no easy mechanism for that happening back and forth. And I'm working on a couple initiatives with some focus groups to make that better, but it's a real struggle.
And that's why I was lucky. I had good insurance, I lived in LA, I was treated at four big cancer centers, and within an hour, I could fly to San Francisco or San Diego to see more specialists. So it's really a function of when you're diagnosed, what is your insurance? What assets do you have? What benefits do you have? I speak to patients who if they don't go to work today, they don't get a paycheck. They can't miss a day to travel eight hours to go see a specialist. So there's a real problem with access in the United States and a real problem, I think, with bifurcated health care.
Dr. Fumiko Chino: I love that you have used the privilege that you did have, even in the context of a stage four diagnosis, and then used that energy that you kind of came out of it to continue to advocate aggressively for other patients. So I, you know, I applaud you a thousand times for that.
Now, Navneet, can you talk about the access barriers from the provider perspective? I know that you had mentioned capacity building in the OP paper and about how outpatient treatment facilities programs development in the community oncology practices could certainly help ease some of these geographic barriers to care that Laurie just so eloquently brought up.
Dr. Navneet Majhail: So, Fumiko, to put this into context, let me start with some numbers first. So if you look at the number of patients in the United States who can potentially benefit from a CAR T-therapy for the currently approved indications, one in five patients gets it. So I'll let that sink in. Despite all these transformative therapies we've talked about, only one to in five to one in four patients who needs a CAR T-therapy will get it. And some of the research that we have done and others have done, once you get to a treatment center, right, so once you get to a treatment center - so you've bypassed all those geographic, insurance, many of these other access barriers to a CAR T-therapy - once you get to a treatment center, two out of the three patients will end up getting an infusion or treatment. So there's still a third of these patients who will not get an infusion once they hit a CAR T center, mostly because their disease is too advanced by the time they show up. So these are the high-level numbers that put into perspective what the delta is, right? What the gap is that we need to solve as we go forward.
So now, as you think about the access barriers, I think Laurie, you were spot on some of the education gaps across many of our colleagues in the community where they may not be aware of the indications, the advances, and the opportunities around CAR T-therapy. So, obviously, I think that's a big issue. Even on the provider side, even though they are patient-centric access barriers, I mean, we feel it too, geography, trying to get patients into see us, right? Some of the insurance barriers you talked about, I mean, the health disparity issues that I think Fumiko, you're very familiar with. And as you can think about a therapy which is expensive, is limited to select sites, all those access barriers that we face across oncology just get accentuated. They get multiplied.
As we think about the community practices, as, and you're spot on, I mean, how do we increase access? A big opportunity is getting these to the community sites. I think provider education is a big one. The capacity pieces, how do we build capacity is a big one. And I think the third one is what I call the economics of care delivery. What that means is not just the cost of these therapies, but things like the infrastructure that needs to be built up, the people you need to hire, train, get to a good place, all those pieces, apheresis, for example and so forth. And then all the reimbursement, revenue cycle pieces that as a practice you have to deal with. So these are some of the barriers at the community practice levels people feel as you consider accessing these therapies.
Dr. Fumiko Chino: Absolutely. You know, Laurie, did you have anything to follow up with that?
Laurie Adami: I just wanted to comment on this financial issue because I know Navneet talked about the high cost of these therapies, which is completely valid, but if you look at the treatment that I had prior to my CAR T, I had over $3 million in costs billed to my insurance. That was before CAR T. So, one of the therapies that I was on in a clinical trial, where I was actually the long tail in the trial, was a PI3 kinase inhibitor trial that I was on for almost six years. And while it never got rid of my cancer, it bought me stable disease. I stayed on that pill for almost six years. It bought me stable disease to allow me to get to CAR T. But that drug got priced for $180,000 a year, and I was on it for six years. Right there, that's almost $1.2 Million.
So, I think if you look at the alternatives, you find out that really CAR T is not, I mean, yes, it is expensive, for sure, but you know, if you look at something like an allo stem cell transplant, which was being tossed at me over the 12 years as an option, that's far more expensive than CAR T, because not only is it a very long time in the hospital - they were telling me to expect up to three months in the hospital - but then a lot of patients have terrible graft-versus-host disease, so you spend the rest of your life in medical care. So, I just wanted to raise that point, and to the extent we can reduce the hospital costs by taking these treatments to patients outpatient, that will be a huge benefit, because that can be half of your cost in hospital stays. When I was in the ICU, I think it was $38,000 a night for one ICU night. So these hospital stays are very costly. But I did want to just point out that it's kind of painted as black and white, so expensive, but I think we have to contrast it for all the other options patients are getting. You know, if you're on a drug for many, many years, a small molecule drug, those drugs are very expensive. And if you can do a one time, one and done, you're far better off financially.
Dr. Fumiko Chino: Absolutely. And I think, and this is not to put it in such stark terms, but I'll say this as a cancer widow, dying in the hospital is very expensive, and it is a terminal diagnosis and then in the ICU, we're talking about incredibly expensive and by definition morbid and mortal. So if we're saving lives and creating cures, that's a high-value proposition.
Now, Laurie, it is very clear that you're a very engaged patient, and I know you've spoken before about how you were very active in your care in terms of researching new treatment options, going to clinicaltrials.gov. Can you speak a little bit from your experience both as a patient and an advocate about how access and knowledge has improved a little bit over time? For example, the Leukemia and Lymphoma Society was recently renamed to the Blood Cancer United, but I know they have a clinical trial support center, and I know that you have played a role as a peer mentor for some other patients, so I would love to hear more about that.
Laurie Adami: Sure. Yeah, so when I was diagnosed 19 years ago, there were very few tools, and it was really a struggle for me to get information. And yes, while I use clinicaltrials.gov, I found it was full of false information. It wasn't updated promptly, and I was very concerned, and then I found out the FDA didn't approve what goes into clinicaltrials.gov. So there's a lot of junk in there. And when patients say, "Oh yeah, I'm looking at clinicaltrials.gov," I'm always encouraging them to reach out to a nonprofit that is focused on their area because that's the best place to get valid information.
Now, the problem is most people don't know about nonprofits because outside of the American Cancer Society and Susan Komen, very few nonprofits spend any money at all advertising because their mission is to cure the disease they're focusing on and to make sure patients get the financial help they need. So the money that they're raising is going to research and helping patients. So you don't see advertisements on TV, "Oh yeah, if you need to find a clinical trial for pancreatic cancer, call PanCAN Action." You just don't see it.
So I had to figure that out on my own, and now it's amazing what organizations like LLS or Blood Cancer United are doing because you can call them, and I've called on behalf of many patients, I've provided all the pathology information and the treatment history. Within 48 hours, they return a list of all the trials that you qualify for in whatever geographic region you request, and it's at no cost at all. And Blood Cancer United will actually call - I just hooked a patient up with a trial at the National Institutes of Health, thankfully a trial that didn't get shut down yet - and they actually called on behalf of that patient to make sure that they were still accepting enrolling patients.
So that's something that I think most patients don't know about, and I wish physicians, when they diagnose their patients, I wish physicians would provide resources. You know, "You should reach out to Blood Cancer United or Lymphoma Research." But the problem is most of these big academic research centers are also doing their own fundraising. So they don't really want to connect you with another nonprofit that's raising money. So it's kind of a conflict a bit. I mean, I know they want to do the best for patients, but they're restricted in terms of what kind of information they can hand out to the patient. And I've always wanted to put like pamphlets in my oncologist's office because when you get diagnosed, no one ever expects to get diagnosed, and 40% of people in the United States are going to get in their lifetime diagnosed with cancer. So you are going to have that bomb go off, a lot of people are, and you don't know what to do. And if someone had told me back when I was diagnosed, these nonprofits have resources, reach out, there are support groups, there are patients you can talk to, it would have saved me so much time and aggravation, and I just had to figure it out on my own. And sadly, that's still the case in large part.
Dr. Fumiko Chino: I love this siren call to be an activated patient, but also for providers to really think about the full dynamic of care for the patient in front of you and to not be narrow in your institution, but to really think about what are all of the resources that we can marshal around everyone.
I do want to leave a little bit of space at the end if there's anything that you feel like we didn't cover.
Dr. Navneet Majhail: Yeah, again, I think, Fumiko, we're still evolving in the field. As we think about where the field is going, we'll have constructs hopefully in the solid tumor space. Autoimmune diseases are coming. We're all excited about that. But I think going back to the fundamentals, so how do we take care of patients well? It's not just the care that happens in the context of the first few weeks before and after infusion, but then how do you watch these patients lifelong to look for late effects, survivorship issues, and so forth as you think about it. And I know we didn't get a lot of time to talk about this, but especially since your focus was how do we take this to the community, a big piece is ensuring the quality of care these patients receive in the community. You mentioned FACT early on and its role in ensuring high-quality care, it becomes even more relevant in the context of outpatient care as we think about these therapies.
Dr. Fumiko Chino: Absolutely.
Now, Laurie, last thoughts from you?
Laurie Adami: So I did want to add that we talk about CAR T and all the risks of CAR T and the long-term follow-up because I understand it's a genetic tool, right? This is not just chemo pills coming off a factory line. This is using your own immune system, modified, etc. But I think we also need to remember, if we contrast it to the brutal treatments I had before CAR T - CAR T, I'm not worried at all about that. If I get secondary cancers down the road, because I was so heavily treated, and most patients as of right now have been heavily treated. They've had radiation, they've had chemotherapy. We know those cause secondary malignancies. All of my side effects have to do with my prior six lines of treatment, not with CAR T. So I just want to remind everybody that, you know, we look at this in a vacuum, but the old stuff wasn't so great either. And maybe we should talk about how these patients are doing after those therapies. Anyway, that was it.
Dr. Navneet Majhail: Laurie, I was going to say, thank you so much. I'm going to take so many of your quotes and enlarge them and put them in my clinic. You've been incredible.
Laurie Adami: Reach out anytime, and if I ever get to Tennessee, I'll come see you. I'll buy you dinner.
Dr. Navneet Majhail: Looking forward to that.
Dr. Fumiko Chino: I love the idea that every single provider will have quotes enlarged from a patient advocate who was treated for their disease site in their clinic, because if there's anything that we can learn outside of the science, it's from the lived experience of cancer treatment and survivorship. I want to thank you so much for this great conversation today.
Many thanks to Dr. Majhail and Ms. Adami, as well as our listeners. You will find the links to the papers that we discussed in the transcript of this episode. If you value the insights that you hear on the JCO OP Put into Practice podcast, please take a moment to rate, review, and subscribe wherever you get your podcasts. I hope you'll join us next month for Put into Practice's next episode. Until then, please stay safe.
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.
Conflicts of Interest
Fumiko Chino
Consulting or Advisory Role
Company: Institute for Value Based Medicine
Research Funding
Company: Merck
Laurie Adami
Stock and Other Ownership Interests
Company: Gilead, Merck, Pfizer and Universal Health Services
Navneet Majhail
Stock and Other Ownership Interests
Company: HCA Healthcare
Consulting or Advisory Role
Company: Anthem, Inc
