Modified XELIRI (mXELIRI; capecitabine and irinotecan) with or without bevacizumab (Avastin) demonstrated similar overall survival (OS) rates to FOLFIRI with or without bevacizumab in the second line, but mXELIRI also showed an improved safety profile.

&ldquo;Modified XELIRI is effective and well tolerated. This regimen is a more convenient alternative to FOLFIRI as a second-line backbone therapy for mCRC,&rdquo; said Tae Won Kim, MD, director of the Clinical Research Center and the Center for Personalized Cancer Medicine, Asan Medical Center Cancer Institute, University of Ulsan College of Medicine, in Seoul, Korea. He presented findings on behalf of the AXEPT trial investigators during the 2017 ESMO Asia Congress.

XELIRI has generally been excluded from guidelines as a recommended backbone for patients with mCRC because of a higher rate of toxicities seen with the regimen in clinical trials, Kim noted. In the BICC-C study, which compared the FOLFIRI, XELIRI, and irinotecan plus bolus fluorouracil/leucovorin regimens, XELIRI demonstrated higher rates of severe vomiting, diarrhea, and dehydration.

However, more recent trials have shown favorable efficacy and tolerability with a modified version of the XELIRI regimen: irinotecan 200 mg/m

In the phase III AXEPT trial, 650 patients with mCRC from Japan, Korea, and China who had progressed during or after first-line chemotherapy were randomized 1:1 to either FOLFIRI or mXELIRI, both with or without added bevacizumab. In each arm, 310 patients were treated.

The primary endpoint was OS, and secondary endpoints included progression-free survival (PFS), objective response rate (ORR), disease control rate (DCR), and safety. Kim explained that the upper margin of the noninferiority hypothesis was a hazard ratio (HR) of 1.3.

In the FOLFIRI arm, 5-FU was given intravenously at 400 mg/m

of leucovorin and 180 mg/m2 of irinotecan, all on day 1, which was followed by 2400 mg/m

of 5-FU through day 3. Added bevacizumab was administered at 5 mg/kg on day 1 of the 2-week cycle. When added to the mXELIRI regimen, bevacizumab was given at 7.5 mg/kg; the regimen was administered every 3 weeks. In both arms, the dose of irinotecan was lowered to 150 mg/m

*28 or *6 homozygotes or double-heterozygotes.

In the intent-to-treat (ITT) population, characteristics were mostly well balanced between the 2 arms, Kim noted. The median age was 60 in the FOLFIRI arm and 61 in the mXELIRI arm. A majority of the patients had an ECOG performance status of 0 or 1 (99%) and left-sided primary tumors (76%) and had received prior oxaliplatin (97%).

Capecitabine had been received by 42.9% of patients in the FOLFIRI arm and 36.8% in the mXELIRI arm. Prior anti-EGFR therapy had been given to 15.1% and 17.2% in the FOLFIRI and mXELIRI arms, respectively.

&ldquo;When this study was planned, targeted therapy was not reimbursed in Korea and in China, [so] less than 30% of the patients were exposed to prior bevacizumab,&rdquo; Kim said. As a result, 83% received concomitant bevacizumab in the trial.

mutations were found in 31.2% of patients in the FOLFIRI arm and among 28.5% in the mXELIRI arm; 8% in the FOLFIRI arm and 7.4% in the mXELIRI arm had UGT1A1 *28 or *6 double-heterozygotes or homozygotes.

Median OS was 15.4 months with FOLFIRI with or without bevacizumab in the ITT population and 16.8 months with XELIRI (HR, 0.85; 95% CI, 0.71-1.02; P = .088). Per protocol, the median OS was 15.4 and 16.8 months with the FOLFIRI and mXELIRI regimens, respectively (HR, 0.85; 95% CI, 0.71-1.03). Median PFS in the ITT group was 7.2 months with FOLFIRI and 8.4 months with mXELIRI, which did not achieve statistical significance (HR, 0.95; 95% CI, 0.81-1.11;

The FOLFIRI arm demonstrated an ORR of 18.4%, and the mXELIRI arm had an ORR of 24.2% (

= .0951), with 2 complete responses from FOLFIRI and 13 from mXELIRI; the DCR was 71.9% and 77.4%, respectively (

Subgroup analyses of OS showed that lower performance status favored treatment with FOLFIRI. No prior treatment with oxaliplatin also favored FOLFIRI. &ldquo;Overall survival with the modified XELIRI arm was noninferior to the FOLFIRI arm in patients with or without bevacizumab,&rdquo; Kim noted.

The rate of grade 3/4 adverse events (AEs) was significantly higher with FOLFIRI compared with mXELIRI (72.3% vs 53.9%;

<.0001). Grade 3/4 neutropenia was especially higher in the FOLFIRI arm (42.9% vs 16.8%;

<.0001). AEs of increased frequency with mXELIRI included nausea, diarrhea, digestive tract perforation, and grade 2 hand-foot syndrome.

Park Y, Muro K, Xu R, et al. Randomized, non-inferiority, phase III trial of second-line chemotherapy for metastatic colorectal cancer, comparing the efficacy and safety of XELIRI &plusmn; bevacizumab vs FOLFIRI &plusmn; bevacizumab (AXEPT). Presented at: 2017 ESMO Asia Congress; November 17-19, 2017; Singapore. Abstract LBA3_PR. oncologypro.esmo.org/Meeting-Resources/ESMO-Asia-2017Congress/Randomized-non-inferiority-phase-III-trial-of-second-line-chemotherapy-for-metastatic-colorectal-cancer-mCRC-comparing-the-efficacy-and-safety-of-XELIRI-bevacizumab-versus-FOLFIRI-bevacizumab-AXEPT-LBA3_PR.

Fuchs CS, Marshall J, Mitchell E, et al. Randomized, controlled trial of irinotecan plus infusional, bolus, or oral fluoropyrimidines in first-line treatment of metastatic colorectal cancer: results from the BICC-C study.

. 2007;25(30):4779-4786. doi: 10.1200/JCO.2007.11.3357.

Articles

Clinical Articles

According to the results of the randomized phase III&nbsp;AXEPT clinical trial, a chemotherapy doublet has proved noninferior to treatment with standard FOLFIRI (folinic acid [leucovorin], fluorouracil [5-FU], and irinotecan) for patients with previously treated metastatic colorectal cancer (mCRC).<sup>1</sup>

Second-Line Chemotherapy Doublet Proves Noninferior to FOLFIRI in mCRC

The MET oncogene has become a rapidly rising target for the treatment of patients with nonsmall cell lung cancer (NSCLC), according to Balazs Halmos, MD, MS. Over the past several years, interest in MET has grown as investigators have considered it both as a biomarker and target for treatment, particularly with the targeting of MET exon 14 skipping mutations (

), leading to the development of several second-generation MET inhibitors.

MET is a transmembrane receptor tyrosine kinase, and this pathway (

) can be activated in one of several ways,1 explained Halmos, director of thoracic oncology, and director of clinical cancer genomics, Montefiore Medical Center, during a presentation at the

New York Lung Cancers Symposium, hosted by Physicians&rsquo; Education Resource&reg;, LLC. The pathway can be activated through protein overexpression; increased expression of its ligand, hepatocyte growth factor;

mutations; gene amplification; and alternative splicing or exon 14 skipping. Each of these methods has been investigated as a potential approach to utilize this pathway for the treatment of patients with cancer.

&ldquo;This plethora of possibilities led to a lot of confusion in the field over the years over which biomarker to use for selecting patients for MET-targeted therapy,&rdquo; Halmos said.

Using MET protein overexpression as a biomarker led to the failure of several randomized studies. For example, the phase III METLung trial of onartuzumab (MetMAb) in combination with erlotinib (Tarceva) failed to meet its primary endpoint of improved overall survival (OS) with added onartuzumab in patients with previously treated locally advanced or metastatic NSCLC. Onartuzumab is a monoclonal antibody that binds to the extracellular domain of MET, yet the combination regimen with onartuzumab demonstrated a median OS of 6.8 months compared with 9.1 months for erlotinib and placebo (hazard ratio [HR], 1.27; 95% CI, 0.98-1.65;

The investigators noted that there may be better ways to select patients for MET-targeted therapy than with MET immunohistochemistry.

A greater signal for MET as an actionable target was seen with the use of

amplification. In the PROFILE 001 study, crizotinib (Xalkori) was investigated in patients with c-

amplified, advanced NSCLC. Although crizotinib is often used in patients with

-rearranged lung cancers, the tyrosine kinase inhibitor (TKI) was originally developed as a type Ia MET inhibitor, Halmos noted. The small trial showed several responses to crizotinib, especially among patients with a higher

&ldquo;In patients with a very high copy number of MET, suddenly there&rsquo;s a lack of other critical driver oncogenes being presented;[this] suggested that in those cancers,

amplification can be the sole clinical driver,&rdquo; Halmos said. However, he noted that it was difficult for investigators to find the right

/CEP7 threshold for identifying patients for such MET-targeted treatment. Although the threshold changes from study to study, the minimum has been set at 5 for high

Use of MET inhibition has also been investigated in combinations as a method of bypassing resistance to treatments. The overall frequency of

-driven acquired resistance is likely to be about 2% to 5%, Halmos said.

&ldquo;It seems that the overexpressed MET kinase clusters on the cell surface along with EGFR, and basically creates a complex on the cell surface that leads to an unconventional EGFR signaling not requiring the ATP binding activity of EGFR. As a result, EGFR inhibition on its own is not successful and dual inhibition is necessary.&rdquo;

An ongoing phase Ib study of savolitinib, a type Ib MET inhibitor, in combination with gefitinib (Iressa) in patients with

positive NSCLC who had acquired resistance to a prior EGFR TKI, has demonstrated clinical activity for the combination of dual MET and EGFR inhibition in resistant patients. As of data cutoff, the overall response rate (ORR) was 31%. Interestingly, the ORR was 52% in T790M-negative patients and 9% in T790M- positive patients.

gene can be identified, investigators have found that in patients with NSCLC, most cluster around exon 14 (

exon 14 is skipped&hellip;a very specific piece of the MET protein will be missing, and this particular piece contains a critical tyrosine residue. This tyrosine residue is important for CBL binding leading to the degradation of MET,&rdquo; he explained. Without the tyrosine residue, MET is not degraded appropriately and can remain overactivated and oncogenic.

Overall, this mutation is found in approximately 3% of patients with nonsquamous NSCLC and in 22% of patients with sarcomatoid carcinoma. Among the patients with nonsquamous NSCLC and a

exon 14 skipping mutation, 68% had an adenocarcinoma histology. Additionally, there tended to be an overlap between

amplification in patients with advanced lung cancer.

&ldquo;The presence of this specific mutation also marks these cancer cells for great sensitivity against MET-targeted compounds, such as crizotinib, cabozantinib [Cabometyx], and a number of new molecules that are being developed,&rdquo; Halmos said in an interview with

exon 14 mutations is critical because they can do just as well with the targeted treatment as

In a retrospective study of patients with a

exon 14 skipping mutation treated with a MET inhibitor, the median OS was 24.6 months compared with 8.1 months in patients who did not receive MET-targeted therapy (HR, 0.11; 95% CI, 0.01-0.92;

= .04). Crizotinib was given to 22 patients who experienced a median progression-free survival of 7.36 months.

Halmos noted, however, that there was some survivor bias in this study.

exon 14&minus;altered cancers can also express high levels of PD-L1, yet this does not translate into significant clinical benefit with immunotherapies, Halmos said. In a study of patients with recurrent or metastatic NSCLC who harbored a

exon 14 skipping mutation and who were being treated with checkpoint inhibitors, the ORR from all 63 patients included in the study was 13%. In patients with PD-L1 expression &ge;50%, the ORR was 33%, and in patients with no PD-L1 expression, the ORR was 20%.

&ldquo;[This] reaffirms that molecular testing doesn&rsquo;t just help us identify patients for molecular treatment, it helps us understand immunotherapy, as well, outside of tumor mutation burden. So, we need to get this multigene testing for all of our patients if we want to continue to advance the care of our patients,&rdquo; Halmos said during his presentation.

Interest in the treatment of patients with

exon skipping mutations with MET inhibitors has led to the development of newer MET inhibitors, such as capmatinib, tepotinib, and glesatinib, with several others in preclinical stages.

Gelsomino F, Facchinetti F, Haspinger ER, et al. Targeting the MET gene for the treatment of non-smallcell lung cancer.

. 2014;89(2):284-299. doi: 10.1016/j.critrevonc.2013.11.006.

Spigel DR, Edelman MJ, O&rsquo;Byrne K, et al. Results from the phase III randomized trial of onartuzumab plus erlotinib versus erlotinib in previously treated stage IIIB or IV non-small-cell lung cancer: METLung.

. 2017;35(4):412-420. doi: 10.1200/JCO.2016.69.2160.

Camidge DR, Ou SHI, Shapiro G, et al. Efficacy and safety of crizotinib in patients with advanced c-MET-amplified non-small cell lung cancer (NSCLC).

. 2014;32(suppl 5s; abstr 8001). meetinglibrary.asco.org/record/92507/abstract.

Yang JJ, Fang J, Shu Y, et al. A phase Ib trial of savolitinib plus gefitinib for Chinese patients with EGFR-mutant MET-amplified advanced NSCLC. Presented at: 2017 International Associatio for the Study of Lung Cancer World Conference on Lung Cancer; October 15-18, 2017; Yokohama, Japan. Abstract OA 09.06. library.iaslc.org/search-speaker?search_speaker=55340.

Awad MM, Oxnard GR, Jackman DM, et al. MET exon 14 mutations in non-small-cell lung cancer are associated with advanced age and stage-dependent MET genomic amplification and c-met overexpression.

. 2016;34(7):721-730. doi: 10.1200/JCO.2015.63.4600.

Awad MM, Leonardi GC, Kravets S, et al. Impact of MET inhibitors on survival among patients (pts) with MET exon 14 mutant (METdel14) non-small cell lung cancer (NSCLC).

2017;35(suppl; abstr 8511). meetinglibrary.asco.org/record/145462/abstract.

Sabari JK, Montecalvo J, Chen R, et al. PD-L1 expression and response to immunotherapy in patients with MET exon 14-altered non-small cell lung cancers (NSCLC).

2017;35(suppl; abstr 8512). meetinglibrary.asco.org/record/152528/abstract.

The MET oncogene has become a rapidly rising target for the treatment of patients with non&ndash;small cell lung cancer (NSCLC), according to Balazs Halmos, MD, MS.

Targeting the MET Pathway for Lung Cancer Treatments, Biomarkers

Just as CMS moves ahead with payment reforms designed to reduce the total cost of hospital care, results from a new study show that cancer treatment costs remain significantly lower at community oncology clinics compared with hospitals. The cost for patients receiving chemotherapy in hospital outpatient facilities is nearly 60% higher than the same treatment at independent practices, according to the study by Lucio Gordan, MD, medical director, Division of Quality and Informatics, Florida Cancer Specialists, and Xcenda, a health economics consultancy. The average difference for patients with breast, lung, or colon cancer was $7512 per month, or $20,060 in the hospital setting versus $12,548 at community practices. Annually, the average difference amounted to $90,144 per patient.

The findings are consistent with 10 previous studies between 2011 and 2016 that found hospital outpatient costs were 38% higher on average, according to a report released by the Community Oncology Alliance (COA). Gordan said that the difference in his study may reflect increased costs of new biologic drugs, more expensive radiology, and higher hospital fees.

A major driver for the difference was chemotherapy, which ran 71%, or $3510, higher per month in hospital outpatient departments; the average spending was $8443 compared with $4933 at community practices. Physician visits cost 3 times as much per month: $3316 versus $765. The widest gap was seen in breast cancer (

), which cost 66% more in outpatient settings, followed by lung cancer at 54% higher and colorectal cancer at 46% higher.

Gordan&rsquo;s analysis adjusted for cancer type, age, geographic region, presence of metastatic disease, comorbidities, and other factors to ensure the comparison of similar hospital-based and community patient populations, he said. He also found that those in hospital settings were likely to have more emergency department (ED) visits and hospitalizations after receiving chemotherapy. For hospital patients, 9.8% had ED visits within 10 days compared with 7.9% for community practice patients.

The study supports COA&rsquo;s campaign to fix payment systems that favor hospitals and lead to acquisitions and closures of independent practices, Gordan said. He presented the findings at COA&rsquo;s annual Payer Exchange Summit on Oncology Payment Reform in October. &ldquo;This is going to be an evolving battle to get payers to understand,&rdquo; he said.

Some hospitals argue that their higher costs are justified because they offer services not available elsewhere, such as 24-hour EDs, uncompensated care, and disaster preparedness. &ldquo;These roles are not explicitly funded; instead they are built into a hospital&rsquo;s overall cost structure and supported by revenues received from providing direct patient care,&rdquo; the American Hospital Association (AHA) said this year. Meanwhile, COA argues that community practices have their own expensive obligations and provide equally good care at much lower costs.

The AHA did not respond to requests for comment on the COA study. Numerous individual hospital centers also did not respond or provide comments.

Nancy Keating, MD, MPH, a professor of healthcare policy and medicine at Harvard Medical School, said that a top reason for the cost differential is hospital systems&rsquo; negotiating power with health plans. By including big systems in their networks, payers make their plans more attractive to their customers. The larger the health system, the more power it has to demand higher payments, adding to the incentive for further expansion.

Although Gordan is focusing on changing private payer policies, the federal government is acting to reduce its spending on hospital-based care. As required by a 2015 budget law, in 2017 CMS put into effect a site-neutral payment policy that cut Medicare reimbursement rates in half for care at new hospital outpatient facilities. The rule, which aims to bring those payments in line with the fees paid to private physicians, applies to outpatient offices built or acquired since November 2015.

&ldquo;One concern that gave rise to this, as expressed by some members of Congress, the Medicare Payment Advisory Commission, and other groups, is the trend of hospitals buying physician practices and converting what had been a physician practice to an off-campus hospital department,&rdquo; said Elizabeth Halpern, a partner at the law firm Hogan Lovells in Washington, DC. &ldquo;Hospitals could buy physician practices, convert them to be part of the hospital, and then get paid for the services they provide there at the hospital rate instead of at the physician rate.&rdquo;

Halpern said that some hospitals went ahead with new outpatient facilities with different service offerings than previously planned, while others put them on hold. &ldquo;Anecdotally, what I&rsquo;d heard is that some transactions or construction plans that were under way&hellip;may have been stopped because the financial model and the reimbursement that was expected wasn&rsquo;t going to be there,&rdquo; she said. Halpern noted that CMS recently announced it is slashing the outpatient reimbursement rate even further in 2018, from the current 50% of the old hospital rate down to 25%.

However, COA executive director Ted Okon said that the site-neutral payment policy affects only sites acquired or built since November 2015, and that the impact of Medicare fee differences &ldquo;pales in comparison&rdquo; with the competitive advantage that hospitals gain from the 340B Drug Discount Program. Close to two-thirds of hospitals get deep discounts on oncology drugs, which are meant to subsidize the cost of treating low-income patients, but instead boost cancer program revenues and motivate hospitals to take over community practices, he said. The Centers for Medicare and Medicaid Services (CMS) now targets that program as well, cutting Medicare payments for 340B drugs from the current average sales price (ASP) plus 6% down to ASP minus 22.5%.

The AHA called the change &ldquo;misguided&rdquo; and said it will sue to block it; the association argued that CMS&rsquo; proposals will make it more difficult for patients to afford or find the care they need. &ldquo;The patients who benefit from the much-needed 340B program are the ones who will have their access to care threatened,&rdquo; AHA executive vice president Tom Nickels said.

Whether payment reforms will be harmful for low-income patients is unclear. Low Medicaid payment rates make chemotherapy infusions money losers for community practices, whereas chemotherapy is generally profitable for 340B hospitals. Payment reforms would reduce hospital revenues, but whether such cuts would lead a hospital to stop offering chemotherapy would likely depend on numerous factors.

Different dynamics are at work for patients with lower-end exchange plans. Some payers already steer them to community practices to control costs, Keating said. Thus, government payment models that encourage practice acquisitions could reduce treatment options for these patients.

Gordan L; Community Oncology Alliance; Xcenda. The value of community oncology: site of care cost analysis. Community Oncology Alliance website. communityoncology.org/wp-content/uploads/2017/09/Site-of-Care-Cost-Analysis-White-Paper_9.25.17.pdf. Published September 25, 2017. Accessed December 20, 2017.

Just as CMS moves ahead with payment reforms designed to reduce the total cost of hospital care, results from a new study show that cancer treatment costs remain significantly lower at community oncology clinics compared with hospitals.

Taking on the Hospital/Community Practice Cost Differential

Improving outcomes for disadvantaged patients with lung cancer has been a priority for over 5 years at Mary Bird Perkins-Our Lady of the Lake Cancer Center in Baton Rouge, Louisiana. Such efforts involve every aspect of lung cancer care, with the cancer center working hardest on the first step in the process: timely screening. In 2015, nearly two-thirds of the 330 patients with lung cancer at Mary Bird Perkins arrived with late-stage disease. The proportion was even higher among patients on Medicaid, at nearly 80%.

The organization seeks to enhance patient outcomes by encouraging earlier screening. They developed a screening program with a satellite location in the neighboring city of Gonzales, and gave local primary care physicians (PCPs) informational flyers to remind them which patients should receive scans. More recently, the cancer center configured the electronic health records used by more than 100 affiliated PCPs to automatically suggest screening referrals for qualifying patients.

&ldquo;We have one of the largest at-risk populations in the country with regards to lung cancer, and our efforts have resulted in success in diagnosing early-stage lung cancers with a diagnostic yield similar to that seen in the landmark [National Cancer Institute] National Lung Screening Trial study,&rdquo; said Brad Vincent, MD, chair of Mary Bird Perkins&rsquo; lung cancer multidisciplinary care team. &ldquo;We have a long way to go to meet the needs of our community due to population growth, and are making strides every week to expand our reach, especially in the underserved areas. We recently partnered with Louisiana State University Health professionals who serve a large portion of that population. Hopefully, this partnership will translate into higher numbers screened and earlier diagnoses for our community.&rdquo;

Such efforts have begun to improve outcomes, and they have made Mary Bird Perkins 1 of 5 practices chosen to help the Association of Community Cancer Centers (ACCC) devise an optimal care coordination model (OCCM) for patients with lung cancer on Medicaid. Practices hoping to improve their treatment of disadvantaged patients with lung cancer can now refer to the successful initiatives from test sites such as Mary Bird.

Genesis&rsquo; facility is designed to facilitate current standards of care. However, nurse navigators, financial counselors, and easy collaboration are among the various specialties offered that cannot help patients who come in too late or who fail to complete treatment. As such, Genesis is working hard to slash the time between a patient&rsquo;s first visit and first treatment by 50% or more.

&ldquo;A 60-day gap between first contact and first treatment was not unusual. We have already trimmed that considerably by combining steps, and we hope to get it well under a month by combining more,&rdquo; said Scott Wegner, MD, the facility&rsquo;s medical director.

&ldquo;When we perform the initial scan here...we try to analyze it while the patient waits and perform any necessary biopsies that same day,&rdquo; Wegner said. &ldquo;When biopsies come back positive, we immediately assign each patient a navigator who specializes in lung cancer, and that navigator assembles a multidisciplinary team that devises a treatment plan, as opposed to automatically sending the patient first to a pulmonologist, then to a surgeon, then to oncologists.&rdquo; Genesis also offers treatments before receiving prior authorization from Medicaid to reduce delays, providing the same standard of therapeutic care to all patients, regardless of their ability to pay. Because Genesis sticks to published standards of care from the American Society of Clinical Oncology, rejections are uncommon.&nbsp;

&ldquo;It&rsquo;s not enough to break even on Medicaid patients. That&rsquo;s just not possible given reimbursement rates, but greater efficiency definitely reduces losses and keeps you on better financial footing,&rdquo; Wegner said.

Once treatment begins, the challenge becomes adherence. Patients on Medicaid are more likely to miss sessions or abandon treatment. A wide variety of factors contribute to the problem, including distrust of doctors, substance abuse problems, and a lack of support from family and friends.

Nevertheless, the ACCC OCCM practices have found that support from nurse navigators, financial counselors, and other support staff can ameliorate these problems and improve adherence rates. Nurse navigators, for example, can handle scheduling and other complexities that might require help from family members. Palliative care specialists can reduce the number of missed sessions by helping to manage the physical and psychological adverse effects of cancer treatment. These specialists are particularly valuable in devising strategies to manage pain effectively without creating or exacerbating substance abuse problems.

Transportation is another major barrier for the Medicaid population, although many plans provide free shuttle service to and from medical appointments, and access to free or discounted rides on public transportation. Shuttle bus schedules cannot be changed easily, and although public transit provides coverage for most city centers, it is less available in rural and suburban parts of the country.

The OCCM participants have responded to these challenges by either reimbursing patients for the cost of cabs or ride-sharing services, oras in Mary Bird&rsquo;s case&mdash;creating a local nonprofit car service run by volunteers. The programs also have employed patient navigators and other support staff to reduce transportation needs by consolidating appointments.

Officials hope that technology will soon reduce the need for extra transportation spending and ease patients&rsquo; lives. &ldquo;People have been touting the potential of telemedicine for at least a decade now, and it has never taken off because of obstacles ranging from patient privacy concerns to insurer reimbursement policies,&rdquo; said Ralph Zinner, MD, a professor of medical oncology with the Sidney Kimmel Cancer Center at Thomas Jefferson University. &ldquo;We think it can be a significant tool for improving patient care. A video call is in no way a replacement for a physical examination, but it does allow for very significant interaction with patients and can probably eliminate the need for some office visits.&rdquo;

Improving outcomes for disadvantaged patients with lung cancer has been a priority for over 5 years at Mary Bird Perkins-Our Lady of the Lake Cancer Center in Baton Rouge, Louisiana.

January 2018

Second-Line Chemotherapy Doublet Proves Noninferior to FOLFIRI in mCRC

Targeting the MET Pathway for Lung Cancer Treatments, Biomarkers

Taking on the Hospital/Community Practice Cost Differential

Organizing Faster Care for Urgent Lung Cancer Cases