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The disruption of the vital enzymatic steps associated with glutamine utilization by glutaminase inhibitors results in reduced availability of metabolic intermediates required for nucleotide synthesis, tricarboxylic acid (TCA) cycle replenishment, and redox balance maintenance, collectively inducing metabolic stress and compromising cancer cell viability [56]

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The underlying assumptions in the methodology, both the status quo that assumes no variation whatsoever in indirect costs per work RVU between settings of care and under the proposal that would allocate half the amount of indirect costs, are not driven by precise numbers, and the proposed change will better recognize the relative resources involved in furnishing services paid under the PFS in facility and non-facility settings