VITRAKVI (larotrectinib)

VITRAKVI (larotrectinib)

SELF ADMINISTRATION - ORAL

Indications for Prior Authorization:

• Indicated for the treatment of adult and pediatric patients with solid tumors that:
  • have a neurotrophic receptor tyrosine kinase (NTRK) gene fusion without a known acquired resistance mutation,
  • are metastatic or where surgical resection is likely to result in severe morbidity, and
  • have no satisfactory alternative treatments or that have progressed following treatment.

The following criteria must be met: 

• Chart note documentation is provided, AND
• Prescribed by an oncologist, AND
• Patient's tumor has a neurotrophic receptor tyrosine kinase (NTRK) gene fusion without a known acquired resistance mutation, AND
• Patient meets one of the following criteria:
  • Patients tumor is metastatic, OR
  • Surgical resection of tumor will likely result in severe morbidity, AND
• Patient meets one of the following criteria:
  • There are no satisfactory alternative treatments, OR
  • The patient has a disease progression following treatment. 

Dosing: 

• Adults and Pediatric Patients with body surface area of at least 1.0 m²:
  • 100 mg orally twice daily
• Pediatric Patients with body surface area less than 1.0 m²:
  • 100 mg/m² orally twice daily
• Vitrakvi® is dose adjusted, withheld or discontinued for adverse reactions

Approval: 

1 year