CYRAMZA (ramucirumab)
OFFICE ADMINISTRATION
Indications for Prior Authorization:
- Patients with advanced/metastatic gastric adenocarcinoma with progression after prior fluoropyrimidine or platinum chemotherapy
- Non-small cell lung cancer (NSCLC, metastatic)
Patients must meet the following criteria for the indications above:
Advanced/metastatic gastric adenocarcinoma
- Documented diagnosis of advanced/metastatic gastric adenocarcinoma with progression after prior fluoropyrimidine or platinum chemotherapy
Non-small cell lung cancer (NSCLC, metastatic)
- Diagnosis of metastatic NSCLC, AND
- Disease progression on or after platinum-based chemotherapy, AND
- Being used in combination with docetaxel, AND
- One of the following:
- Negative EGFR or ALK mutation, OR
- Positive EGFR or ALK mutation AND prior treatment with FDA-approved therapy* for EGFR or ALK genomic tumor aberrations, OR
- Unknown EGFR or ALK mutation status, AND
- Patient has pure squamous cell histology
- *Table of FDA-approved therapies for NSCLC tumors expressing EGFR or ALK genomic tumor abberations.
- EGFR: erlotinib (Tarceva), afatinib (Gilotrif)
- ALK: crizotinib (Xalkori), ceritinib (Zykadia)
The following indications do not meet the criteria for use established by the Western Health Advantage Pharmacy and Therapeutics Committee:
- Any other diagnosis not listed in the approved indications
Dosing:
Advanced/metastatic gastric adenocarcinoma
- The dose of ranibizumab is 8 mg/kg by IV infusion over 60 minutes every 2 weeks
Non-small cell lung cancer (NSCLC, metastatic)
- Up to 10mg/kg IV on day 1 of 21-day cycles
Monitoring:
- Pre-medicate with intravenous histamine (H1) antagonist
Last review date: July 21, 2016