afatinib (Gilotrif®)

SELF ADMINISTRATION - ORAL

Indications for Prior Authorization:

  • Treatment of patients with metastatic non-small cell lung cancer (NSCLC) whose tumors have epidermal growth factor (EGFR) exon 19 deletions or exon 21 substitution mutation

Patients must meet the following criteria for the indication(s) above:

  • All patients must undergo genetic testing to confirm EGFR status
  • Gene mutations must be documented by FDA approved genetic testing

The Following Conditions Do Not Meet the Criteria for Use as Established by the WHA P & T Committee:

  • All uses not listed in the approved indications

Recommended Dosing

  • 40 mg orally once daily until disease progression or intolerable side effects
  • Drug should be taken 1 hour before or 2 hours after meals.

Approval:

Six months


 

Last review date: January 1, 2014

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