belinostat (Beleodaq®)

OFFICE ADMINISTRATION

Indications for Prior Authorization:

  • Indicated for second line therapy for patients with relapsed or refractory peripheral T-cell lymphoma

Patient must meet the following criteria for the above indications:

  • Patients must have failed first line therapy with CHOP or CHOP-like regimens

The following indications do not meet the criteria for use established by the Western Health Advantage Pharmacy and Therapeutics Committee:

  • For any indications not mentioned above

Dosing:

  • Days 1 to 5 of a 21 day cycle: 1 g/m2 given once daily as an IV infusion over 30 minutes
  • May be repeated until disease progression or unacceptable toxicity

Approval:

6 months


 

Last review date: September 1, 2014