Bortezomib (Velcade)

Office administration

JCODE: J9041

Indications for Prior Authorization

  • Multiple Myeloma
  • Relapsed or Refractory Mantle Cell Lymphoma*
  • Relapsed or Refractory Cutaneous or Peripheral T-cell Lymphoma*
  • Waldenstrom's Macroglobinemia**

* Patient has disease recurrence or progression on or following treatment with prior chemotherapy.

** Must be given with rituximab

The drug is not covered for the following conditions:

  • Metastatic colorectal cancer
  • Advanced non-small cell lung cancer
  • Metastatic neuroendocrine carcinoma
  • Metastatic melanoma
  • Metastatic sarcoma
  • Any condition not listed in the indication section above.

Dosing

  • Previous untreated Multiple Myeloma:
    • Cycle 1-4:  Up to 1.3 mg/m2 twice a week (IV/SubQ)
    • Cycles 5-9: Up to 1.3 mg/m2 once weekly (IV/SubQ)
    • *Each cycle is 6 weeks
  • Refractory or relapsed Multiple Myeloma or Mantle Cell Lymphoma:
    • Up to 1.3 mg/m2 weekly (IV) for two weeks.
    • Repeat every three weeks.
  • Refractory or relapsed Cutaneous or T-cell Lymphoma:
    • Up to 1.3 mg/m2 (IV) for up to four doses per 21 day cycle.
  • Peripheral T-cell Lymphoma:
    • Up to 1.3 mg/m2 (IV) for up to four doses per 21 day cycle.
  • Waldenstrom's Macroglobinemia:
    • Up to 1.3 mg/m2 (IV/SubQ)

Approval Period

Renew for one year if patient has clinical response.


Western Health Advantage Pharmacy and Therapeutics Committee

Approved: January 2014

Last review date: July 20, 2016