Larotrectinib (Vitrakvi®)

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

Last review date: December 4, 2019

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