CYRAMZA (ramucirumab)

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