Aetna considers temsirolimus (Torisel) medically necessary for members with advanced (metastatic or unresectable) renal cell carcinoma. Temsirolimus is considered experimental and investigational for all other indications.
Temsirolimus (Torisel) is an intravenous chemotherapeutic agent in the class mTOR inhibitor for the treatment of renal cell carcinoma. It was approved by the U.S. Food and Drug Administration (FDA) in May 2007 for the treatment of advanced renal cell carcinoma in adults. Current guidelines from the National Comprehensive Cancer Network (NCCN, 2013) recommend use of temsirolimus in kidney cancer for the following indications: 1) first-line therapy as a single agent for relapsed or medically unresectable stage IV disease (clear cell or non-clear cell); 2) subsequent therapy as a single agent for relapsed or medically unresectable stage IV disease with predominant clear cell histology.
Continued use beyond 3 months (12 weeks) is considered medically necessary for persons with stable disease (tumor size within 25% of baseline). Continued use is considered not medically necessary when there is evidence of disease progression or unacceptable toxicity occurs.
CPT Codes / HCPCS Codes / ICD-9 Codes
Other CPT codes related to the CPB:
96413 - 96417
HCPCS codes covered if selection criteria are met:
Injection, temsirolimus, 1 mg (Torisel)
ICD-9 codes covered if selection criteria are met:
189.0 - 189.1
Malignant neoplasm of kidney and renal pelvis
The above policy is based on the following references:
Hudes G, et al. Temsirolimus, Interferon Alfa, or both for advanced renal-cell carcinoma. N Engl J Med 2007;356:2271-81.
Torisel® (temsirolimus) prescribing information. Wyeth Pharmaceuticals, Inc., May 2012.,Acccessed 03/05/2013
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