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Pharmacy Clinical Policy Bulletins
Aetna Non-Medicare Prescription Drug Plan
Subject: Antineoplastics

Status Drug PR PR-QL PR-AL ST M EX‡
P temozolamide   X      
P tretinoin oral   X      
P Gleevec®  (imatinib mesylate®) X X      
P Nexavar®  (sorafenib) X X      
P Tarceva®  (erlotinib) X X      
P Sutent®  (sunitinib) X X      
P Tasigna®  (nilotinib) X X      
P Temodar®  (temozolamide)   X      
P Xeloda®  (capecitabine)   X      
P Zytiga™  (abiraterone) X X      
NP Afinitor®  (everolimus) X X      
NP Afinitor Disperz™  (everolimus) X X      
NP Bosulif®  (bosutinib) X X      
NP Caprelsa®  (vandetanib) X X      
NP Cometriq ™  (cabozantinib) X X      
NP Erivedge™  (vismodegib) X X      
NP Gilotrif™  (afatinib) X X      
NP Hycamtin cap®  (topotecan HCl cap)   X      
NP Inlyta®  (axitinib) X X      
NP Jakafi®  (ruxolitinib phosphate) X X      
NP Mekinist™  (trametinib) X X      
NP Oforta®  (fludarabine) X X      
NP Pomalyst®  (pomalidomide) X X      
NP Revlimid®  (lenalidomide) X        
NP Sprycel™  (dasatinib) X X      
NP Stivarga®  (regorafenib) X X      
NP Sylatron™  (peginterferon alfa-2b) X X      
NP Tafinlar®  (dabrafenib) X X      
NP Tykerb®  (lapitinib) X X      
NP Vandetanib®  (vandetanib) X X      
NP Vesanoid®  (tretinoin oral)   X      
NP Votrient™  (pazopanib) X X      
NP Xalkori®  (crizotinib) X X      
NP Xtandi®  (enzalutamide) X X      
NP Zelboraf™  (vemurafenib) X X      
NP Zolinza®  (vorinostat) X X      


Policy:

  1. Precertification Criteria
  2. Under some plans, including plans that use an open or closed formulary, Afinitor, Afinitor Disperz, Bosulif, Caprelsa, Cometriq, Erivedge, Gilotrif, Gleevec, Hycamtin capsules, Inlyta, Jakafi, Mekinist, Nexavar, Oforta, Pomalyst, Revlimid, Sprycel, Stivarga, Sutent, Sylatron, Tafinlar, Tarceva, Tasigna, Temodar, temozolamide, tretinoin oral, Tykerb, Vandetanib, Vesanoid, Votrient, Xalkori, Xeloda, Xtandi, Zelboraf, Zytiga, and Zolinza are subject to precertification and quantity limits.  If precertification requirements apply Aetna considers these drugs to be medically necessary for those members who meet all of the following precertification criteria:


    For Hycamtin, Temodar, temozolamide, tretinoin oral, Vesanoid, and Xeloda – Only Quantity limits  apply

    For Afinitor 

    • A documented diagnosis of one of the following:
      • Advanced renal cell carcinoma AND a documented failure of sunitinib (Sutent) or sorafenib (Nexavar)
      • Subependymal giant cell astrocytoma (SEGA) associated with tuberous sclerosis (TSC) that can not be treated with surgery
      • Progressive neuroendocrine tumors located in the pancreas (PNET) that cannot be removed by surgery or that have spread to other parts of the body (metastatic)
      • Waldenström’s acroglobulinemia/lymphoplasmacytic lymphoma, as a single agent for salvage therapy for disease that does not respond to primary therapy or for progressive or relapsed disease
      • Renal angiomyolipoma and tuberous sclerosis complex (TSC) not requiring immediate surgery
      • Advanced hormone receptor-positive, HER2-negative breast cancer (advanced HR+BC) in combination with exemestane (Aromasin) after failure of treatment with letrozole (Femara) or anastrozole (Arimidex)

    For Afinitor Disperz

    • A documented diagnosis of subependymal giant cell astrocytoma (SEGA) associated with tuberous sclerosis (TSC) that can not be treated with surgery

    For Bosulif

    • A documented Diagnosis of chronic, accelerated, or blast phase Philadelphia chromosome positive (Ph+) chronic myelogenous leukemia (CML) AND documentation of resistance or intolerance to prior therapy with nilotinib (Tasigna)

    For Caprelsa and Vandetanib 

    • A documented diagnosis of one of the following:
      • Symptomatic or progressive medullary thyroid cancer in patients with unresectable (i.e. cannot be treated with surgery), locally advanced, or metastatic disease

    For Cometriq

    • A documented diagnosis of progressive, metastatic medullary thyroid cancer

    For Erivedge 

    • A documented  diagnosis of one of the following:
      • Locally advanced basal cell carcinoma that has recurred following surgery or who are not candidates for surgery, and who are not candidates for radiation
      • Metastatic basal cell carcinoma

    For Gilotrif

    • A documented diagnosis of metastatic, non-small cell lung cancer (NSCLC) in patients whose tumors have epidermal growth factor receptor (EGFR) exon 19 deletions or exon 21 (L858R) substitution mutations, as detected by an FDA-approved test

    For Gleevec 

    • A documented diagnosis of one of the following:
      • Chronic Myelogenous Leukemia (CML) documented as any one of the following:

        • Newly diagnosed adult patients with Philadelphia chromosome positive chronic myeloid leukemia (Ph+ CML) in chronic phase
        • Primary therapy for newly diagnosed CML confirmed by Ph+ or BCR-ABL+gene
        • Pediatric patients with Ph+ CML in chronic phase who are newly diagnosed or whose disease has recurred after stem cell transplant or who are resistant to interferon-alpha therapy
        • Philadelphia chromosome positive (Ph+ CML) in blast crisis, accelerated phase, or in chronic phase after failure of interferon-alpha therapy
        • Follow-up therapy for CML patients with molecular or cytogenetic relapse, or patients not in cytogenetic remission, after hematopoietic stem cell transplant (HSCT)
        • Patient is stable on the medication
      • Acute lymphoblastic leukemia (Ph+ ALL) documented as any one of the following:
        • Newly diagnosed Ph+ ALL in combination with chemotherapy
        • Adult patients with relapsed or refractory Philadelphia chromosome positive acute lymphoblastic leukemia (Ph+ ALL)
      • Adults with myelodysplastic/myeloproliferative diseases (MDS/MPD) associated with PDGFR (platelet-derived growth factor receptor) gene re-arrangements
      • Adult patients with aggressive systemic mastocytosis without the D816V c-Kit mutation or with c-Kit mutational status unknown
      • Adult patients with hypereosinophilic syndrome (HES) and/or chronic eosinophilic leukemia (CEL) who have the FIP1L1-PDGFRα fusion kinase (mutational analysis or FISH 
        demonstration of CHIC2 allele deletion) and for patients with HES and/or CEL who are FIP1L1-PDGFRα fusion kinase negative or unknown
      • Adult patients with unresectable, recurrent and/or metastatic dermatofibrosarcoma protuberans
      • Gastrointestinal stromal tumors (GIST) documented as any one of the following:
        • Primary treatment of documented GIST (resectable, unresectable, recurrent, or metastatic)
        • Adult patients with Kit (CD117) positive unresectable and/or  metastatic malignant  gastrointestinal stromal tumors (GIST)
        • Adjuvant treatment of adult patients following resection of Kit (CD117) positive GIST
      • Induction or re-induction therapy for Ph+ lymphoblastic lymphoma, in combination with hyperCVAD chemotherapy (plus rituximab if CD20+)
      • Unresectable or recurrent desmoid tumor, or treatment for gross residual disease following resection

    For Inlyta

    • A documented diagnosis of advanced renal cell carcinoma after failure of one prior systemic therapy that includes but not limited to Nexavar, Afinitor, Avastin plus interferon, Sutent, Torisel, or Votrient

    For Jakafi

    • A documented diagnosis of myelofibrosis that can include any of the following: either primary myelofibrosis, or post-polycythemia vera myelofibrosis or post-essential  thrombocythemiayelofibrosis

    For Mekinist

    • A documented diagnosis of unresectable or metastatic melanoma in adult patients with BRAF V600E or V600K mutations as detected by an FDA approved test AND member has not received prior BRAF inhibitor therapy (i.e., vemurafenib (Zelboraf), dabrafenib (Tafinlar))

    For Nexavar 

    • A documented diagnosis of one of the following:
      • Unresectable (i.e. cannot be treated with surgery), hepatocellular carcinoma (HCC)
      • Advanced renal cell carcinoma (RCC)
      • Progressive or symptomatic metastatic thyroid carcinoma in patients with nonradioiodineresponsive tumors at sites other than central nervous system, with any of the following histologic types:  follicular, Hürthle cell, or papillary
      • Disseminated symptomatic medullary thyroid carcinoma
      • Progressive gastrointestinal stromal tumor (GIST) when patient is no longer receiving benefit from imatinib or sunitinib
      • Angiosarcoma as a single agent, in the following soft tissue OR sarcoma (STS) subtypes: STS of extremity, retroperitoneal/intra-abdominal STS

    For Oforta

    • A documented diagnosis of B-cell chronic lymphocytic leukemia (CLL) whose disease has not responded to or has progressed during or after treatment with at least one standard alkylating agent-containing regimen

    For Pomalyst

    • A documented diagnosis of multiple myeloma and documentation of ALL of the following:
      •  Two prior therapies that include lenalidomide (Revlimid) and bortezomib (Velcade)
         before initiating therapy with Pomalyst
      •  Disease progression on or within 60 days of completion of the last therapy
      •  If Female-of reproductive potential, documentation of all of the following:
        • Two negative pregnancy tests obtained prior to initiating therapy with Pomalyst
        • Monthly negative pregnancy tests during therapy
        • Patient has been counseled about the use of reliable contraception and must use 2 forms of contraception before, during, and 1 month after initiation of therapy with Pomalyst
      • Patient assessment to determine if prophylactic aspirin or anti-thrombotic treatment (warfarin, clopidogrel) will need to be taken to reduce the risk of VTE (embolism, stroke).
      • Confirmation of enrollment in the restricted distribution program called POMALYST REMS (refer to special notes below)

    For Revlimid 

    • A documented diagnosis of one of the following:
      • Myelodysplastic syndrome (MDS) documented as any one of the following:
        • Transfusion-dependent anemia due to Low- or Intermediate (INT)-1-risk myelodysplastic syndrome (MDS) associated with a deletion 5q cytogenetic abnormality with or without additional cytogenetic abnormalities
        • Low or INT-1 risk MDS with deletion 5q cytogenetic abnormality with symptomatic anemia and clinically significant cytopenias
        • Low or INT-1 risk MDS without deletion 5q cytogenetic abnormality with symptomatic anemia and serum erythropoietin levels > 500 mU/mL and a low probability of response to immunosuppressive therapy
        • Low or INT-1 risk MDS without deletion 5q cytogenetic abnormality with symptomatic anemia and no response to initial treatment with epoetin alfa or darbepoetin alfa
      • Multiple myeloma documented as any one of the following:
        • Will be taken in combination with dexamethasone in patients who have received at  least one prior therapy
        • Multiple myeloma (including symptomatic smoldering myeloma and progressive solitary plasmacytoma) in combination with dexamethasone as primary therapy
        • Will be taken as monotherapy for disease relapse or for progressive or refractory disease
        • Will be taken as single agent maintenance therapy following stem cell transplant or in those responding to primary induction therapy
      • Systemic light chain amyloidosis, with dexamethasone as primary treatment
      • Mantle cell lymphoma, as monotherapy for relapsed, refractory, or progressive disease
      • Diffuse large B-cell lymphoma, relapsed or refractory
      • Chronic lymphocytic leukemia, relapsed or refractory
      • Lymphoma associated with Castleman's disease in noncandidates for high-dose therapy, as second-line therapy with or without rituximab

    For Sprycel

    • A documented diagnosis of one of the following:
      • Newly diagnosed Philadelphia chromosome-positive chronic phase chronic myeloid leukemia (Ph+ CP-CML) AND resistance or intolerance to prior therapy with nilotinib (Tasigna)
      • Chronic, accelerated, or myeloid or lymphoid blast phase Philadelphia chromosome-positive chronic myeloid leukemia (CML) AND resistance or intolerance to prior therapy with nilotinib (Tasigna)
      • Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph+ ALL) AND resistance or intolerance to prior therapy with imatinib mesylate (Gleevec)

    For Stivarga

    • A documented diagnosis of one of the following:
      • Metastatic colorectal cancer AND documentation of prior therapy with ALL of the following:
        • Fluoropyrimidine-, oxaliplatin-, and irinotecan-based chemotherapy (i.e. FOLFIRI/FOLFOX/CapOx, others)
        • bevacizumab (Avastin)
        • panitumumab (Vectibix) OR cetuximab (Erbitux) (FOR KRAS mutation-negative patients only)
      • Locally advanced, unresectable or metastatic gastrointestinal stromal tumor (GIST) AND documentation of prior therapy with imatinib mesylate (Gleevec) AND sunitinib (Sutent)

    For Sutent

    • A documented diagnosis of one of the following:
      • Advanced Renal Cell Carcinoma
      • Gastrointestinal Stromal Tumor (GIST) AND a documented disease progression while on therapy with imatinib mesylate/Gleevec OR documented  intolerance to imatinib mesylate /Gleevec
      • Progressive neuroendocrine tumors located in the pancreas (pNET) that cannot be removed by surgery or that have spread to other parts of the body (metastatic)

    For Sylatron

    • A documented diagnosis of melanoma with microscopic or gross nodal involvement within 84 days of surgery including complete lymphadenectomy

    For Tafinlar

    • A documented diagnosis of unresectable or metastatic melanoma in adult patients with BRAF V600E mutation as detected by an FDA approved test AND
    • Documentation that Tafinlar will not be used in patients with wild-type BRAF melanoma due to the potential risk of tumor promotion in these patients

    For Tarceva 

    • A documented diagnosis of one of the following:
      • Non-small cell lung cancer (NSCLC) AND any one of the following:
        • Locally advanced or metastatic NSCLC after failure of at least one prior chemotherapy regimen
        • Locally advanced or metastatic non-small cell lung cancer whose disease has not progressed after four cycles of platinum-based first line chemotherapy
        • Non-small cell lung cancer in members with known active EGFR mutation or gene amplification
      • Advanced, unresectable, or metastatic pancreatic cancer in combination with gemcitabine

    For Tasigna 

    • A documented diagnosis of one of the following:
      • Newly diagnosed Philadelphia chromosome positive chronic myelogenous leukemia (Ph+CML) in chronic phase
      • Chronic phase (CP) or accelerated phase (AP) Philadelphia chromosome positive chronic myelogenous leukemia (Ph+CML)

    For Tykerb 

    • A documented  diagnosis of one of the following:
      • Breast cancer, Advanced or metastatic, HER2 overexpression in combination with capecitabine after prior therapies
      • Breast cancer -Inflammatory, relapsed or refractory
      • Metastatic breast cancer, HER2 overexpression, first-line
      • Metastatic breast cancer, HER2 overexpression, refractory, monotherapy
      • Breast cancer, Advanced, hormone positive and HER2-positive in combination with letrozole (Femara)
      • Breast cancer in combination with trastuzumab (without cytotoxic therapy) or capecitabine for trastuzumab-exposed HER2 positive recurrent metastatic disease
      • Hormone receptor positive metastatic breast cancer that overexpresses the HER2 receptor in postmenopausal women for whom hormonal therapy is indicated
      • Breast cancer in combination with aromatase inhibitor for the treatment if recurrent or stage IV estrogen receptor-positive, HER2-positive disease in postmenopausal women who have received no prior endocrine therapy within one year

    For Votrient

    • A documented diagnosis of one of the following:
      • Advanced renal cell carcinoma with clear cell hisotology
      • Advanced soft tissue sarcoma after failure of one prior chemotherapy regimen
      • Clinically progressive or symptomatic metastatic thyroid carcinoma-follicular carcinoma, Hürthle cell carcinoma, or papillary carcinoma in patients with nonradioiodine-responsive tumors at sites other than central nervous system
      • Medically inoperable uterine sarcoma limited to the uterus

    For Xalkori 

    • A documented diagnosis of locally advanced or metastatic non-small cell lung cancer (NSCLC) that is anaplastic lymphoma kinase (ALK) positive as detected by an FDA approved test

    For Xtandi

    • A documented diagnosis of metastatic castration-resistant prostate cancer in patients who have previously received docetaxel AND
      • A documented resistance or intolerance to prior therapy with (abiraterone) Zytiga OR
        • A medical contraindication to corticosteroids

    For Zelboraf

    • A documented diagnosis of unresectable or metastatic melanoma with BRAFV600E mutation as detected by an FDA approved test.

    For Zolinza

    • A documented  diagnosis of one of the following:
      • Cutaneous manifestations in patients with T-cell lymphoma (CTCL) who have progressive, persistent or recurrent disease on or following two systemic therapies (e.g.  oral tretinoin AND oral bexarotene (Targretin)
      • Primary systemic biologic therapy for mycosis fungoides (MF)/Sezary syndrome documented as any one of the following:
        • Early–stage MF (stage IA, IB-IIA) with blood involvement or with folliculotropic/large cell transformation
        • Advanced-stage MF (stage IIB, stage III) or Sezary syndrome
        • Adjuvant systemic biologic therapy for MF/Sezary syndrome
        • After total skin electron beam therapy in patients with stage IIB MF
        • After chemotherapy in patients with stage IV disease
        • Systemic biologic therapy for refractory or progressive early-stage or stage IIB disease with patch/plaque lesions

    For Zytiga 

    • A documented diagnosis of late-stage (metastatic) castration-resistant prostate cancer and documentation of ALL of the following:
      • Will be taking Zytiga in combination with prednisone
      • Will NOT be used in combination with Xtandi

     

    Quantity Limits:  For Hycamtin, Temodartemozolamide, tretinoin oral, Vesanoid, a maximum of a 30-day supply will be allowed per prescription as indicated in the table below.  For Afinitor, Afinitor Disperz, BosulifCaprelsaCometriq, Erivedge, Gilotrif, GleevecInlyta, Jakafi, Nexavar, Oforta, Pomalyst, Tarceva, Stivarga, Sylatron, Sprycel, Sutent, Tasigna, Tykerb, Vandetanib, Votrient, Zelboraf, Zolinza and Zytiga a maximum of 30-day supply will be allowed per prescription if member fulfills criteria above.  A quantity of these agents will be considered medically necessary as indicated in the table below:

    Drug Quantity Limits
    Afinitor All Strengths: 30 day supply
    Afinitor Disperz All Strengths: 30 day supply
    Bosulif All Strengths: 30 day supply (Up to 84 tablets)
    Caprelsa All Strengths: 30 day supply
    Cometriq All Strengths: 30 day supply
    Erivedge All Strengths: 30 day supply (Up to 60 tablets)
    Gilotrif All Strengths: 30 day supply
    Gleevec All Strengths: 30 day supply
    Hycamtin capsules All Strengths: 30 day supply
    Inlyta All Strengths 30 day supply
    Jakafi All Strengths: 30 day supply (Up to 60 tablets)
    Mekinist All Strengths: 30 day supply
    Nexavar All Strengths: 30 day supply
    Oforta All Strengths: 30 day supply
    Pomalyst All Strengths: 30 day supply
    Sprycel All Strengths: 30 day supply
    Stivarga All Strengths: 30 day supply
    Sutent All Strengths: 30 day supply
    Sylatron All Strengths: 30 day supply
    Tafinlar All Strengths: 30 day supply
    Tarceva All Strengths: 30 day supply
    Tasigna All Strengths: 30 day supply
    Temodar All Strengths: 30 day supply
    temozolamide All Strengths: 30 day supply
    tretinoin oral All Strengths: 30 day supply
    Tykerb All Strengths: 30 day supply
    Vandetanib All Strengths: 30 day supply
    Vesanoid All Strengths: 30 day supply
    Votrient All Strengths: 30 day supply
    Xalkori All strengths 30 day supply (up to 60 tablets)
    Xeloda All Strengths: 30 day supply
    Xtandi All Strengths: 30 day supply
    Zelboraf All Strengths: 30 day supply (up to 240 tablets)
    Zolinza All Strengths: 30 day supply
    Zytiga All Strengths: 30 day supply (up to 120 tablets)


    For coverage of additional quantities, a member's treating physician must request prior authorization through the Aetna Pharmacy Management Precertification Unit.  Additional quantities will be considered medically necessary for those members who meet the following criteria:

    • Member is being treated in the concomitant phase for newly diagnosed glioblastoma multiforme (in combination with radiotherapy) for 42 days (with a maximum of 49 days) - For Temodar and temozolamide only



Special Notes:

POMALYST REMS Program
Because of the embryo-fetal risk, POMALYST is available only through a restricted program under a Risk Evaluation and Mitigation Strategy (REMS) called “POMALYST REMS.” Prescribers and pharmacists must be certified with the program; patients must sign an agreement form and comply with the requirements. Further information about the POMALYST REMS program is available at [celgeneriskmanagement.com] or by telephone at 1‑888‑423‑5436.
 



Place of Service:

Outpatient

The above policy is based on the following references:

1. AHFS Drug Information® with AHFSfirstReleases®. ( www.statref.com), American Society Of Health-System Pharmacistey s®, Bethesda, MD. Updated periodically.
2. DRUGDEX® System [Internet database]. Greenwood Village, Colo: Thomson Micromedex. Updated periodically.
3. Drug Facts and Comparisons on-line. (www.drugfacts.com), Wolters Kluwer Health, St. Louis, MO. Updated periodically.
4. PDR® Electronic Library™ [Internet database]. Greenwood Village, Colo: Thomson Micromedex. Updated periodically.
5. National Comprehensive Cancer Network; Practice Guidelines in Oncology : Chronic Myelogenous Leukemia V.3.2008 accessed  1-21-08 at http://www.nccn.org/professionals/physician_gls/PDF/cml.pdf 
6. Vorinostat (Zolinza) for Cutaneous T-Cell Lymphoma. Medical Letter Drug Ther. 2007; 49:1256
7. FDA approves Sprycel, a new treatment for a rare type of leukemia. Pharmacist's Letter/Prescriber's Letter 2006;22(8):220812
8. Sorafenib (Nexavar)  for Renal Cell Carcinoma. Medical Letter Drug Ther. 2007; 49:1255
9. Sunitinib (Sutent) for Renal Cell Carcinoma. Medical Letter Drug Ther. 2007; 49:1255
10. Dasatinib (Sprycel) for CML and PH+ALL. Medical Letter Drug Ther. 2007; 49:1252
11. Non–Small Cell Lung Cancer: Clinical Practice Guideline.  Released October 23, 2007, by the National Comprehensive Cancer Network. http://www.nccn.org/professionals/physician_gls/PDF/nscl.pdf
12. Clinical Practice Guideline: Hepatobiliary Cancers.  Released September 11, 2007, by the National Comprehensive Cancer Network. http://www.nccn.org/professionals/physician_gls/PDF/hepatobiliary.pdf
13. Detailed guide: leukemia – chronic myeloid (CML). American Cancer Society Web site. http://www.cancer.org/docroot/CRI/CRI_2_3x.asp?rnav=cridg&dt=83. accessed March 2008
14. List A, Dewald G, Bennett J, et al. Lenalidomide in the myelodysplastic syndrome with chromosome 5q deletion. N Engl J Med. 2006;355:1456-1465. accessed March 2008
15. NCCN Practice Guidelines in Oncology-v3.2007 Soft Tissue Sarcoma-Gastrointestinal Stromal Tumors accessed March 2008 at http://www.nccn.org/professionals/physician_gls/PDF/sarcoma.pdf
16. NCCN Practice Guidelines in Oncology v. 2.2008 Breast Cancer accessed March 2008 a http://www.nccn.org/professionals/physician_gls/PDF/breast.pdf
17. NCCN Drugs and Biological Compendia: Everolimus accessed (subscription required)        6-3-09 at http://www.nccn.org/professionals/drug_compendium/MatrixGenerator/HTML/Everolimus.asp 
18. Rini BI; Cambell SC; Escudier B, Renal Cell Carcinoma, Lancet,  vol 373, iss 9669, p 1119-1132, yr 2009 http://itsnt14.its.uiowa.edu/articles/614700/614754.pdf 
19. Annemans L; Lemkuhl H; Tenderich G; Schulz U; Et Al Economic Evaluation Of Everolimus And Mycophenolate Mofetil Versus Azathioprine In De Novo Heart Transplantation. Transplant Proc, vol 39, iss 10, p 3306-3312, yr 2007
20. Motzer R J; Escudier B; Oudard S; Hutson T E; Et Al Efficacy Of Everolimus In Advanced Renal Cell Carcinoma: A Double-Blind, Randomised, Placebo-Controlled Phase III Trial Lancet, Vol 372, Iss 9637, P 449-456, Yr 2008 
21. National Comprehensive Cancer Network. Clinical practice guidelines in oncology. Kidney cancer v.2.2009 2009. http://www.nccn.org/professionals/physician_gls/PDF/kidney.pdf
22. Atkins, Michael. Molecularly targeted therapy for advanced renal cell carcinoma. In: UpToDate (online subscription required), Waltham, MA, Updated January 2009

Copyright Aetna Inc. All rights reserved. Pharmacy Clinical Policy Bulletins are developed by Aetna to assist in administering plan benefits and constitute neither offers of coverage nor medical advice. This Clinical Policy Bulletin contains only a partial, general description of plan or program benefits and does not constitute a contract. Aetna does not provide health care services and, therefore, cannot guarantee any results or outcomes. Participating providers are independent contractors in private practice and are neither employees nor agents of Aetna or its affiliates. Treating providers are solely responsible for medical advice and treatment of members. This Clinical Policy Bulletin may be updated and therefore is subject to change.

November 22, 2013
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