Unitedhealthcare Cancer Therapy Pathways Program Regimens
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UnitedHealthcare Cancer Therapy Pathways Program Overview 2 Breast Cancer 3 Pancreatic Cancer 15 Melanoma 19 Colon/Rectal Cancer 23 Hepatobiliary Cancers 30 Lung Cancer, Small Cell 35 Lung Cancer, Non-Small Cell 40 Ovarian, Fallopian and Primary Peritoneal Cancer 56 Head and Neck Cancer 67 Multiple Myeloma 74 Lymphoma, Diffuse Large B-Cell 86 Lymphoma, Follicular 92 Lymphoma, Marginal Zone 97 Lymphoma, Mantle Cell 101 Change control 1 OVERVIEW Cancer Therapy Pathways Program With the rapid approval of new therapies, along with the rising cost of cancer care, pathways serve a critical role in the delivery of high-quality and high-value cancer treatments while reducing an unwarranted variation in care. The UnitedHealthcare Cancer Therapy Pathways Program aims to improve quality and value in cancer care by identifying anti-cancer regimens supported by evidence-based guidelines to help reduce total cost of care and improve outcomes. The program’s regimens are selected on the basis of clinical benefit (efficacy) and side-effect profile (toxicity). Among regimens with comparable efficacy and toxicity, additional consideration is given to the frequency of hospitalizations during therapy, duration of therapy, drug costs and total cost of care. Care decisions are between the physician and the patient The Cancer Therapy Pathways Program is not a substitute for the experience and judgment of a physician or other health care professional. Any clinician participating in the program must use independent medical judgment in the context of individual clinical circumstances to determine any patient’s care or treatment. Care decisions are between the physician and patient. 2 Breast Cancer: Neoadjuvant/Adjuvant HER2 NEGATIVE: • Doxorubicin + Cyclophosphamide (dose dense) Paclitaxel weekly (ddAC weekly T) • Doxorubicin + Cyclophosphamide (dose dense) Paclitaxel every 2 weeks (ddAC q2w T) • Docetaxel + Cyclophosphamide (TC) HER2 POSITIVE: • Doxorubicin + Cyclophosphamide Paclitaxel weekly + Trastuzumab* (AC TH) • Docetaxel + Carboplatin + Trastuzumab* (TCH) • Paclitaxel + Trastuzumab* Breast Cancer: Adjuvant (Residual Disease Post-Neoadjuvant Treatment) TRIPLE NEGATIVE BREAST CANCER: • Capecitabine HER2 POSITIVE: • Ado-trastuzumab emtansine (T-DM1) Breast Cancer: Metastatic and Recurrent – Endocrine Therapy HER2 NEGATIVE: 1st Line of Therapy • Fulvestrant + Anastrozole • Anastrozole + Palbociclib • Letrozole + Palbociclib • Exemestane + Palbociclib • Anastrozole + Abemaciclib • Letrozole + Abemaciclib • Exemestane + Abemaciclib 1st + Subsequent Lines of Therapy • Anastrozole • Letrozole • Exemestane • Tamoxifen • Fulvestrant 2nd + Subsequent Lines of Therapy • Anastrozole • Letrozole • Exemestane • Tamoxifen • Fulvestrant • Fulvestrant + Palbociclib • Fulvestrant + Abemaciclib 3 HER2 POSITIVE: • Anastrozole + Trastuzumab* • Letrozole + Trastuzumab* • Exemestane + Trastuzumab* • Anastrozole + Lapatinib • Letrozole + Lapatinib • Exemestane + Lapatinib Breast Cancer: Metastatic and Recurrent – Chemotherapy HER2 NEGATIVE: 1st + Subsequent Lines of Therapy • Doxorubicin • Paclitaxel • Docetaxel • Capecitabine • Gemcitabine • Vinorelbine • Atezolizumab + Nab-Paclitaxel (in PD-L1+ mTNBC only) HER2 POSITIVE: 1st + Subsequent Lines of Therapy * • Docetaxel + Trastuzumab + Pertuzumab * • Paclitaxel + Trastuzumab + Pertuzumab • Ado-Trastuzumab Emtansine (T-DM1) • Capecitabine + Lapatinib * • Paclitaxel + Trastuzumab * • Vinorelbine + Trastuzumab * • Gemcitabine + Trastuzumab * • Capecitabine + Trastuzumab *Kanjinti™ and Trazimera™ are the preferred products under UnitedHealthcare commercial plans, Kanjinti™ is the preferred product under UnitedHealthcare Community Plans (in most markets) and all products are preferred under UnitedHealthcare Medicare plans. 4 References 1. 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SWOG S0221: Comparison of Two Schedules of Paclitaxel as Adjuvant Therapy for Breast Cancer ASCO Meeting Library (suppl; abstr CRA1008). Accessed May 20, 2019. Retrieved from meetinglibrary.asco.org/record/82186/abstract 4. Jones, S.E., Michael, A.S., Frankie, A.H., et al. (2006, Dec. 1). Phase III Trial Comparing Doxorubicin Plus Cyclophosphamide With Docetaxel Plus Cyclophosphamide as Adjuvant Therapy for Operable Breast Cancer. Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology. Accessed May 20, 2019. Retrieved from ncbi.nlm.nih.gov/pubmed/17135639 5. Jones, S., Holmes, F.A., O’Shaughnessy, J., et al. (2009, March 10). Docetaxel With Cyclophosphamide Is Associated With an Overall Survival Benefit Compared With Doxorubicin and Cyclophosphamide: Seven-Year Follow-Up of U.S. Oncology Research Trial 9735. Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology. Accessed May 20, 2019. 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