Unitedhealthcare Cancer Therapy Pathways Program Regimens

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Unitedhealthcare Cancer Therapy Pathways Program Regimens 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. Citron, M.L., Donald A.B., Constance C., et al. (2003, April 15). Randomized Trial of Dose-Dense Versus Conventionally Scheduled and Sequential Versus Concurrent Combination Chemotherapy as Postoperative Adjuvant Treatment of Node-Positive Primary Breast Cancer: First Report of Intergroup Trial C9741/Cancer and Leukemia Group B Trial 9741. Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology. Accessed May 20, 2019. Retrieved from ncbi.nlm.nih.gov/pubmed/12668651 2. Mamounas, E.P., John, B., Barry, L., et al. (2005, June 1). Paclitaxel After Doxorubicin Plus Cyclophosphamide as Adjuvant Chemotherapy for Node-Positive Breast Cancer: Results From NSABP B-28. Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology. Accessed May 20, 2019. Retrieved from ncbi.nlm.nih.gov/pubmed/15897552 3. Budd, G.T., William E.B., Halle, C.M., et al. 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. Retrieved from ncbi.nlm.nih.gov/pubmed/?term=19204201 6. Preethi, J., Bannuru, R.R., Cohen, J.T., et al. Cost-Effectiveness of Adjuvant Chemotherapy in Early-Stage Breast Cancer. Journal of Clinical Oncology. Accessed May 20, 2019. Retrieved from ascopubs.org/doi/abs/10.1200/JCO.2018.36.15_suppl.e18887 7. Fisher, B., Brown, A.M., Dimitrov, N.V., et al. (September 1990). Two Months of Doxorubicin- Cyclophosphamide With and Without Interval Reinduction Therapy Compared With Six Months of Cyclophosphamide, Methotrexate and Fluorouracil in Positive-Node Breast Cancer Patients With Tamoxifen-Nonresponsive Tumors: Results From the National Surgical Adjuvant Breast and Bowel Project B-15. Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology. Accessed May 20, 2019. Retrieved from ncbi.nlm.nih.gov/pubmed/?term=2202791 8. Sparano, J.A., Molin, W., Silvana, M., et al. (2008, April 17). Weekly Paclitaxel in the Adjuvant Treatment of Breast Cancer. The New England Journal of Medicine. Accessed May 20, 2019. Retrieved from ncbi.nlm.nih.gov/pubmed/18420499 9. Von, G., Raab, G., Caputo, A., et al. (2005, April 20). Doxorubicin With Cyclophosphamide Followed by Docetaxel Every 21 Days Compared With Doxorubicin and Docetaxel Every 14 Days as Preoperative Treatment in Operable Breast Cancer: The GEPARDUO Study of the German Breast Group. Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology. Accessed May 20, 2019. Retrieved from ncbi.nlm.nih.gov/pubmed/?term=15837982 10. Hutchins. L.F., Stephanie, J.G., Peter, M.R., et al. (2005, Nov. 20). Randomized, Controlled Trial of Cyclophosphamide, Methotrexate, and Fluorouracil Versus Cyclophosphamide, Doxorubicin, and Fluorouracil With and Without Tamoxifen for High-Risk, Node-Negative Breast Cancer: Treatment Results of Intergroup Protocol INT-0102. Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology. Accessed May 20, 2019. Retrieved from ncbi.nlm.nih.gov/pubmed/16293862 11. Fisher, B., Anderson, S., Tan-Chiu, E., et al. (2001, Feb. 15). Tamoxifen and Chemotherapy for Axillary Node-Negative, Estrogen Receptor-Negative Breast Cancer: Findings From National Surgical Adjuvant Breast and Bowel Project B-23. Retrieved from ncbi.nlm.nih.gov/pubmed/11181655 12. Mackey, J.R., Pieńkowski, T., Crown, J., et al. (June 2016). Long-Term Outcomes After Adjuvant Treatment of Sequential Versus Combination Docetaxel With Doxorubicin and Cyclophosphamide in 5 Node-Positive Breast Cancer: BCIRG-005 randomized trial. Retrieved from ncbi.nlm.nih.gov/pubmed/26940688 13. Martin, M., Pienkowski, T., Mackey, J., et al. (2005, June 2). Adjuvant Docetaxel for Node-Positive Breast Cancer. The New England Journal of Medicine. Accessed May 20, 2019. Retrieved from ncbi.nlm.nih.gov/pubmed/?term=15930421 14. Piccart, M.J., Di, A., Beauduin, M., et al. (2001, June 15). Phase III Trial Comparing Two Dose Levels of Epirubicin Combined With Cyclophosphamide With Cyclophosphamide, Methotrexate and Fluorouracil in Node-Positive 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/?term=11408507 15. Masuda, N., Lee, S., Ohtani, S., et al. (2017, June 1). Adjuvant Capecitabine for Breast Cancer After Preoperative Chemotherapy. The New England Journal of Medicine. Accessed May 20, 2019. Retrieved from ncbi.nlm.nih.gov/pubmed/28564564 16. Kosaka, Y., Rai, Y., Masuda, N., et al. (2015). Phase III Placebo-Controlled, Double-Blind, Randomized Trial of Pegfilgrastim to Reduce the Risk of Febrile Neutropenia in Breast Cancer Patients Receiving Docetaxel/Cyclophosphamide Chemotherapy. Retrieved from ncbi.nlm.nih.gov/pubmed/25576433 17. Jones, R.L., Walsh, G., Ashley, S., et al. (2009, Jan. 27). A Randomised Pilot Phase
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