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BC Cancer Benefit Drug List September 2021

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BC Cancer Benefit Drug List September 2021 Page 1 of 65 BC Cancer Benefit Drug List September 2021 DEFINITIONS Class I Reimbursed for active cancer or approved treatment or approved indication only. Reimbursed for approved indications only. Completion of the BC Cancer Compassionate Access Program Application (formerly Undesignated Indication Form) is necessary to Restricted Funding (R) provide the appropriate clinical information for each patient. NOTES 1. BC Cancer will reimburse, to the Communities Oncology Network hospital pharmacy, the actual acquisition cost of a Benefit Drug, up to the maximum price as determined by BC Cancer, based on the current brand and contract price. Please contact the OSCAR Hotline at 1-888-355-0355 if more information is required. 2. Not Otherwise Specified (NOS) code only applicable to Class I drugs where indicated. 3. Intrahepatic use of chemotherapy drugs is not reimbursable unless specified. 4. For queries regarding other indications not specified, please contact the BC Cancer Compassionate Access Program Office at 604.877.6000 x 6277 or [email protected] DOSAGE TUMOUR PROTOCOL DRUG APPROVED INDICATIONS CLASS NOTES FORM SITE CODES Therapy for Metastatic Castration-Sensitive Prostate Cancer using abiraterone tablet Genitourinary UGUMCSPABI* R Abiraterone and Prednisone Palliative Therapy for Metastatic Castration Resistant Prostate Cancer abiraterone tablet Genitourinary UGUPABI R Using Abiraterone and prednisone acitretin capsule Lymphoma reversal of early dysplastic and neoplastic stem changes LYNOS I first-line treatment of epidermal growth factor receptor mutation-positive afatinib tablet Lung LUAVAFAT I advanced non-small cell lung cancer with afatinib aldesleukin injectable Skin & Melanoma Treatment of In-Transit Melanoma with Intralesional Aldesleukin IL-2 SMILALD I pediatric patients with high risk neuroblastoma treated on the ANBL0032 aldesleukin injectable Pediatric I study treatment of pediatric patients with high-risk neuroblastoma who achieve aldesleukin injectable Pediatric a response to prior first-line multi-agent, multimodal therapy using R dinutuximab in combination with sargramostim, aldesleukin and tretinoin treatment of ALK-positive advanced non-small cell lung cancer with alectinib capsule Lung LUAVALE I alectinib treatment of fludarabine-refractory B-chronic lymphocytic leukemia and T- alemtuzumab injectable Lymphoma LYALEM I prolymphocytic leukemia Only reimbursable when aminolevulinic acid prescribed by physicians in the topical solution Skin & Melanoma topical therapy for skin cancer with PDT (Photodynamic Therapy) SMPDT I (LEVULAN® KERASTICK®) Skin Tumour Group within the BC Cancer Skin PDT Program amsacrine injectable Leukemia & BMT LKNOS I patients with thrombocytosis related to a myeloproliferative disorder who anagrelide capsule Leukemia & BMT have had an inadequate response to or are intolerant of hydroxyurea LKANAG I and/or interferon neoadjuvant or adjuvant therapy for breast cancer using anastrozole in anastrozole tablet Breast BRAJANAS I postmenopausal women neoadjuvant or adjuvant ovarian suppression and aromatase inhibitor in anastrozole tablet Breast BRAJLHRHAI I premenopausal women with high-risk early stage breast cancer first or second line hormonal treatment for advanced breast cancer in anastrozole tablet Breast BRAVANAS I postmenopausal women therapy for advanced breast cancer using a LHRH agonist and an anastrozole tablet Breast BRAVLHRHA I aromatase inhibitor therapy of advanced breast cancer using palbociclib and aromatase anastrozole (cont'd) tablet Breast UBRAVPALAI I inhibitor with or without LHRH agonist therapy of advanced breast cancer using ribociclib and aromatase anastrozole anastrozole Breast UBRAVRIBAI R inhibitor with or without LHRH agonist * denotes change Page 2 of 65 BC Cancer Benefit Drug List September 2021 DOSAGE TUMOUR PROTOCOL DRUG APPROVED INDICATIONS CLASS NOTES FORM SITE CODES hormonal treatment for advanced endometrial cancer in postmenopausal anastrozole (cont'd) tablet Gynecology GOENDAI I women with contraindications to tamoxifen or intolerant of tamoxifen anastrozole (cont'd) tablet Gynecology therapy for advanced ovarian cancer using an aromatase inhibitor GOOVAI I therapy of non-metastatic castration-resistant prostate cancer using apalutamide tablet Genitourinary UGUPAPA R apalutamide first-line induction and consolidation therapy of acute promyelocytic arsenic trioxide injectable Leukemia & BMT LKATOATRA I leukemia using arsenic trioxide and tretinoin first-line induction and consolidation therapy of acute promyelocytic arsenic trioxide injectable Leukemia & BMT LKATOP I leukemia using arsenic trioxide, tretinoin and daunorubicin induction and consolidation therapy of relapsed acute promyelocytic arsenic trioxide injectable Leukemia & BMT LKATOR I leukemia using arsenic trioxide and tretinoin (All-Trans Retinoic Acid) asparaginase injectable Leukemia & BMT LKNOS, LYNOS I (KIDROLASE®) treatment of acute lymphoblastic leukemia and lymphoblastic lymphoma asparaginase-erwinia injectable Leukemia & BMT using asparaginase-Erwinia (Erwinase®) in patients allergic to LKNOS, LYNOS I (ERWINASE®) asparaginase (Kidrolase®) or pegaspargase (Oncaspar®) atezolizumab injectable Lung treatment of advanced non-small cell lung cancer LUAVATZ I treatment of advanced non-small cell lung cancer using 4-weekly atezolizumab injectable Lung LUAVATZ4 I atezolizumab second-line treatment of recurrent or metastatic merkel cell carcinoma avelumab injectable Skin & Melanoma SMMCCAVE I using avelumab axitinib tablet Genitourinary therapy for metastatic renal cell carcinoma using axitinib GUAXIT I Treatment of Metastatic Renal Cell Carcinoma Using Pembrolizumab and axitinib tablet Genitourinary GUAVPEMAX I Axitinib azacitidine injectable Leukemia & BMT therapy of acute myeloid leukemia using azacitidine and sorafenib LKAMLAS I azacitidine (cont'd) injectable Leukemia & BMT therapy of myelodysplastic syndrome ULKMDSA R bacillus calmette guerin The three substrains of BCG available injectable Genitourinary therapy for high risk superficial transitional cell bladder cancer GUBCG I (BCG) are considered interchangeable by BC Cancer for the treatment of bladder cancer (i.e., Montreal [PACIS] 120 mg bacillus calmette guerin palliative therapy for BCG-refractory superficial high-grade transitional = TICE [OncoTICE] 1 to 8 x 108 CFU injectable Genitourinary GUBCGIFN I (BCG) (cont'd) cell carcinoma bladder with BCG and Interferon = Connaught [ImmuCyst] 81 mg) BUT only the current contract brand is reimbursed at the current contract price bendamustine injectable Lymphoma treatment of Non-Hodgkin Lymphoma with bendamustine LYBEND I bendamustine (cont'd) injectable Lymphoma treatment of Non-Hodgkin Lymphoma with bendamustine and rituximab LYBENDR I bendamustine injectable Lymphoma treatment of relapsed chronic lymphocytic leukemia with bendamustine LYCLLBEND I treatment of relapsed/refractory chronic lymphocytic leukemia or small bendamustine injectable Lymphoma LYCLLBENDR I lymphocytic lymphoma with bendamustine and rituximab treatment of previously untreated chronic lymphocytic leukemia (CLL) bendamustine (cont'd) injectable Lymphoma LYCLLFBR I with bendamustine and rituximab treatment of rituximab-refractory follicular lymphoma with obinutuzumab bendamustine injectable Lymphoma LYOBBEND I in combination with bendamustine * denotes change Page 3 of 65 BC Cancer Benefit Drug List September 2021 DOSAGE TUMOUR PROTOCOL DRUG APPROVED INDICATIONS CLASS NOTES FORM SITE CODES palliative therapy of metastatic colorectal cancer using capecitabine and bevacizumab injectable Gastrointestinal GIAVCAPB I bevacizumab palliative combination chemotherapy for metastatic colorectal cancer bevacizumab injectable Gastrointestinal GICIRB I using irinotecan, bevacizumab and capecitabine palliative combination chemotherapy for metastatic colorectal cancer bevacizumab injectable Gastrointestinal GICOXB I using oxaliplatin, bevacizumab and capecitabine palliative combination chemotherapy for metastatic colorectal cancer bevacizumab (cont'd) injectable Gastrointestinal GIFFIRB I using irinotecan, fluorouracil, folinic acid (leucovorin) and bevacizumab palliative combination chemotherapy for metastatic colorectal cancer bevacizumab (cont'd) injectable Gastrointestinal GIFFOXB I using oxaliplatin, fluorouracil, leucovorin, and bevacizumab bevacizumab (cont'd) injectable Neuro-Oncology patients with relapsed malignant gliomas CNBEV I alternative treatment of gynecological malignancies using bevacizumab, bevacizumab (cont'd) injectable Gynecology GOCABRBEV I carboplatin and paclitaxel NAB (ABRAXANE) Alternative Treatment of Gynecological Malignancies using Note: Biosimilar bevacizumab bevacizumab (cont'd) injectable Gynecology GOCISPBEV I Bevacizumab, Cisplatin and Paclitaxel (ZIRABEV®, MVASI®) is funded primary treatment of metastatic/recurrent cancer of the cervix with bevacizumab (cont'd) injectable Gynecology GOCXCATB I for treatment started on or after bevacizumab, carboplatin and paclitaxel treatment of platinum resistant epithelial ovarian cancer with November 1st, 2019. AVASTIN® bevacizumab (cont'd) injectable Gynecology GOOVBEVG I bevacizumab and gemcitabine is funded for treatment started treatment of platinum resistant epithelial ovarian cancer with prior to November 1st, 2019. bevacizumab injectable Gynecology GOOVBEVLD I bevacizumab and pegylated liposomal doxorubicin treatment of platinum resistant epithelial ovarian cancer with bevacizumab (cont'd) injectable Gynecology GOOVBEVP I bevacizumab and
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