Stivarga (regorafenib tablets - Bayer) — Cigna

Colon, Rectal and Appendiceal Cancer

Initial criteria

Patient age ≥ 18 years
Patient has advanced or metastatic disease
Patient has been previously treated with a fluoropyrimidine (e.g., capecitabine, 5-fluorouracil [5-FU])
Patient has been previously treated with oxaliplatin
Patient has been previously treated with irinotecan
Patient meets ONE of the following (i or ii): i. Patient’s tumor or metastases are wild-type RAS (KRAS wild-type and NRAS wild-type) AND patient meets ONE of the following (a or b): a) Patient has tried Erbitux (cetuximab intravenous infusion) or Vectibix (panitumumab intravenous infusion); OR b) Patient’s tumor did not originate on the left side of the colon (from the splenic fixture to rectum); OR ii. Patient’s tumor or metastases have a RAS mutation (either KRAS or NRAS mutation)

1 year