Votrient (pazopanib tablets) — Cigna

Initial criteria

• Patient age ≥ 18 years
• Patient does not have gastrointestinal stromal tumor
• Patient has advanced or metastatic disease
• Patient has ONE of the following: alveolar soft part sarcoma OR angiosarcoma OR dedifferentiated chordoma OR dedifferentiated liposarcoma OR desmoid tumors (aggressive fibromatosis) OR dermatofibrosarcoma protuberans with fibrosarcomatous transformation OR epithelioid hemangioendothelioma OR extraskeletal myxoid chondrosarcoma OR non-adipocytic sarcoma OR pleomorphic rhabdomyosarcoma OR solitary fibrous tumor/hemangiopericytoma

Approval duration

1 year