Tarceva (erlotinib) — United Healthcare
Central Nervous System (CNS) Cancers
Initial criteria
- Diagnosis of brain, leptomeningeal, or spine metastases from NSCLC
- Tumors are positive for one of the following: EGFR exon 19 deletions OR exon 21 (L858R) substitution mutations OR a known sensitizing EGFR mutation (e.g., S768I, L861Q, G719X)
Reauthorization criteria
- Patient does not show evidence of progressive disease while on Tarceva therapy
Approval duration
12 months