Tykerb (lapatinib) — United Healthcare

Colon Cancer

Initial criteria

Diagnosis of colon cancer
AND Disease is HER2-amplified and RAS and BRAF wild-type
AND One of the following:
Disease is proficient mismatch repair/microsatellite-stable (pMMR/MSS)
OR
Disease is positive for deficient mismatch repair/microsatellite instability-high (dMMR/MSI-H) or polymerase epsilon/delta (POLE/POLD1) mutation
AND One of the following:
Ineligible for or progressed on checkpoint inhibitor immunotherapy [e.g., Opdivo (nivolumab), Keytruda (pembrolizumab), Jemperli (dostarlimab-gxly)]
OR Has a contraindication to checkpoint inhibitor immunotherapy
AND One of the following:
Used as initial therapy for unresectable metachronous metastases AND previous therapy with FOLFOX or CapeOX within the past 12 months
OR Intensive chemotherapy with oxaliplatin, irinotecan, or capecitabine is not recommended
OR Used as second-line or subsequent therapy for progression of advanced/metastatic disease
AND Used in combination with trastuzumab
AND Patient has not previously been treated with a HER2 inhibitor [e.g., trastuzumab, Perjeta (pertuzumab), Nerlynx (neratinib)]

12 months