BELEODAQ (belinostat)
OFFICE ADMINISTRATION
Indications for Prior Authorization:
- Indicated for second line therapy for patients with relapsed or refractory peripheral T-cell lymphoma
Patient must meet the following criteria for the above indications:
- Patients must have failed first line therapy with CHOP or CHOP-like regimens
The following indications do not meet the criteria for use established by the Western Health Advantage Pharmacy and Therapeutics Committee:
- For any indications not mentioned above
Dosing:
- Days 1 to 5 of a 21 day cycle: 1 g/m2 given once daily as an IV infusion over 30 minutes
- May be repeated until disease progression or unacceptable toxicity
Approval:
6 months
Last review date: September 1, 2014