LOQTORZI (toripalimab-tpzi)

LOQTORZI (toripalimab-tpzi)

Office-Administration – intravenous infusion

Diagnosis considered for coverage:

Nasopharyngeal carcinoma (NPC): Indicated, in combination with cisplatin and gemcitabine, for the first-line treatment of adults with metastatic or with recurrent, locally advanced NPC. Indicated, as a single agent, for the treatment of adults with recurrent unresectable or metastatic NPC with disease progression on or after a platinum-containing chemotherapy.

Coverage Criteria:

For diagnosis of nasopharyngeal carcinoma (NPC):

• Diagnosis of nasopharyngeal carcinoma (NPC); AND
• Disease is one of the following: 
  • metastatic 
  • recurrent and locally advanced; AND 
• One of the following: 
  • All of the following: 
    • Loqtorzi is being used as first line NPC treatment 
    • Loqtorzi is being used in combination with cisplatin and gemcitabine 
    • Treatment duration of Loqtorzi has not exceeded a total of 24 months during the patient's lifetime, OR
  • Both of the following: 
    • Loqtorzi is being used as recurrent NPC treatment 
    • Disease has progressed on or after a platinum containing chemotherapy 

Reauthorization Criteria:

For diagnosis of NPC:

• All of the following: 
  • Loqtorzi is being used as first line NPC treatment 
  • Patient does not show evidence of progressive disease while on therapy 
  • Treatment duration of Loqtorzi has not exceeded a total of 24 months during the patient's lifetime; OR
• Both of the following: 
  • Loqtorzi is being used as recurrent NPC treatment
  • Patient does not show evidence of progressive disease while on therapy

Dosing:

• First-line treatment of RM-NPC in combination with gemcitabine-cisplatin
  • 240 mg IV every 3 weeks until disease progression, unacceptable toxicity, or up to 24 months
• Treatment as a single agent of RM-NPC with disease progression on or after chemotherapy
  • 3 mg/kg IV every 2 weeks until disease progression or unacceptable toxicity

Coverage Duration: 

• Initial: 1 year
• Reauthorization: 1 year

Authorization is not covered for the following:

• The use of this drug for indications not listed in this policy does not meet the coverage criteria established by the Western Health Advantage (WHA) Pharmacy and Therapeutics (P&T) Committee.

Policy Updates:

• 06/01/2024 – New policy for Loqtorzi approved by WHA P&T Committee. (P&T, 05/21/2024)

References:

1. Loqtorzi Prescribing Information.Coherus BioSciences, Inc. Redwood City, CA. October 2023