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PERTUZUMAB INJ,SOLN

Clinical Criteria Summary

Exclusion Criteria

  • Known hypersensitivity to pertuzumab or any of its excipients (L-histidine acetate, sucrose, polysorbate 20)
  • Baseline Left Ventricular Ejection Fraction < 55% (< 50% if metastatic disease)
  • Uncontrolled HTN
  • Arrhythmia requiring treatment
  • Myocardial infarction within prior 6 months
  • History of Congestive Heart Failure (New York Heart Association Class 3 or 4)
  • Cumulative prior anthracycline exposure > 360 mg/m2 of doxorubicin or its equivalent
  • Tissue does not overexpress HER2 protein (defined as IHC 3+ or FISH amplification ratio > 2.0)
  • Pregnancy

Inclusion Criteria (Indications & Treatment Regimens)

  • Metastatic breast cancer: In combination with trastuzumab and chemotherapy for patients not previously treated with HER2-directed therapy or chemotherapy
  • Neoadjuvant therapy for breast cancer: In combination with trastuzumab and chemotherapy for HER2-positive, locally advanced, inflammatory, or early-stage breast cancer with primary tumor diameter > 2 cm or node positive
  • Adjuvant therapy for breast cancer: In combination with trastuzumab and chemotherapy for HER2-positive, early breast cancer at high risk of recurrence
  • Metastatic colorectal cancer: In combination with trastuzumab for HER2-positive, KRAS wild-type, chemotherapy-refractory metastatic colorectal cancer

Additional Inclusion Criteria (General Clinical Requirements)

  • Care provided by VA or VA Community Care oncology provider
  • Goals of care and role of Palliative Care consult discussed and documented
  • Eastern Cooperative Oncology Group Performance Status 0 – 2

Additional Inclusion Criteria (Pregnancy & Contraception Management)

  • For patients who can become pregnant and patients with partners who can become pregnant: Counseling provided on potential risks vs benefits of treatment; use of effective contraception during therapy and for 7 months after last dose

Source Documents