Product Details
Lonsurf
Trifluridine + Tipiracil20 mg + 8.19 mg
Tablet
DIN/PIN/NPN
02472112
Manufacturer
Taiho Pharma Canada, Inc.
Formulary Listing Date
2021-03-25
Unit Price
78.5385
Amount MOH Pays
78.5385
Coverage Status
Exceptional Access Program Product
ODB Formulary Therapeutic Classification
Therapeutic Note
NO
ATC Code
L01BC59
Interchangeable Products
NOLU Clinical Criteria
NOEAP Criteria
Therapeutic Class | Reimbursement Criteria |
---|---|
Oncology Drugs | Trifluridine/Tipiracil
Initial Criteria: In combination with best supportive care (BSC) for the treatment of metastatic gastric cancer (mGC) or adenocarcinoma of the gastroesophageal junction (GEJ) in adult patients who meet ALL of the following criteria:
1As confirmed via imaging during/within 3 months of previously completed line(s) of therapy Note: If patients have experienced intolerances with the prior lines of therapy, please provide a description of the intolerance including grade of toxicity which required the drug regimen to be stopped. Renewal Criteria: Renewals should include radiographic reports and will be evaluated according to modified Response Evaluation Criteria in Solid Tumors (mRECIST) or RECIST 1.1 criteria. Approval duration of initial and renewals: 6 months. Recommended dose: EAP Drug Request Form: |