Xgeva

For the treatment of bony metastases in patients with hormone refractory prostate cancer.

Xgeva is considered through CCO for those receiving prostate cancer treatment from a cancer clinic.

Hormone refractory prostate cancer is determined using the following criteria:

• Patient has an elevated PSA level or evidence of progressive bony disease¹, despite castrate serum testosterone levels (Less than 1.7 nmol/L or less than 50 ng/dL)².

¹Progressive bony disease is defined as progressive changes in radionucleotide bone scan or clinical signs of disease profession, such as pathologic fracture or increasing bone pain.

²Note: Patients who have undergone orchidectomy do not need to provide a serum testosterone level in the request submission.

Approved Dosing: 120 mg subcutaneously every four (4) weeks

Duration of Approval: 1 Year

Renewals will be considered for patient responding to treatment with Xgeva and who still requires treatment.

Duration of Approval: 1 Year

EAP Drug Request Form:

Standard Form for EAP Drug Requests