Page 12 - CUA Adv Prostate Ca Drug Acccess Listing

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A BC Cancer Compassionate Access Program request must be approved prior to treatment. 1. BC Cancer
Restricted funding* Protocol
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UGUNMPDA
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Eligibility : R [8-21]
• nmCRPC 2. BC Cancer
• No radiological evidence of metastases (negative bone scan, negative CT of pelvis Benefit Drug
abdomen, chest) within the last 6 months (exception: pelvic lymph nodes < 2 cm in short List [9-21]
axis below the aortic bifurcation)
• No prior chemotherapy for nmCRPC
Darolutamide Not • PSADT ≤ 10 months
(Nubeqa) nmCRPC Tablet • Should have ECOG PS 0-2
Bayer specified
Patients with nmCRPC are eligible to receive apalutamide, darolutamide or enzalutamide, but
not sequentially.
Patients who have progressed to mCRPC on darolutamide are eligible to received docetaxel,
cabazitaxel and radium.

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Exclusions :
• mCRPC (exception: pelvic lymph nodes < 2 cm in short axis below the aortic bifurcation)
• Prior treatment for nmCRPC with apalutamide or enzalutamide
• Prior chemotherapy for nmCRPC

Limited coverage drug requiring Special Authority Request Form 2 1. Limited
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Coverage
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Eligibility : Drug Program
Denosumab 60 mg/ mL • Men with osteoporosis AND clinical or radiographically-documented fracture due to 2. Special
Authority
osteoporosis AND contraindication to oral bisphosphonates for one of the following
(Prolia) Osteoporosis Syr 0234541 reasons: Request Form
Amgen
o immune-mediated hypersensitivity reaction to oral bisphosphonates
• OR
o abnormalities of the esophagus which delay esophageal emptying such as
stricture or achalasia.
1. BC Cancer
Protocol
SCDMAB [5-
Covered by BC Pharmacare Plan P (Palliative Drug Benefit). Application form must be 14]
submitted prior to treatment initiation 1 2. BC
BC Palliative Care Benefit Application PharmaCare
Formulary
Denosumab mCRPC with 120 mg / Eligibility :
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(Xgeva) Bone mets 1.7 mL Vial 2368153
Amgen • Patients with mCRPC with bone metastases
• Evidence of castration resistance (progressive disease despite testosterone < 1.7 nmol/L)
• Palliative Drug Benefit application form must be submitted prior to initiation of treatment
• As a supportive care medication, denosumab is not covered by BC Cancer Agency but
may be reimbursed by private insurance plans

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v.01-SEP-2021