| Coverage Policy Manual | |
| Policy #: | 2020015 |
| Category: | Pharmacy |
| Initiated: | July 2020 |
| Last Review: | August 2025 |
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| Fam-trastuzumab deruxtecan-nxki (e.g., Enhertu) | |
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| Description: |
Fam-trastuzumab deruxtecan-nxki (e.g., Enhertu), is an antibody –drug conjugate that is composed of a humanized monoclonal antibody specifically targeting HER2-overexpressing tumor cells, with the same amino acid sequence as trastuzumab. Internalization and intracellular linker cleavage of the drug by lyzozomal enzymes within the tumor cell leads to DNA damage and apoptotic cell death. Trastuzumab deruxtecan has a higher drug-to antibody ration than trastuzumab emtasine (approximately 8 vs 3 to 4).
Enhertu has a black box warning for interstitial lung disease and embryo-fetal toxicity. Interstitial lung disease (ILD) and pneumonitis, including fatal cases, have been reported with Enhertu. Individuals should be monitored for signs and symptoms including cough, dyspnea, fever, and other new or worsening respiratory symptoms. Enhertu should be discontinued in all individuals with Grade 2 or higher ILD/pneumonitis.
Regulatory Status
On December 20, 2019, the U.S. Food and Drug Administration approved fam-trastuzumab deruxtecan-nxki (e.g., Enhertu) use in unresectable or metastatic HER2-postive breast cancer. Accelerated approval was granted based on tumor response rate and duration of response. Continued approval for this indication may be contingent upon verification and description of clinical benefit in a confirmatory trial.
On January 15, 2021, the Food and Drug Administration approved Fam-trastuzumab deruxtecan-nxki for the treatment of adult individuals with locally advanced or metastatic HER2-positive gastric or gastroesophageal junction (GEJ)adenocarcinoma who have received a prior trastuzumab-based regimen.
On August 5, 2022, the FDA approved an expanded indication fam-trastuzumab-deruxtecan-nxki to treat unresectable or metastatic HER2-low breast cancer. It is the first targeted therapy approved by the FDA for HER 2-low breast cancer and received Priority Review and Breakthrough Therapy designations for this indication.
On August 11, 2022, fam-trastuzumab deruxtecan-nxki was granted accelerated approval by the FDA for treatment of adult individuals with unresectable or metastatic non-small cell lung cancer (NSCLC) who’s tumors have activating HER2 (ERBB2) mutations as detected by an FDA approved test* and have received a prior systemic therapy. Continued approval for this indication will be contingent fam-trastuzumab deruxtecan-nxki upon confirmation of a clinical benefit.
*The FDA also approved two companion diagnostics for Enhertu: Oncomine DX Target Test (for tissue) and Guardant 360 CDX (for plasma). If a mutation is not detected in a plasma specimen, the tumor tissue should be tested.
On April 6, 2024, fam-trastuzumab deruxtecan-nxki was granted accelerated approval by the for treatment of adult individuals with unresectable or metastatic HER2-positive (IHC 3+) solid tumors who have received prior systemic treatment and have no satisfactory alternative treatment options (tumor-agnostic HER-2 directed therapy).
On January 27, 2025 the Food and Drug Administration approved fam-trastuzumab deruxtecan-nxki(e.g., Enhertu) in adult individuals with unresectable or metastatic Hormone receptor (HR)-positive, HER2-low (IHC 1+ or IHC 2+/ISH-) or HER2-ultralow (IHC 0 with membrane staining) breast cancer, as determined by an FDA-approved test, that has progressed on one or more endocrine therapies in the metastatic setting OR HER2-low (IHC 1+ or IHC 2+/ISH-) breast cancer, as determined by an FDA-approved test, who have received a prior chemotherapy in the metastatic setting; or developed disease recurrence during or within 6 months of completing adjuvant chemotherapy.
Coding
See CPT/HCPCS Code section below.
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Policy/ Coverage: |
Effective August 1, 2021, for members of plans that utilize an oncology benefits management program, Prior Approval is required for this service and is managed through the oncology benefits management program.
INITIAL AND CONTINUATION APPROVAL will be for duration of treatment course or 12 months (whichever comes first). Approval timeframes may differ for members/participants of Self-Insured plans.
Effective November 1, 2025
Meets Primary Coverage Criteria Or Is Covered For Contracts Without Primary Coverage Criteria
Fam-trastuzumab deruxtecan-nxki (e.g., Enhertu) meets member benefit certificate primary coverage criteria that there be scientific evidence of effectiveness
improving health outcomes when ALL the following criteria are met:
The use of this drug is covered if an FDA-approved oncologic indication exists [not listed as an indication below with the member meeting all of the additional requirements of the prescribing information (package insert listed in the “Indications and Usage”).
FDA Labeled Indications:
HER-2 POSITIVE BREAST CANCER
INITIAL APPROVAL:
NON-SMALL CELL LUNG CANCER
INITIAL APPROVAL:
GASTRIC CANCER
INITIAL APPROVAL:
UNRESECTABLE OR METASTATIC HER2-POSITIVE TUMORS
INITIAL APPROVAL:
CONTINUATION OF THERAPY FOR ABOVE LISTED FDA LABELED INDICATIONS:
Off Label Indications:
The use of this drug for off-label indications not listed below is subject to policy 2000030.
INITIAL APPROVAL:
The following indications are covered when the individual meets the related NCCN category 1 or 2A recommendations specific to the indications below (e.g., histology, cancer staging, surgical status, mono- or combination therapy, and previous lines of therapy):
Please see the NCCN Drugs and Biologics Compendium for a complete list of NCCN 1 & 2A indications. To view the most recent and complete version of the guideline or Compendium, go online to NCCN.org. Please note, NCCN makes no warranties of any kind whatsoever regarding their content, use or application and disclaims any responsibility for their application or use in any way.
Does Not Meet Primary Coverage Criteria Or Is Not Covered For Contracts Without Primary Coverage Criteria
Fam-trastuzumab deruxtecan-nxki (e.g., Enhertu), for any indication or circumstance not described above, does not meet member benefit certificate primary coverage criteria that there be scientific evidence of effectiveness in improving health outcomes.
For members with contracts without primary coverage criteria, fam-trastuzumab deruxtecan-nxki (e.g., Enhertu), for any indication or circumstance not described above, is considered investigational. Investigational services are specific contract exclusions in most member benefit certificate of coverage.
POLICY GUIDELINES
The ECOG or Eastern Cooperative Oncology Group Performance Status is based on the following scale:
Individual does not have unacceptable toxicity resulting from the treatment (e.g., severe infusion-related reactions, severe immune-mediated adverse reactions such as pneumonitis, hepatitis, colitis, endocrinopathies, nephritis with renal dysfunction, dermatologic adverse reactions).
Prescribing provider to endure individual does not have pneumonitis, interstitial lung disease (NCCN, 2021), or symptomatic congestive heart failure.
DOSAGE AND ADMINISTRATION
For FDA labeled indications, Fam-trastuzumab deruxtecan-nxki (e.g., Enhertu) must be dosed in accordance with the indication specific recommended dose per FDA label unless otherwise specified below.
For off-label indications, authorizations will not exceed the maximum FDA labeled dose and frequency across all the FDA labeled indications unless higher dose is allowed for the specific indication below.
Breast Cancer – HER2 and HER2 low
The recommended dose is 5.4 mg/kg given as an intravenous infusion once every 3 weeks (21 day-cycle) until disease progression or unacceptable toxicity.
Gastric Cancer
The recommended dose 6.4 mg/kg given as an intravenous infusion once every 3 weeks (21-day cle) until disease progression or unacceptable toxicity.
NSCLC
The recommended dosage for lung cancer is 5.4 mg/kg given as an intravenous infusion once every 3 weeks (21-day cycle) until disease progression or unacceptable toxicity.
Please see prescription guidance for recommended dose modifications, temporary interruption or treatment discontinuation in management of adverse reactions.
HER2-positive solid tumors
The recommended dose is 5.4 mg/kg given as an intravenous infusion once every 3 weeks (21 day-cycle) until disease progression or unacceptable toxicity.
Fam-trastuzumab deruxtecan-nxki (e.g., Enhertu) is available as 100 mg lyophilized powder in a single-dose vial.
Fam-trastuzumab deruxtecan-nxki (e.g., Enhertu) should be administered as an intravenous infusion
by a healthcare professional.
Please refer to a separate policy on Site of Care or Site of Service Review policy #2018030 for pharmacologic/biologic medications.
Effective February 2025 through October 31, 2025
Meets Primary Coverage Criteria Or Is Covered For Contracts Without Primary Coverage Criteria
INITIAL APPROVAL STANDARD REVIEW for up to 12 months
Fam-trastuzumab deruxtecan-nxki (e.g., Enhertu) meets member benefit certificate primary coverage criteria that there be scientific evidence of effectiveness
improving health outcomes when ALL the following criteria are met:
For labeled indications, all products must be dosed in accordance with the label unless otherwise specified.
For off-label indications, authorizations will not exceed 6.4 milligrams per kilogram of body weight every 3 weeks OR maximum recommended doses as outlined in dosage and administration section unless medical literature supports a higher dose.
HER-2 POSITIVE BREAST CANCER
INVASIVE BREAST CANCER
INFLAMMATORY BREAST CANCER
HER-2 POSITIVE BREAST CANCER WITH BRAIN METASTASES
COLON CANCER
RECTAL CANCER
ESOPHAGEAL OR ESOPHAGOGASTRIC JUNCTION CANCERS
GALLBLADDER CANCER
CHOLANGIOCARCINOMA
NON-SMALL CELL LUNG CANCER
BLADDER CANCER
VULVAR CANCER
CERVICAL CANCER
VAGINAL CANCER
ENDOMETRIAL CANCER
SMALL BOWEL ADENOCARCINOMA
SALIVARY GLAND TUMOR
OVARIAN, FALLOPIAN TUBE AND PRIMARY PERITONEAL CANCER
OCCULT PRIMARY DISEASE
CONTINUED APPROVAL FOR ABOVE LISTED INDICATIONS for up to 12 months:
Policy Guidelines
The ECOG or Eastern Cooperative Oncology Group Performance Status is based on the following scale:
The use of this drug is covered if a -approved oncologic indication exists (not listed as an indication above) with the member meeting all of the additional requirements of the prescribing information (package insert listed in the “Indications and Usage”) AND/OR a NCCN category 1 or 2A recommendation is recognized in the NCCN Drugs and Biologics Compendium with the member meeting specified criteria (See policy #2000030).
Dosage and Administration
Dosing per Guidelines where applicable. For off-label indications, authorizations will not exceed
6.4 milligrams per kilogram of body weight every 3 weeks OR maximum recommended doses as outlined below unless medical literature supports a higher dose.
Breast Cancer – HER2 and HER2 low
The recommended dose is 5.4 mg/kg given as an intravenous infusion once every 3 weeks (21-day cycle) until disease progression or unacceptable toxicity.
Gastric Cancer
The recommended dose 6.4 mg/kg given as an intravenous infusion once every 3 weeks (21-day cycle) until disease progression or unacceptable toxicity.
NSCLC
The recommended dosage for lung cancer is 5.4 mg/kg given as an intravenous infusion once every 3 weeks (21-day cycle) until disease progression or unacceptable toxicity.
Please see prescription guidance for recommended dose modifications, temporary interruption, or treatment discontinuation in management of adverse reactions.
HER2-positive solid tumors
The recommended dose is 5.4 mg/kg given as an intravenous infusion once every 3 weeks (21-daycycle) until disease progression or unacceptable toxicity.
Fam-trastuzumab deruxtecan-nxki (e.g., Enhertu) is available as 100 mg lyophilized powder in a single-dose vial.
Fam-trastuzumab deruxtecan-nxki (e.g., Enhertu) should be administered as an intravenous infusion
by a healthcare professional.
Please refer to a separate policy on Site of Care or Site of Service Review policy #2018030 for pharmacologic/biologic medications.
Does Not Meet Primary Coverage Criteria Or Is Investigational For Contracts Without Primary Coverage Criteria
Fam-trastuzumab deruxtecan-nxki (e.g., Enhertu), for any indication or circumstance not described above, does not meet member benefit certificate primary coverage criteria that there be scientific evidence of effectiveness in improving health outcomes.
For members with contracts without primary coverage criteria, fam-trastuzumab deruxtecan-nxki (e.g., Enhertu), for any indication or circumstance not described above, is considered investigational. Investigational services are specific contract exclusions in most member benefit certificate of coverage.
Due to the detail of the policy statement, the document containing the coverage statements for dates prior to February 1, 2025, is not online. If you would like a hardcopy print, please email: codespecificinquiry@arkbluecross.com
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| Rationale: |
A phase 2 study (Modi S, et al 2019) was performed with trastuzumab deruxtecan in 184 patients with HER2 positive pathologically documented unresectable or metastatic breast cancer who had previously treated with trastuzumab emtansine. Eligible patients were age 18 or greater and had an ECOG score of 0 or 1. Excluded reasons were untreated or symptomatic brain metastases, history of noninfectious interstitial lung disease, (ILD), or pneumonitis or current or suspected ILD or pneumonitis. This study was evaluating the safety and efficacy of the recommended dose, 5.4 mg/kg, in those who in the first phase received this dose.
The primary endpoint was overall response (complete plus partial response) to the trastuzumab deruxtecan therapy in those who had tumor progression during or after trastuzumab emtansine and had received the 5.4 mg/kg of trastuzumab deruxtecan in phase 1 and 2 of the study. Secondary endpoints included response duration, progression free survival and overall survival rate.
Of the 184 participants, 52.7% had hormone receptor-positive tumors. Median number or previous lines of therapy for metastatic disease was 6 and 100% included trastuzumab emtansine, and trastuzumab and 65.8% had pertuzumab. Results showed an overall response rate of 60.3%, complete response rate of 4.3% and a partial response rate of 56%. There was also a median duration of response of 14.8 months and a disease control rate of 97.3%. Median progression free survival (PFS) was 13.4 months, after a median follow-up of 11.1 months. 9% of the patients experienced ILD including severe, life threatening and fatal cases. Fatal outcomes from either ILD or pneumonitis occurred in 2.6%of patients.
2021 Update
In an open-label, randomized, phase 2 trial, trastuzumab deruxtecan as compared with chemotherapy in patients with HER2-positive advanced gastric cancer was evaluated. Patients with centrally confirmed HER2-positive gastric or gastroesophageal junction adenocarcinoma that had progressed while they were receiving at least two previous therapies, including trastuzumab, were randomly assigned in a 2:1 ratio to receive trastuzumab deruxtecan (6.4 mg per kilogram of body weight every 3 weeks) or physician’s choice of chemotherapy. The primary end point was the objective response, according to independent central review. Secondary end points included overall survival, response duration, progression-free survival, confirmed response (response persisting ≥4 weeks), and safety.
Of 187 treated patients, 125 received trastuzumab deruxtecan and 62 chemotherapy (55 received irinotecan and 7 paclitaxel). An objective response was reported in 51% of the patients in the trastuzumab deruxtecan group, as compared with 14% of those in the physician’s choice group (P<0.001). Overall survival was longer with trastuzumab deruxtecan than with chemotherapy (median, 12.5 vs. 8.4 months; hazard ratio for death, 0.59; 95% confidence interval, 0.39 to 0.88; P = 0.01, which crossed the prespecified O’Brien–Fleming boundary [0.0202 on the basis of number of deaths]). The most common adverse events of grade 3 or higher were a decreased neutrophil count (in 51% of the trastuzumab deruxtecan group and 24% of the physician’s choice group), anemia (38% and 23%, respectively), and decreased white-cell count (21% and 11%). A total of 12 patients had trastuzumab deruxtecan–related interstitial lung disease or pneumonitis (grade 1 or 2 in 9 patients and grade 3 or 4 in 3), as adjudicated by an independent committee. One drug-related death (due to pneumonia) was noted in the trastuzumab deruxtecan group; no drug related deaths occurred in the physician’s choice group.
Therapy with trastuzumab deruxtecan led to significant improvements in response and overall survival, as compared with standard therapies, among patients with HER2-positive gastric cancer. Myelosuppression and interstitial lung disease were the notable toxic effects. (Shitara K, Bang YJ, Iwasa S, et. al., 2020).
2022 Update
HER 2-low breast cancer
HER2-low breast cancer is a newly defined breast cancer subtype. According to the FDA, “about 60% of patients previously classified as having HER2-negative subtype can now be considered as HER2-low.” It describes cancers that have “some HER2 proteins on the cell surface, but not enough to be classified as HER2-positive.” HER2-low breast cancers may be hormone receptor-positive (HR+) or triple negative.
Fam-trastuzumab deruxtecan’ s expanded approval for HER 2-low breast cancer was based on data from the multicenter, open-label DESTINY-Breast04 trial, which enrolled 557 adult patients with unresectable or metastatic HER2-low breast cancer, including both HR- and HR+ patients. Low HER2 expression was defined as an immunohistochemistry (IHC) score of 1+ or 2+ with a negative in situ hybridization (ISH) test. Patients were randomized 2:1 to receive either Enhertu every 3 weeks or physician’s choice of chemotherapy.
Treatment with fam-trastuzumab deruxtecan resulted in a median progression-free survival (PFS) of 9.9 months (95% CI, 9.0–11.3) versus 5.1 months (95% CI, 4.2–6.8) with chemotherapy (hazard ratio, 0.50; 95% CI, 0.40–0.63). The median overall survival was 23.4 months (95% CI, 20.0–24.8) with fam-trastuzumab deruxtecan compared with 16.8 months (95% CI, 14.5–20.0) with chemotherapy, translating to a 6.6-month improvement in survival (hazard ratio, 0.64; 95% CI, 0.49–0.84; P = 0.001).
An estimated 287,850 new cases of female breast cancer will be diagnosed in the United States in 2022, of which 80%– 85% were previously considered to be HER2-negative. About 60% of these cancers previously defined as HER2-negative can now be considered HER2-low (approximately 48%–51% of all new U.S. breast cancer cases). Patients with HER2-low breast cancer will be eligible for fam-trastuzumab deruxtecan if they have received a prior chemotherapy in the metastatic setting, or their cancer returned during, or within 6 months of completing, adjuvant chemotherapy.
HER2-Mutant NSCLC
The accelerated approval by the FDA was based on the results from the DESTINY-Lung02 Phase II trial. A total of 91 patients were enrolled. The median duration of follow-up was 13.1 months (range, 0.7 to 29.1). Centrally confirmed objective response occurred in 55% of the patients (95% confidence interval [CI], 44 to 65). The median duration of response was 9.3 months (95% CI, 5.7 to 14.7). Median progression-free survival was 8.2 months (95% CI, 6.0 to 11.9), and median overall survival was 17.8 months (95% CI, 13.8 to 22.1). The safety profile was generally consistent with those from previous studies; grade 3 or higher drug-related adverse events occurred in 46% of patients, the most common event being neutropenia (in 19%). Adjudicated drug-related interstitial lung disease occurred in 26% of patients and resulted in death in 2 patients. Responses were observed across different
HER2 mutation subtypes, as well as in patients with no detectable HER2 expression or
HER2 amplification.
2023 Update
Annual policy review completed with a literature search using the MEDLINE database through September 2023. No new literature was identified that would prompt a change in the coverage statement.
2024 Update
The first tumor-agnostic approval of a HER2-directed therapy was based on results from the subgroup of patients with HER2-positive IHC 3+ tumors in each of the DESTINY-PanTumor02, DESTINY-Lung01 and DESTINY-CRC02 Phase II trials.
In the DESTINY-PanTumor02 Phase II trial, individuals with centrally or locally assessed HER2-positive (IHC 3+) solid tumors including either biliary tract, bladder, cervical, endometrial, ovarian, pancreatic or other tumors treated with fam-trastuzumab deruxtecan showed a confirmed ORR of 51.4% (95% confidence interval [CI] 41.7-61.0) and a median Duration of Response (DoR) range of 19.4 months (range 1.3-27.9+ [+ denotes ongoing responses at data cutoff]). In DESTINY-Lung01, individuals with centrally confirmed HER2-positive (IHC 3+) non-small cell lung cancer (NSCLC) treated with fam-trastuzumab deruxtecan showed a confirmed ORR of 52.9% (95% CI 27.8-77.0) and median DoR range of 6.9 months (range 4.0-11.7+). A confirmed ORR of 46.9% (95% CI 34.3-59.8) and median DoR range of 5.5 months (range 1.3+-9.7+) was seen in individuals with centrally confirmed HER2-positive (IHC 3+) colorectal cancer in the DESTINY-CRC02 trial.
The safety of fam-trastuzumab deruxtecan was evaluated in 347 individuals with unresectable or metastatic HER2-positive (IHC 3+) solid tumors in the DESTINY-Breast01, DESTINY-PanTumor02, DESTINY-Lung01 and DESTINY-CRC02 trials. The safety profile observed across the trials was consistent with previous clinical trials of fam-trastuzumab deruxtecan with no new safety concerns identified.
2025 UPDATE
HER2-targeted therapies are approved only for HER2-positive breast and gastric cancers. We assessed the safety/tolerability and activity of the novel HER2-targeted antibody-drug conjugate trastuzumab deruxtecan (T-DXd) in 60 patients with pretreated, HER2-expressing (IHC ≥ 1+), non-breast/non-gastric or
HER2-mutant solid tumors from a phase I trial (NCT02564900). Most common (>50%) treatment-emergent adverse events (TEAE) were nausea, decreased appetite, and vomiting. Two drug-related TEAEs were associated with fatal outcomes. The confirmed objective response rate (ORR) was 28.3% (17/60). Median progression-free survival (PFS) was 7.2 [95% confidence interval (CI), 4.8-11.1] months. In
HER2-mutant non-small cell lung cancer (NSCLC), ORR was 72.7% (8/11), and median PFS was 11.3 (95% CI, 8.1-14.3) months. Confirmed responses were observed in six tumor types, including HER2-expressing NSCLC, colorectal cancer, salivary gland cancer, biliary tract cancer, endometrial cancer, and HER2-mutant NSCLC and breast cancer. Results suggest T-DXd holds promise for HER2-expressing/mutant solid tumors. SIGNIFICANCE: T-DXd demonstrated promising activity in a heterogeneous patient population with heavily pretreated HER2-expressing or HER2-mutant solid tumors, especially
HER2-mutant NSCLC. The safety profile was generally acceptable. Interstitial lung disease can be severe and requires prompt monitoring and intervention.(
Tsurutani J, May 2020)
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| References: |
Enhertu(2024) package insert Basking Ridge, NJ: Daiichi Sankyo, Inc. Enhertu®,(fam-trastzumab deruxtecan-nxki). [package insert]. Basking Ridge, NJ: Daiichi Sankyo, Inc; 2019. Modi S, et al.(2019) Trastuzumab Deruxtecan in Previously Treated HER2-Positive Breast Cancer. N Engl J Med 2020;382:610-21. DOI: 10:1056/NEJMoa1914510 National Comprehensive Cancer Network (NCCNA)(2021) National Comprehensive Cancer Network, Inc. 2021 Practice Guidelines in Oncology—Breast Cancer v.5.2021. Available at https://www.nccn.org/professionals/drug_compendium/content/. Accessed August 16, 2021. National Comprehensive Cancer Network (NCCNA)(2021) National Comprehensive Cancer Network, Inc. 2021 Practice Guidelines in Oncology—Gastric Cancer. V.4.2021. Available at https://www.nccn.org/professionals/drug_compendium/content/. Accessed August 16, 2021. NCCN Guidelines®.(2020) Breast Cancer version 4.2020 – May 18,2020 Last accessed 6/20/2020. NCCN(2024) National Comprehensive Cancer Network, Inc for Fam-trastuzumab deruxtecan, (Enhertu). https://www.nccn.org. Accessed 9/4/24. All rights reserved. Shitara K, Bang YJ, Iwasa S, et.al.(2020) Trastuzumab Deruxtecan in Previously Treated HER2-Positive Gastric Cancer. N Engl J Med. 2020 Jun 18;382(25):2419-2430. doi: 10.1056/NEJMoa2004413. Epub 2020 May 29. PMID: 32469182. U.S. Food and Drug Administration (FDA).(2019) fam-trastuzumab deruxtecan-nxki. Prescribing Information. https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/209939orig1s000,209940orig1s000lbl.pdf. Last accessed August 16, 2021. Wolff AC, Hammond EH, Allison KH, et.al.(2018) Human Epidermal Growth Factor Receptor 2 Testing in Breast Cancer: American Society of Clinical Oncology/College of American Pathologists Clinical Practice Guideline Focused Update. J Clin Oncol 2018:36:20:2105-24 DOI: https://doi.org/10.1200/JCO.2018.778738. Yamaguchi K, Bang YJ, Iwasa S, et. al.,(2021) Trastuzumab deruxtecan (T-DXd; DS-8201) in patients with HER2-positive advanced gastric or gastroesophageal junction (FEJ) adenocarcinoma: Final overall survival (OS) results from a randomized, multicenter, ope-label, phase 2 study (DESTINY-Gastric01). ASCO Annual Meeting 2021. J Clin Oncol 39, 2021. DOI:10.1200/JCO.2021.39.15_suppl.4048 |
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| Group specific policy will supersede this policy when applicable. This policy does not apply to the Wal-Mart Associates Group Health Plan participants. | |
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