OH Criteria for Use

• Indication:
  • Endometrial Cancer (EC)
    • In combination with carboplatin and paclitaxel, followed by JEMPERLI as a single agent for the treatment of adult patients with primary advanced or recurrent endometrial cancer that is mismatch repair deficient (dMMR), as determined by an FDA-approved test, or microsatellite instability-high (MSI-H).
    • As a single agent for the treatment of adult patients with dMMR recurrent or advanced endometrial cancer, as determined by an FDA-approved test, that has progressed on or following prior treatment with a platinum-containing regimen in any setting and are not candidates for curative surgery or radiation.
• Service line: Oncology
• Formulary location: Outpatient infusion
• Service location: Outpatient infusion
• Patient population: Adult (≥ 18 years)
• Prior authorization required: Yes
• Restriction/criteria of use (all will apply unless specified):
  • Endometrial cancer indication:
    • In combination with carboplatin and paclitaxel, followed by JEMPERLI as a single agent:
      • Patient must be diagnosed with primary advanced or recurrent endometrial cancer that is mismatch repair deficient (dMMR), as determined by an FDA-approved test, or microsatellite instability-high (MSI-H)
      • ECOG status of 0 or 1
    • As a single agent:
      • Patient must be diagnosed with mismatch repair deficient (dMMR) recurrent or advanced endometrial cancer, as determined by an FDA-approved test
      • Patient must have progressed on or following prior treatment with a platinum-containing regimen
      • ECOG status of 0 or 1

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