OH Formulary Restrictions:

• Indication: HLA-A*02:01-positive unresectable or metastatic uveal melanoma
• Service Line: Hematology/Oncology
• Formulary Location: Inpatient, Outpatient Infusion
• Service location: Inpatient, Outpatient Infusion, Observation (outpatient)
• Patient Population: Adults
• Prior Authorization Required: Yes
• Restriction/Criteria of Use (all will apply unless specified):
  • HLA-A*02:01-positive unresectable or metastatic uveal melanoma.
  • No prior systemic therapy in the metastatic or advanced setting including chemotherapy, immunotherapy, or targeted therapy.
  • No prior regional, liver-directed therapy including chemotherapy, radiotherapy, or embolization.
  • Eastern Cooperative Oncology Group (ECOG) Performance Status of 0 or 1.

Note: To admit patient for 24 hours to an OBS bed (outpatient) x first 3 doses with remainder of doses given in the infusion center. If adverse events, patient will be flipped to an acute care bed (inpatient).

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