Criteria
Coverage is subject to the specific terms of the member's benefit plan.
Trabectedin (Yondelis) may be considered medically necessary for the following indications:
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Treatment of unresectable or metastatic liposarcoma or leiomyosarcoma for individuals who received a prior anthracycline-containing regimen;
or
Compendia Sources
Trabectedin (Yondelis) may be considered medically necessary for treatment of any of the current category 1, 2A, or 2B NCCN recommendations.
The use of trabectedin (Yondelis) for all other indications not listed in this policy is considered experimental/investigational and therefore non-covered because the safety and/or effectiveness cannot be established by the available published peer-reviewed literature.
Procedure Code
