Diagnosis: Clear cell renal cell carcinoma.
Treatment: MVASI.

The insurer denied coverage for MVASI. The denial is overturned.

This is a male patient with untreated metastatic kidney cancer. The request is being considered for medical necessity for MVASI with Votrient by his treating provider.

Scientific evidence in peer-reviewed literature supports a result of improvement in health outcome for this patient with a diagnosis of metastatic kidney cancer. As per National Comprehensive Cancer Network (NCCN), MVASI is used as standard of care. MVASI is the best available treatment for this patient as this time. Based on the documentation provided for review, there is no contraindication to MVASI listed in the chart. Therefore, this patient is a good candidate for MVASI.

"In the last decades, the prognosis of metastatic renal cell carcinoma (mRCC) has remarkably improved following the advent of the "targeted therapy" era. The expanding knowledge on the prominent role played by angiogenesis in RCC pathogenesis has led to approval of multiple anti-angiogenic agents such as sunitinib, pazopanib, axitinib, cabozantinib, sorafenib, and bevacizumab. These agents can induce radiological responses and delay cancer progression for months or years before onset of resistance, with a clinically meaningful activity. The need for markers of prognosis and efficacy of anti-angiogenic agents has become more compelling as novel systemic immunotherapy agents have also been approved in RCC and can be administered as an alternative to angiogenesis inhibitors..." (D'Aniello et al.).

The requested service is likely to favor benefit over risks in this patient. This patient has metastatic kidney cancer; MVASI is recommended to be used in treatment for this type of cancer and is supported by NCCN and literature. The requested medication is likely to be more beneficial than any other standard services.

The carrier's denial of MVASI should be overturned.