Belinostat (Beleodaq) (CPB 0887, reviewed 2025-12-09)
Summary
Aetna considers belinostat (Beleodaq) medically necessary for commercial plans as a single agent in these cases: peripheral T-cell lymphoma that is relapsed or refractory or used for palliative intent, hepatosplenic T-cell lymphoma after two or more previous lines of chemotherapy, relapsed or refractory extranodal NK/T-cell lymphoma with an inadequate response or contraindication to asparaginase-based therapy, and adult T-cell leukemia/lymphoma or breast implant-associated anaplastic large cell lymphoma used for subsequent therapy. Aetna considers belinostat experimental, investigational, or unproven for all other indications, including B-cell lymphomas, Hodgkin lymphoma, and multiple myeloma, and for concomitant use with Folotyn (pralatrexate), Istodax (romidepsin), Ninlaro (ixazomib), or Zolinza (vorinostat). Continuation of belinostat is medically necessary for a listed indication when there is no evidence of unacceptable toxicity or disease progression on the current regimen.
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