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 Formulary Chapter 8: Malignant disease and immunosuppression - Full Chapter
Notes:

THIS CHAPTER IS CURRENTLY UNDER REVIEW. FOR FURTHER ADVICE PLEASE CONTACT YOUR LEAD PHARMACIST OR CCG MEDICINES OPTIMISATION TEAM (PRIMARY CARE ENQUIRIES ONLY)

Formulary and commissioned oncology and haematology regimens

From April 2013 cancer treatments listed on the National Cancer Drug Fund list are funded through the NHS England as outlined on their dedicated website.

Treatments recommended in a NICE Technology Appraisal will be added to Formulary but may not always be provided at all centres (Some centres may not see the cohort of patients the NICE Technology Appraisal covers)

For patient information about chemotherapy and chemotherapy regimens, please see the Macmillan cancer support website: 

Royal Papworth Hospital NHS Foundation Trust does not routinely administer chemotherapy and does not have facilities for the preparation of injectable cytotoxic medication. If a patient requires treatment, usual practice is to transfer to an alternative hospital able to provide this service. The Trust accepts that an occasion may arise where transfer of the patient gives cause for concern. In this situation the Consultant wishing to prescribe cytotoxic medication must discuss the case directly with the Chief Pharmacist.

Chapter Links...
 Details...
08.03.04.01  Expand sub section  Breast cancer
Anastrozole
(Breast cancer, Tablet)
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Restricted Drug Restricted
Advice

  • No liquid version, but tablets disperse in water. Ideally do not crush first. This should be avoided by women of child bearing potential and preferably be done in a closed system.

  • Advanced breast cancer in post menopausal women who previously had a clinical response to tamoxifen.

 
   
Exemestane
(Tablet)
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Restricted Drug Restricted
Advice

  • No liquid version, but tablets dissolve in about 30minutes. Ideally do not crush first. This should be avoided by women of child bearing potential and preferably be done in a closed system.

  • Advanced breast cancer in post menopausal women who previously had a clinical response to tamoxifen, and can't tolerate anastrazole.

 
   
Goserelin (Zoladex)
(Breast cancer, Implant)
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Restricted Drug Restricted
Advice

  • See section 08.03.04.02 for prostate cancer and 6.7.2 for gynae and gender dysphoria.

  • The Trust only stocks 1-monthly preparations for inpatients who are due the next dose but cannot bring in their own supply.

  • Secondary care clinics to recommend (not supply) gonadorelin analogues in line with local Formulary choices (see C&PJPG Formulary).

  • Goserelin is a first line option gonadorelin analogue for breast cancer, assisted reproduction, endometriosis, endometrial thinning and uterine fibroids; triptorelin is first line choice for prostate cancer.

 
   
Letrozole
(Tablet)
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Formulary
Advice
 
   
Tamoxifen
(Breast cancer/ mastocytosis, Tablet)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Advice

  • If needed tablets can be dispersed in water. This should be avoided by women of child bearing potential and preferably be done in a closed system.

 
Link  MHRA Drug Safety Update December 2014: Tamoxifen - drug interactions, genetic variants and variability in clinical response (article November 2010)
Link  UKMi Q&A February 2019: Tamoxifen and SSRI or SNRI antidepressants - is there an interaction
   
Intrabeam radiotherapy system (Carl Zeiss UK)
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Restricted Drug Restricted
Red Hospital
NHS England

  • For use in accordance with NICE TA501 for adjuvant treatment of early breast cancer. 

 
Link  NICE 501: Intrabeam radiotherapy system for adjuvant treatment of early breast cancer
   
 ....
 Non Formulary Items
Fulvestrant  (Faslodex)
(Injection)

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Non Formulary
Black

  • NOT RECOMMENDED in line with NICE TA503 - Fulvestrant for untreated locally advanced or metastatic oestrogen-receptor positive breast cancer. 



  • Fulvestrant is not recommended, within its marketing authorisation, for treating locally advanced or metastatic oestrogen-receptor positive breast cancer in postmenopausal women who have not had endocrine therapy before.

Link  NICE TA503 NOT RECOMMENDED: Fulvestrant for untreated locally advanced or metastatic oestrogen-receptor positive breast cancer
 
Toremifene  (Fareston)

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Non Formulary
Grey
 
  
Key
note Notes
Section Title Section Title (top level)
Section Title Section Title (sub level)
First Choice Item First Choice item
Non Formulary Item Non Formulary section
Restricted Drug
Restricted Drug
Unlicensed Drug
Unlicensed
Track Changes
Display tracking information
click to search medicines.org.uk
Link to adult BNF
click to search medicines.org.uk
Link to children's BNF
click to search medicines.org.uk
Link to SPCs
SMC
Scottish Medicines Consortium
Cytotoxic Drug
Cytotoxic Drug
CD
Controlled Drug
High Cost Medicine
High Cost Medicine
Cancer Drugs Fund
Cancer Drugs Fund
NHSE
NHS England
Homecare
Homecare
CCG
CCG

Traffic Light Status Information

Status Description

OTC

Available Over the Counter. Consider Self Care   

Green

Formulary - Can be prescribed in both secondary and primary care.   

Advice

Formulary - Specialist Advice, secondary care advice provided for primary care initiation.  

Amber No SCG

Formulary - Specialist initiation without shared care guidance.  

Amber SCG

Formulary - Specialist initiation with shared care guidance.  

Red Hospital

Restricted - Hospital only, not to be prescribed in primary care.  

Switch

Not recommended for prescribing. Switch to alternative cost-effective option.   

Black

Not recommended for prescribing in primary or secondary care.  

Grey

Not recommended as no formal application made for addition to the formulary. Contact relevant pharmacy team for further information.   

Non Formulary

Non-Formulary (category under review).  

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