| Formulary Chapter 8: Malignant disease and immunosuppression - Full Chapter
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| 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. |
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| Chapter Links... |
 CUH Access to oncolnet |
 Leuprorelin-containing depot products: need to strictly follow instructions for reconstitution and administration to reduce the risk of handling errors that may result in lack of efficacy |
| NHSE Cancer Drug Fund List |
| Details... |
| 08.03.04.01 |
Breast cancer |
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Goserelin (Zoladex®)
(Breast cancer, Implant)
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First Choice
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- Administration frequency - 28 days.
- Goserelin is a first line option gonadorelin analogue for breast cancer, endometriosis, endometrial thinning and uterine fibroids (licensed for use every 28 days).
- See section 08.03.04.02 for prostate cancer and 6.7.2 for non-malignant indications.
- Local Enhanced Service (LES) available in Primary Care for administration.
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Leuprorelin acetate (Prostap® 3 DCS)
(Breast cancer, injection)
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Second Choice
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- Administration frequency - 3 monthly.
- Leuprorelin acetate is second line formulary option for the management of breast cancer and endometriosis.
- See section 08.03.04.02 for prostate cancer and 6.7.2 for non-malignant indications.
- Local Enhanced Service (LES) available in Primary Care for administration.
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Leuprorelin acetate (Prostap® SR DCS)
(Breast cancer, injection)
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Second Choice
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- Administration frequency - monthly.
- Leuprorelin acetate is second line formulary option for the management of breast cancer, endometriosis, endometrial thinning and uterine fibroids.
- See section 08.03.04.02 for prostate cancer and 6.7.2 for non-malignant indications.
- Local Enhanced Service (LES) available in Primary Care for administration.
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Letrozole
(Tablet)
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Formulary
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Anastrozole
(Breast cancer, Tablet)
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 Restricted
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- 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.
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Exemestane
(Tablet)
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Restricted
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- 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.
June 2020 - Availability of exemestane 25mg tablets
- Accord have limited supplies available.
- Mylan have stock available via AAH.
- Pfizer have also confirmed availability.
- Zentiva - this is out of stock and no date for resupply confirmed yet.
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Tamoxifen
(Breast cancer/ mastocytosis, Tablet)
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Formulary
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- 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.
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MHRA Drug Safety Update December 2014: Tamoxifen - drug interactions, genetic variants and variability in clinical response (article November 2010)
UKMi Q&A February 2019: Tamoxifen and SSRI or SNRI antidepressants - is there an interaction
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Intrabeam radiotherapy system (Carl Zeiss UK)
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Restricted
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- For use in accordance with NICE TA501 for adjuvant treatment of early breast cancer.
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NICE 501: Intrabeam radiotherapy system for adjuvant treatment of early breast cancer
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| Non Formulary Items |
Fulvestrant (Faslodex®)
(Injection)
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Non Formulary
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- 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.
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NICE TA503 NOT RECOMMENDED: Fulvestrant for untreated locally advanced or metastatic oestrogen-receptor positive breast cancer
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Toremifene (Fareston®)
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Non Formulary
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Triptorelin (Decapeptyl® SR 3mg)
(Breast cancer, Injection )
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Non Formulary
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- Not recommended in Cambridgeshire and Peterborough for breast cancer, endometriosis and uterine fibroids.
- Goserelin is a first line option gonadorelin analogue for breast cancer, endometriosis, endometrial thinning and uterine fibroids (licensed for use every 28 days).
- See section 06.07.02 for non-malignant indications.
- Triptorelin (Decapeptyl SR) is first line formulary choice for prostate cancer indications. See section 08.03.04.02 for prostate cancer indications.
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Key |
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Cytotoxic Drug
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Controlled Drug
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High Cost Medicine
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Cancer Drugs Fund
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NHS England |
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Homecare |
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CCG |
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Traffic Light Status Information
| Status |
Description |
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Available Over the Counter. Consider Self Care |
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Formulary - Can be prescribed in both secondary and primary care. |
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Formulary - Specialist Advice, secondary care advice provided for primary care initiation. |
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Formulary - Specialist initiation without shared care guidance. |
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Formulary - Specialist initiation with shared care guidance. |
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Restricted - Prescribing (and monitoring where applicable) to remain with the hospital or specialist service. Not to be prescribed in Primary Care |
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Not recommended for prescribing. Switch to alternative cost-effective option. |
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Not recommended for prescribing in primary or secondary care. |
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Not recommended as no formal application made for addition to the formulary. Contact relevant pharmacy team for further information.
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Non-Formulary (category under review). |
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