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8. Malignant Disease and Immunosuppression

NICE NG14: Melanoma: assessment and management

NICE NG35: Myeloma: diagnosis and management

NICE CG164: Familial breast cancer: classification, care and managing breast cancer and related risks in people with a family history of breast cancer

CD&D APC Patient Decision Aids Resource available at: http://medicines.necsu.nhs.uk/guidelines/durham-darlington/

CD&D APC “Do Not Prescribe List” and “Grey List – drugs prescribed under limited circumstances” available at: http://medicines.necsu.nhs.uk/guidelines/durham-darlington/

Dexrazoxane
BNF | BNFC | SPC

500mg vials (with diluent)

Approved for use in line with NECN Extravasation Policy – only through specialist Cancer Centre

Commissioner: NHS England – Anthracycline Extravasation - Only when used in line with a current chemotherapy protocol from the North of England Cancer Network in line with the appropriate Network Site Specific Group’s clinical guidelines or chemotherapy algorithm

NHS England – Not routinely commissioned – Anthracycline Cardiotoxicity

Folinic Acid
BNF | BNFC | SPC

15mg tablets
3mg, 15mg, 30mg & 300mg injections

For Methotrexate-Induced Mucositis and Myelosuppression

Mesna
BNF | BNFC | SPC

1g in 10ml injection; 400mg tablets

For Urothelial Toxicity 

Bendamustine
BNF | BNFC | SPC

25mg & 100mg injections

Commissioner: NHS England - Only when used in line with a current chemotherapy protocol from the North of England Cancer Network in line with the appropriate Network Site Specific Group’s clinical guidelines or chemotherapy algorithm or NICE TA216.

When used for the treatment of low grade lymphomas, mantle cell NHL or relapsed multiple myeloma only when funded through the Cancer Drugs Fund.

Busulfan
BNF | BNFC | SPC

2mg tablets; 25mg capsules u
60mg in 10ml inj

Commissioner: NHS England - Only when used in line with a current chemotherapy protocol from the North of England Cancer Network in line with the appropriate Network Site Specific Group’s clinical guidelines or chemotherapy algorithm.

Chlorambucil
BNF | BNFC | SPC

2mg tablets

Commissioner: NHS England - Only when used in line with a current chemotherapy protocol from the North of England Cancer Network in line with the appropriate Network Site Specific Group’s clinical guidelines or chemotherapy algorithm.

Cyclophosphamide
BNF | BNFC | SPC

50mg tablets
1g injection

For treatment of inflammatory conditions unresponsive to other agents, only in accordance with a locally agreed drug protocol.

Commissioner: NHS England - only when used in line with a current chemotherapy protocol from the North of England Cancer Network in line with the appropriate Network Site Specific Group’s clinical guidelines or chemotherapy algorithm.

Estramustine
BNF | BNFC | SPC

140mg capsules

Commissioner: NHS England - Only when used in line with a current chemotherapy protocol from the North of England Cancer Network in line with the appropriate Network Site Specific Group’s clinical guidelines or chemotherapy algorithm.

Lomustine
BNF | BNFC | SPC

10mg u & 40mg capsules

Commissioner: NHS England - Only when used in line with a current chemotherapy protocol from the North of England Cancer Network in line with the appropriate Network Site Specific Group’s clinical guidelines or chemotherapy algorithm.

Melphalan
BNF | BNFC | SPC

2mg tablets; 50mg injection

Commissioner: NHS England - Only when used in line with a current chemotherapy protocol from the North of England Cancer Network in line with the appropriate Network Site Specific Group’s clinical guidelines or chemotherapy algorithm.

Bleomycin
BNF | BNFC | SPC

15,000 units injection

Commissioner: NHS England - Only when used in line with a current chemotherapy protocol from the North of England Cancer Network in line with the appropriate Network Site Specific Group’s clinical guidelines or chemotherapy algorithm.

Doxorubicin
BNF | BNFC | SPC

50mg injection
20mg & 50mg pegylated liposomal injection

Commissioner: NHS England - Commissioner: NHS England - Only when used in line with a current chemotherapy protocol from the North of England Cancer Network in line with the appropriate Network Site Specific Group’s clinical guidelines or chemotherapy algorithm or NICE TA91 NICE TA389 OR if indication funded from the Cancer Drugs Fund.

Epirubicin
BNF | BNFC | SPC

50mg injection

Commissioner: NHS England - Only when used in line with a current chemotherapy protocol from the North of England Cancer Network in line with the appropriate Network Site Specific Group’s clinical guidelines or chemotherapy algorithm.

Idarubicin
BNF | BNFC | SPC

5mg & 10mg capsules

Commissioner: NHS England - Only when used in line with a current chemotherapy protocol from the North of England Cancer Network in line with the appropriate Network Site Specific Group’s clinical guidelines or chemotherapy algorithm.

Mitomycin
BNF | BNFC | SPC

10mg, 20mg & 40mg injections

0.04% preservative free eye drops (unlicensed)

 

Intravenous Injection
Commissioner: NHS England - Only when used in line with a current chemotherapy protocol from the North of England Cancer Network in line with the appropriate Network Site Specific Group’s clinical guidelines or chemotherapy algorithm.


Bladder Installation
Commissioner: NHS England - Only when used in line with a current chemotherapy protocol from the North of England Cancer Network in line with the appropriate Network Site Specific Group’s clinical guidelines or chemotherapy algorithm.

Opthalmic Use (injection or drops)
Only prescribed by a consultant ophthalmologist for use in theatre.

Mitoxantrone
BNF | BNFC | SPC

20mg in 10ml injection

Commissioner: NHS England - Only when used in line with a current chemotherapy protocol from the North of England Cancer Network in line with the appropriate Network Site Specific Group’s clinical guidelines or chemotherapy algorithm.

Pixantrone▼
BNF | BNFC | SPC

29mg powder for reconstitution injection

Commissioner: NHS England – Only when used in line with a current chemotherapy protocol from the North of England Cancer Network in line with the appropriate Network Site Specific Group’s clinical guidelines or chemotherapy algorithm or NICE TA306.

Azacitidine
BNF | BNFC | SPC

100mg vial

Commissioner: NHS England - Only when used in line with a current chemotherapy protocol from the North of England Cancer Network in line with the appropriate Network Site Specific Group’s clinical guidelines or chemotherapy algorithm.

NICE TA218

NICE TA399 – not approved for treating acute myeloid leukaemia with more than 30% bone marrow blasts.

Capecitabine
BNF | BNFC | SPC

150mg & 500mg tablets

Commissioner: NHS England - Only when used in line with a current chemotherapy protocol from the North of England Cancer Network in line with the appropriate Network Site Specific Group’s clinical guidelines or chemotherapy algorithm.

NICE TA191, NICE TA100, NICE TA61

MHRA Drug Safety Alert (January 2014): Capecitabine: risk of severe skin reactions—discontinue treatment.  Severe skin reactions such as Stevens-Johnson syndrome and toxic epidermal necrolysis have been reported during treatment with capecitabine. Some cases were fatal.  More details here

Clofarabine▼
BNF | BNFC | SPC

Commissioner: NHS England - Only when used in line with a current chemotherapy protocol from the North of England Cancer Network in line with the appropriate Network Site Specific Group’s clinical guidelines or chemotherapy algorithm OR if indication funded from the Cancer Drugs Fund.

Cladribine
BNF | BNFC | SPC

10mg in 10ml solution for preparing infusions,
2mg in 1ml subcutaneous injection

NHS England – Not routinely commissioned – Multiple Sclerosis – Pulmonary Langerhans Histiocytosis


Litak formulation
Commissioner: NHS England - Only when used in line with a current chemotherapy protocol from the North of England Cancer Network in line with the appropriate Network Site Specific Group’s clinical guidelines or chemotherapy algorithm.

Cytarabine
BNF | BNFC | SPC

100mg in 5ml & 1g in 10ml injections
50mg vial- Intrathecal injection , cytarabine encapsulated in liposomes

Intravenous injections only
Intravenous administration would normally only be part of Level 2 or higher haematology protocols and should be undertaken at a specialist haematology centre.
50mg vial intrathecal injection , cytarabine encapsulated in liposomes
Prescribing MUST be in accordance with intrathecal prescribing policies.

Fludarabine
BNF | BNFC | SPC

10mg tablets

Commissioner: NHS England - Only when used in line with a current chemotherapy protocol from the North of England Cancer Network in line with the appropriate Network Site Specific Group’s clinical guidelines or chemotherapy algorithm.

NICE TA29

Nelarabine▼
BNF | BNFC | SPC

Commissioner: NHS England - Only when used in line with a current chemotherapy protocol from the North of England Cancer Network in line with the appropriate Network Site Specific Group’s clinical guidelines or chemotherapy algorithm.

Fluorouracil
BNF | BNFC | SPC

2.5g in 50ml & 2.5g in 100ml injections

10mg in 0.4ml subconjunctival injection u

Intravenous injection or infusion
Commissioner: NHS England - Only when used in line with a current chemotherapy protocol from the North of England Cancer Network in line with the appropriate Network Site Specific Group’s clinical guidelines or chemotherapy algorithm.
For ophthalmic use
Only when prescribed by a consultant ophthalmologist for use in opthalmology theatre.

Gemcitabine
BNF | BNFC | SPC

200mg & 1g & 2g injection

Commissioner: NHS England - Only when used in line with a current chemotherapy protocol from the North of England Cancer Network in line with the appropriate Network Site Specific Group’s clinical guidelines or chemotherapy algorithm.

NICE TA116, NICE TA25, NICE TA389

Mercaptopurine
BNF | BNFC | SPC

50mg tablets

AMBER when used for inflammatory bowel disease (see chapter 1) 

Methotrexate
BNF | BNFC | SPC

2.5mg tablets
10mg in 5ml oral solution u
Injections (various strengths) – including prefilled syringesu
5mg in 2ml intrathecal injection

For medical management of ectopic pregnancy / pregnancy of unknown origin only where prescribed by a consultant obstetrician.

Otherwise only when used in line with a current chemotherapy protocol from the North of England Cancer Network in line with the appropriate Network Site Specific Group’s clinical guidelines or chemotherapy algorithm.

When prescribed as intrathecal chemotherapy only in accordance with intrathecal prescribing policies.

AMBER when used in chronic inflammatory conditions, e.g. Crohn’s disease, rheumatoid arthritis. Prescriptions will be for ONCE WEEKLY administration ONLY.

Pemetrexed
BNF | BNFC | SPC

100mg & 500mg injection

Commissioner: NHS England - Only when used in line with a current chemotherapy protocol from the North of England Cancer Network in line with the appropriate Network Site Specific Group’s clinical guidelines or chemotherapy algorithm or NICE TA135, NICE TA181, NICE TA190, NICE TA124, NICE TA402

Raltitrexed
BNF | BNFC | SPC

Commissioner: NHS England - Only when used in line with a current chemotherapy protocol from the North of England Cancer Network in line with the appropriate Network Site Specific Group’s clinical guidelines or chemotherapy algorithm.

Trifluridine-tipiracil
BNF | BNFC | SPC

Commissioner: NHS England - Only when used in line with a current chemotherapy protocol from the North of England Cancer Network in line with the appropriate Network Site Specific Group’s clinical guidelines or chemotherapy algorithm or NICE TA405

Etoposide
BNF | BNFC | SPC

50mg & 100mg capsules
100mg in 5ml & 500mg in 25ml injections

Commissioner: NHS England - Only when used in line with a current chemotherapy protocol from the North of England Cancer Network in line with the appropriate Network Site Specific Group’s clinical guidelines or chemotherapy algorithm.

Vinblastine
BNF | BNFC | SPC

10mg injection

Commissioner: NHS England - Only when used in line with a current chemotherapy protocol from the North of England Cancer Network in line with the appropriate Network Site Specific Group’s clinical guidelines or chemotherapy algorithm.
Administration MUST be by the intravenous route only. Infusions MUST be diluted to 50ml.

Vincristine
BNF | BNFC | SPC

2mg in 2ml injection
2mg in 20ml prefilled syringe
2mg in 50ml infusion bags

Commissioner: NHS England - Only when used in line with a current chemotherapy protocol from the North of England Cancer Network in line with the appropriate Network Site Specific Group’s clinical guidelines or chemotherapy algorithm.
Administration MUST be by the intravenous route only. Infusions MUST be diluted to 50ml.

Vindesine
BNF | BNFC | SPC

5mg injection

Commissioner: NHS England - Only when used in line with a current chemotherapy protocol from the North of England Cancer Network in line with the appropriate Network Site Specific Group’s clinical guidelines or chemotherapy algorithm.
Administration MUST be by the intravenous route only. Infusions MUST be diluted to 50ml

Vinorelbine
BNF | BNFC | SPC

20mg, 30mg capsules
10mg in 1ml & 50mg in 5ml injections

Commissioner: NHS England - Only when used in line with a current chemotherapy protocol from the North of England Cancer Network in line with the appropriate Network Site Specific Group’s clinical guidelines or chemotherapy algorithm.
Administration MUST be by the intravenous or oral route only. Infusions MUST be diluted to 50ml. ORAL doses are not equivalent to intravenous.

Abraxane
BNF | BNFC | SPC

5mg in 1ml powder for suspension for infusion

Commissioner: NHS England - Only when used in line with a current chemotherapy protocol from the North of England Cancer Network in line with the appropriate Network Site Specific Group’s clinical guidelines or chemotherapy algorithm.

NICE TA360, NICE TA362

Restricted for use within its current license for metastatic breast cancer patients who cannot tolerate standard taxanes.

Afatinib▼
BNF | BNFC | SPC

20mg, 30mg, 40mg, 50mg film coated tablets

Commissioner: NHS England - Only when used in line with NICE TA310

Aflibercept▼
BNF | BNFC | SPC

Commissioner: NHS England - Only when used in line with a current chemotherapy protocol from the North of England Cancer Network in line with the appropriate Network Site Specific Group’s clinical guidelines or chemotherapy algorithm

Not recommended in these circumstances NICE TA307

MHRA Drug Safety Update (April 2016): Aflibercept (Zaltrap▼): minimising the risk of osteonecrosis of the jaw

Axitinib
BNF | BNFC | SPC

1mg, 3mg, 5mg and 7mg film coated tablets

Commissioner: NHS England – Only when used in line with a current chemotherapy protocol from the North of England Cancer Network in line with the appropriate Network Site Specific Group’s clinical guidelines or chemotherapy algorithm.

Tertiary Centre Only: NICE TA333

Bevacizumab
BNF | BNFC | SPC

For ophthalmological uses in accordance with NTAG recommendations (see chapter 11)

NICE does not recommend bevacizumab in the following TAs:

Ovarian, fallopian tube and primary peritoneal cancer (recurrent advanced, platinum-sensitive or partially platinum-sensitive) - bevacizumab (TA285)

Bevacizumab in combination with paclitaxel and carboplatin for first-line treatment of advanced ovarian cancer (TA284)

NICE is unable to make a recommendation about the use in the NHS of bevacizumab for treating relapsed, platinum-resistant epithelial ovarian, fallopian tube or primary peritoneal cancer because no evidence submission was received from Roche Products for the technology (TA353)

Bevacizumab for treating EGFR mutation-positive non-small-cell lung cancer (TA436)

Commissioner: NHS England - Otherwise only when used in line with a current chemotherapy protocol from the North of England Cancer Network in line with the appropriate Network Site Specific Group’s clinical guidelines or chemotherapy algorithm OR if indication funded from the Cancer Drugs Fund.

Bexarotene
BNF | BNFC | SPC

Commissioner: NHS England - Only when used in line with a current chemotherapy protocol from the North of England Cancer Network in line with the appropriate Network Site Specific Group’s clinical guidelines or chemotherapy algorithm.

Bortezomib
BNF | BNFC | SPC

3.5mg injection

Commissioner: NHS England - Commissioner: NHS England - Only when used in line with a current chemotherapy protocol from the North of England Cancer Network in line with the appropriate Network Site Specific Group’s clinical guidelines or chemotherapy algorithm or NICE TA228, NICE TA129, NICE TA311, NICE TA370 OR if indication funded from the Cancer Drugs Fund.

Bosutinib▼
BNF | BNFC | SPC

Commissioner: NHS England - Only when used in line with a current chemotherapy protocol from the North of England Cancer Network in line with the appropriate Network Site Specific Group’s clinical guidelines or chemotherapy algorithm OR if indication funded from the Cancer Drugs Fund OR NICE TA401.

MHRA Drug Safety Update (May 2016): BCR-ABL tyrosine kinase inhibitors: risk of hepatitis B reactivation

Brentuximab▼
BNF | BNFC | SPC

Commissioner: NHS England - Only when used in line with a current chemotherapy protocol from the North of England Cancer Network in line with the appropriate Network Site Specific Group’s clinical guidelines or chemotherapy algorithm OR if indication funded from the Cancer Drugs Fund

Cabazitaxel
BNF | BNFC | SPC

40mg/1ml concentrate for IV infusion

Commissioner: NHS England - Only when used in line with a current chemotherapy protocol from the North of England Cancer Network in line with the appropriate Network Site Specific Group’s clinical guidelines or chemotherapy algorithm

 NICE TA391

MHRA Drug Safety Update (Nov 2013): Cabazitaxel - risk of medication error resulting in overdose.  .

Carboplatin
BNF | BNFC | SPC

50mg in 5ml & 450mg in 45ml injections

Commissioner: NHS England - Only when used in line with a current chemotherapy protocol from the North of England Cancer Network in line with the appropriate Network Site Specific Group’s clinical guidelines or chemotherapy algorithm.

Ceritinib▼
BNF | BNFC | SPC

150mg capsule

Commissioner: NHS England – Only when used in line with a current chemotherapy protocol from the North of England Cancer Network in line with the appropriate Network Site Specific Group’s clinical guidelines or chemotherapy algorithm OR if indication funded from the Cancer Drugs Fund.

NICE TA395

Cetuximab
BNF | BNFC | SPC

100mg in 20ml & 500mg in 100ml vials for IV infusion

Commissioner: NHS England - Commissioner: NHS England - Only when used in line with a current chemotherapy protocol from the North of England Cancer Network in line with the appropriate Network Site Specific Group’s clinical guidelines or chemotherapy algorithm OR if indication funded from the Cancer Drugs Fund.

NICE TA176, NICE TA439

Tertiary Centre Only: NICE TA172, NICE TA145

MHRA DSU February 2014

Cisplatin
BNF | BNFC | SPC

50mg in injection

Commissioner: NHS England - Only when used in line with a current chemotherapy protocol from the North of England Cancer Network in line with the appropriate Network Site Specific Group’s clinical guidelines or chemotherapy algorithm.

Cobimetinib
BNF | BNFC | SPC

Commissioner: NHS England – Only when used in line with a current chemotherapy protocol from the North of England Cancer Network in line with the appropriate Network Site Specific Group’s clinical guidelines or chemotherapy algorithm.

NICE TA414

Crizotinib▼
BNF | BNFC | SPC

Commissioner: NHS England – Only when used in line with a current chemotherapy protocol from the North of England Cancer Network in line with the appropriate Network Site Specific Group’s clinical guidelines or chemotherapy algorithm OR if indication funded from the Cancer Drugs Fund OR NICE TA406, NICE TA422

MHRA Drug Safety Update (November 2015):  risk of cardiac failure

Dacarbazine
BNF | BNFC | SPC

500mg injection

Commissioner: NHS England - Only when used in line with a current chemotherapy protocol from the North of England Cancer Network in line with the appropriate Network Site Specific Group’s clinical guidelines or chemotherapy algorithm.

Dasatinib
BNF | BNFC | SPC

Commissioner: NHS England – Only when used in line with a current chemotherapy protocol from the North of England Cancer Network in line with the appropriate Network Site Specific Group’s clinical guidelines or chemotherapy algorithm OR if indication funded from the Cancer Drugs Fund OR NICE TA425, NICE TA426

MHRA Drug Safety Update (May 2016): BCR-ABL tyrosine kinase inhibitors: risk of hepatitis B reactivation

Docetaxel
BNF | BNFC | SPC

20mg & 80mg injections

Commissioner: NHS England - Only when used in line with a current chemotherapy protocol from the North of England Cancer Network in line with the appropriate Network Site Specific Group’s clinical guidelines or chemotherapy algorithm.

NICE TA109, NICE TA101

Erbulin
BNF | BNFC | SPC

Commissioner: NHS England - Only when used in line with a current chemotherapy protocol from the North of England Cancer Network in line with the appropriate Network Site Specific Group’s clinical guidelines or chemotherapy algorithm OR if indication funded from the Cancer Drugs Fund OR NICE TA432

Erlotinib
BNF | BNFC | SPC

25mg, 100mg & 150mg tablets

Commissioner: NHS England - Only when used in line with a current chemotherapy protocol from the North of England Cancer Network in line with the appropriate Network Site Specific Group’s clinical guidelines or chemotherapy algorithm.

NICE TA258, NICE TA162, NICE TA227, NICE TA374

See Letter Sent to Healthcare Professionals (Jan 2016) - Erlotinib (Tarceva): first-line maintenance indication now restricted to patients with a tumour that has an EGFR-activating mutation

Everolimus
BNF | BNFC | SPC

See NICE TA421, NICE TA432

Commissioner: NHS England - Only when used in line with protocol from the North of England Cancer Network in line with the appropriate Network Site Specific Group’s clinical guidelines or chemotherapy algorithm OR if indication funded from the Cancer Drugs Fund.
NHS England – Renal Angiomyolipoma – Not Routinely Commissioned

Gefitinib
BNF | BNFC | SPC

250mg tablets

Only when used in line with a current chemotherapy protocol from the North of England Cancer Network in line with the appropriate Network Site Specific Group’s clinical guidelines or chemotherapy algorithm.

Commissioner: NHS England - NICE TA192, NICE TA374

Hydroxycarbamide
BNF | BNFC | SPC

500mg capsules
500mg in 5ml suspension u

Commissioner: NHS England - Only when used in line with a current chemotherapy protocol from the North of England Cancer Network in line with the appropriate Network Site Specific Group’s clinical guidelines or chemotherapy algorithm.

AMBER when used to treat non-malignant conditions in accordance with a clearly documented shared care protocol.CDDFT Intranet Link

Ibrutinib
BNF | BNFC | SPC

Commissioner: NHS England - Only when used in line with a current chemotherapy protocol from the North of England Cancer Network in line with the appropriate Network Site Specific Group’s clinical guidelines or chemotherapy algorithm OR NICE TA429

Ibrutinib with bendamustine and rituximab for treating relapsed or refractory chronic lymphocytic leukaemia after systemic therapy (terminated appraisal) (TA437)
NICE is unable to make a recommendation about the use of ibrutinib with bendamustine and rituximab for relapsed or refractory chronic lymphocytic leukaemia

Idelalisib▼
BNF | BNFC | SPC

100mg & 150mg film coated tablets

Commissioner: NHS England – Only when used in line with a current chemotherapy protocol from the North of England Cancer Network in line with the appropriate Network Site Specific Group’s clinical guidelines or chemotherapy algorithm.

NICE TA359

MHRA Drug Safety Update (May 2016): Idelalisib (Zydelig▼): interim measures following signal of serious infection and deaths related to infection found in clinical trials

MHRA Drug Safety Update (Sept 2016): Idelalisib (Zydelig▼): updated indications and advice on minimising the risk of infection

Imatinib▼
BNF | BNFC | SPC

100mg & 400mg capsules

Commissioner: NHS England - Only when used in line with a current chemotherapy protocol from the North of England Cancer Network in line with the appropriate Network Site Specific Group’s clinical guidelines or chemotherapy algorithm NICE TA70, NICE TA86, NICE TA251

NICE TA241, NICE TA209, TA326 , NICE TA425, NICE TA426

MHRA Drug Safety Update (May 2016): BCR-ABL tyrosine kinase inhibitors: risk of hepatitis B reactivation

Ipilimumab▼
BNF | BNFC | SPC

50mg vial for preparing IV infusion

Commissioner NHS England - Tertiary centre only in line with NICE TA268 & TA319

OR if indication funded from the Cancer Drugs Fund.

Related NICE guidance:

CG131: Colorectal cancer

Irinotecan
BNF | BNFC | SPC

40mg in 2ml & 100mg in 5ml injections

Commissioner: NHS England - Only when used in line with a current chemotherapy protocol from the North of England Cancer Network in line with the appropriate Network Site Specific Group’s clinical guidelines or chemotherapy algorithm.

Lapatanib
BNF | BNFC | SPC

Commissioner: NHS England - Only when used in line with a current chemotherapy protocol from the North of England Cancer Network in line with the appropriate Network Site Specific Group’s clinical guidelines or chemotherapy algorithm.

Necitumumab
BNF | BNFC | SPC

NICE TA411: Necitumumab, in combination with gemcitabine and cisplatin, is not recommended within its marketing authorisation for adults with locally advanced or metastatic epidermal growth factor receptor (EGFR)-expressing squamous non-small-cell lung cancer that has not been treated with chemotherapy.

Nilotinib
BNF | BNFC | SPC

150mg & 200mg capsules

Only when used in line with a current chemotherapy protocol from the North of England Cancer Network in line with the appropriate Network Site Specific Group’s clinical guidelines or chemotherapy algorithm.

Commissioner: NHS England - NICE TA251, NICE TA241, NICE TA425, NICE TA426

MHRA Drug Safety Update (May 2016): BCR-ABL tyrosine kinase inhibitors: risk of hepatitis B reactivation

Nintedanib▼
BNF | BNFC | SPC

100mg and 150mg soft capsules

Commissioner: NHS England – Only when used in line with a current chemotherapy protocol from the North of England Cancer Network in line with the appropriate Network Site Specific Group’s clinical guidelines or chemotherapy algorithm

NICE TA347

Commissioner: NHS England: idiopathic pulmonary fibrosis as per NICE TA379

 

Olaparib▼
BNF | BNFC | SPC

50mg capsules

Commissioner: NHS England – Only when used in line with a current chemotherapy protocol from the North of England Cancer Network in line with the appropriate Network Site Specific Group’s clinical guidelines or chemotherapy algorithm.

NICE TA381

Osimertinib
BNF | BNFC | SPC

Commissioner: NHS England – Only when used in line with a current chemotherapy protocol from the North of England Cancer Network in line with the appropriate Network Site Specific Group’s clinical guidelines or chemotherapy algorithm OR if indication funded from the Cancer Drugs Fund.

NICE TA416

Oxaliplatin
BNF | BNFC | SPC

50mg & 100mg injections

Commissioner: NHS England - Only when used in line with a current chemotherapy protocol from the North of England Cancer Network in line with the appropriate Network Site Specific Group’s clinical guidelines or chemotherapy algorithm.

NICE TA100

Paclitaxel
BNF | BNFC | SPC

30mg in 5ml, 100mg in 16.7ml and 150mg in 25ml concentrate for preparing IV infusion

NICE TA91, NICE TA55 NICE TA389

Commissioner: NHS England - Only when used in line with a current chemotherapy protocol from the North of England Cancer Network in line with the appropriate Network Site Specific Group’s clinical guidelines or chemotherapy algorithm.

Panitumumab
BNF | BNFC | SPC

20mg/ml injection

Commissioner: NHS England - Commissioner: NHS England - Only when used in line with a current chemotherapy protocol from the North of England Cancer Network in line with the appropriate Network Site Specific Group’s clinical guidelines or chemotherapy algorithm OR if indication funded from the Cancer Drugs Fund.

NICE TA439

Panobinostat▼
BNF | BNFC | SPC

10mg, 15mg and 20mg hard capsules

Commissioner: NHS England – Only when used in line with a current chemotherapy protocol from the North of England Cancer Network in line with the appropriate Network Site Specific Group’s clinical guidelines or chemotherapy algorithm.

NICE TA380

Pazopanib
BNF | BNFC | SPC

200mg & 400mg tablets

Commissioner: NHS England - Only when used in line with a current chemotherapy protocol from the North of England Cancer Network in line with the appropriate Network Site Specific Group’s clinical guidelines or chemotherapy algorithm

NICE TA215

Pegaspargase
BNF | BNFC | SPC

Commissioner: NHS England – Only when used in line with a current chemotherapy protocol from the North of England Cancer Network in line with the appropriate Network Site Specific Group’s clinical guidelines or chemotherapy algorithm.

NICE TA408

Pembrolizumab▼
BNF | BNFC | SPC

50mg vial for preparing IV infusion

Commissioner: NHS England - Only when used in line with a current chemotherapy protocol from the North of England Cancer Network in line with the appropriate

NICE TA357, NICE TA366, NICE TA428

Pentostatin
BNF | BNFC | SPC

Commissioner: NHS England - Only when used in line with a current chemotherapy protocol from the North of England Cancer Network in line with the appropriate Network Site Specific Group’s clinical guidelines or chemotherapy algorithm.

Pertuzumab▼
BNF | BNFC | SPC

Commissioner: NHS England – Only when used in line with a current chemotherapy protocol from the North of England Cancer Network in line with the appropriate Network Site Specific Group’s clinical guidelines or chemotherapy algorithm OR if indication funded from the Cancer Drugs Fund OR NICE TA424

Pomalidomide
BNF | BNFC | SPC

Commissioner: NHS England – Only when used in line with a current chemotherapy protocol from the North of England Cancer Network in line with the appropriate Network Site Specific Group’s clinical guidelines or chemotherapy algorithm OR if indication funded from the Cancer Drugs Fund OR NICE TA427

Procarbazine
BNF | BNFC | SPC

50mg capsules

Commissioner: NHS England - Only when used in line with a current chemotherapy protocol from the North of England Cancer Network in line with the appropriate Network Site Specific Group’s clinical guidelines or chemotherapy algorithm

Radium-223 dichloride▼
BNF | BNFC | SPC

Commissioner: NHS England – Only when used in line with a current chemotherapy protocol from the North of England Cancer Network in line with the appropriate Network Site Specific Group’s clinical guidelines or chemotherapy algorithm.

NICE TA412

Ramucirumab▼
BNF | BNFC | SPC

Commissioner: NHS England – Only when used in line with a current chemotherapy protocol from the North of England Cancer Network in line with the appropriate Network Site Specific Group’s clinical guidelines or chemotherapy algorithm or

NICE TA378,

NICE TA403: combination with docetaxel, is not recommended within its marketing authorisation for treating locally advanced or metastatic non-small-cell lung cancer in adults whose disease has progressed after platinum-based chemotherapy.

Ruxolitinib▼
BNF | BNFC | SPC

5mg, 15mg and 20mg tablets

Commissioner: NHS England – Only when used in line with a current chemotherapy protocol from the North of England Cancer Network in line with the appropriate Network Site Specific Group’s clinical guidelines or chemotherapy algorithm

NICE TA289

NICE is unable to make a recommendation about the use in the NHS of ruxolitinib for treating polycythaemia vera that is resistant to hydroxycarbamide or for people who cannot tolerate hydroxycarbamide because no evidence submission was received from Novartis Pharmaceuticals for the technology (TA356).

Sipuleucel-T
BNF | BNFC | SPC
Sorafenib
BNF | BNFC | SPC

Commissioner: NHS England - Only when used in line with a current chemotherapy protocol from the North of England Cancer Network in line with the appropriate Network Site Specific Group’s clinical guidelines or chemotherapy algorithm OR if indication funded from the Cancer Drugs Fund.

Streptozocin
BNF | BNFC | SPC

1g injection (only available on a named patient basis)u

Commissioner: NHS England - Only when used in line with a current chemotherapy protocol from the North of England Cancer Network in line with the appropriate Network Site Specific Group’s clinical guidelines or chemotherapy algorithm.

Suitinib
BNF | BNFC | SPC

50mg 100mg & 400mg capsules

Commissioner: NHS England - Only when used in line with a current chemotherapy protocol from the North of England Cancer Network in line with the appropriate Network Site Specific Group’s clinical guidelines or chemotherapy algorithm OR if indication funded from the Cancer Drugs Fund.

NICE TA179, NICE TA169

Temsirolimus
BNF | BNFC | SPC

Commissioner: NHS England – Only when used in line with a current chemotherapy protocol from the North of England Cancer Network in line with the appropriate Network Site Specific Group’s clinical guidelines or chemotherapy algorithm OR if indication funded from the Cancer Drugs Fund.

Topotecan
BNF | BNFC | SPC

0.25mg & 1mg capsules
1mg & 4mg vials

Commissioner: NHS England - Only when used in line with a current chemotherapy protocol from the North of England Cancer Network in line with the appropriate Network Site Specific Group’s clinical guidelines or chemotherapy algorithm.

NICE TA184, NICE TA91, NICE TA389

Tertiary Centre Only: NICE TA183

Trabectedin
BNF | BNFC | SPC

250microgram injection

Tertiary centre only
Tertiary Centre Only: NICE TA222, NICE TA185 NICE TA389

 

Trametinib▼
BNF | BNFC | SPC

500microgram and 2mg film coated tablets

Commissioner: NHS England – Only when used in line with a current chemotherapy protocol from the North of England Cancer Network in line with the appropriate Network Site Specific Group’s clinical guidelines or chemotherapy algorithm OR if indication funded from the Cancer Drugs Fund.

NICE TA396

Trastuzumab
BNF | BNFC | SPC

150mg vial for preparing IV infusion
600mg s/c injection

Commissioner: NHS England - Only when used in line with a current chemotherapy protocol from the North of England Cancer Network in line with the appropriate Network Site Specific Group’s clinical guidelines or chemotherapy algorithm OR if indication funded from the Cancer Drugs Fund.

NICE TA208, NICE TA107, NICE TA34, NICE TA371

Tretinoin
BNF | BNFC | SPC

10mg capsules

Commissioner: NHS England - Only when used in line with a current chemotherapy protocol from the North of England Cancer Network in line with the appropriate Network Site Specific Group’s clinical guidelines or chemotherapy algorithm.

Temozolomide
BNF | BNFC | SPC

NHS England – Not routinely commissioned

Protein kinase inhibitors
BNF | BNFC | SPC

NHS England – Not routinely commissioned

Irinotecan peglylated liposomal
BNF | BNFC | SPC

50mg (5 mg/ml) concentrate for solution for infusion

Not approved as per NICE TA440

Tertiary Centre Only: NICE TA85, NICE TA99

Azathioprine
BNF | BNFC | SPC

Tablets - 25mg, 50mg

50mg in 5ml u suspension
Shared Care (Amber) for non-cancer indications

Mycophenolate Mofetil
BNF | BNFC | SPC

Capsules - 250mg, 500mg

1g in 5ml (200mg/ml) oral suspension

Shared Care (Amber) for non-cancer indications

MHRA Drug Safety Update (Jan 2015): Mycophenolate mofetil (CellCept) and mycophenolic acid: risk of hypogammaglobulinaemia and risk of bronchiectasis

MHRA Drug Safety Update (Dec 2015): Mycophenolate mofetil, mycophenolic acid: new pregnancy-prevention advice for women and men

Mycophenolate Sodium
BNF | BNFC | SPC

180mg & 360mg e/c tablets

2nd line therapy in patients who do not tolerate mycophenolate mofetil.

Rituximab
BNF | BNFC | SPC

100mg in 10ml & 500mg in 50ml concentrate for IV infusion

Treatment of rheumatological conditions in line with NICE guidance otherwise only when used in line with a current chemotherapy protocol from the North of England Cancer Network in line with the appropriate Network Site Specific Group’s clinical guidelines or chemotherapy algorithm.

NICE TA243, NICE TA226, NICE TA65, NICE TA193, NICE TA174, NICE TA137NICE TA308,

MHRA Drug Safety Update (December 2013): Rituximab: screen for hepatitis B virus before treatment

Alemtuzumab▼
BNF | BNFC | SPC

30mg in 1ml concentrate for IV infusion
- for use in lymphocytic leukaemia & prevention of graft vs. host disease on bone marrow transplant patients
- approved for use in high-risk kidney and pancreas transplantation 
12mg in 1.2ml concentrate for IV infusion
- approved as an option for treating adults with active relapsing– remitting multiple sclerosis in line with NICE (subject to NHS ENGLAND
funding)

Ofatumumab▼
BNF | BNFC | SPC

100mg in 5ml concentrate for IV infusion

Commissioner: NHS England - Only when used in line with a current chemotherapy protocol from the North of England Cancer Network in line with the appropriate Network Site Specific Group’s clinical guidelines or chemotherapy algorithm and is used in line with NICE TA344 or when funded via the Cancer Drug Fund.

Obinutuzumab▼
BNF | BNFC | SPC

1000mg in 40ml concentrate for IV infusion

Commissioner: NHS England - Only when used in line with a current chemotherapy protocol from the North of England Cancer Network in line with the appropriate Network Site Specific Group’s clinical guidelines or chemotherapy algorithm and is used in line with NICE TA343 or when funded via the Cancer Drug Fund.

First choice for most indications

Ciclosporin (Neoral)
BNF | BNFC | SPC

Capsules - 10mg, 25mg, 50mg & 100mg

100mg in 1ml sugar-free oral solution (oily)

Shared Care (Amber) for non-cancer indications

Tacrolimus
BNF | BNFC | SPC

Capsules - 500 microgram, 1mg

Shared Care (Amber) for non-cancer indications

Sirolimus
BNF | BNFC | SPC

1mg & 2mg tablets
1mg per ml oral solution

Approved for renal transplantation in children and adolescents in line
with NICE

Basiliximab
BNF | BNFC | SPC

20mg vial for preparing IV infusion

Commissioner: NHS England - NICE TA85, NICE TA99

Belatacept
BNF | BNFC | SPC

NHS England – Not Routinely Commissioned

Antithymocyte Immunoglobulin
BNF | BNFC | SPC

Commissioner: NHS England - BCSH Guidelines

Azathioprine
BNF | BNFC | SPC

25mg & 50mg tablets

50mg in 5ml suspension
50mg injection

Commissioner: NHS England – New Patients Only

Ciclosporin
BNF | BNFC | SPC

Commissioner: NHS England – New Patients Only

Mycophenolate Mofetil
BNF | BNFC | SPC

Commissioner: NHS England – New Patients Only

MHRA Drug Safety Update (Dec 2015): Mycophenolate mofetil, mycophenolic acid: new pregnancy-prevention advice for women and men

Mycophenolic Acid
BNF | BNFC | SPC

Commissioner: NHS England – New Patients Only

MHRA Drug Safety Update (Dec 2015): Mycophenolate mofetil, mycophenolic acid: new pregnancy-prevention advice for women and men

Sirolimus
BNF | BNFC | SPC

Commissioner: NHS England – New Patients Only

Tacrolimus
BNF | BNFC | SPC

Commissioner: NHS England – New Patients Only

Everolimus
BNF | BNFC | SPC

Commissioner: NHS England– Not Routinely Commissioned NICE TA348

Aldesleukin
BNF | BNFC | SPC

NHS England - not routinely commissioned

Interferon Alfa-2b
BNF | BNFC | SPC

10 mega units & 30 mega units multidose pen injections

BCG Connaught
BNF | BNFC | SPC

81mg vial for bladder instillation

Lenalidomide▼
BNF | BNFC | SPC

Capsules - 5mg, 10mg, 15mg, 25mg

Commissioner: NHS England - Only when used in line with a current chemotherapy protocol from the North of England Cancer Network in line with the appropriate Network Site Specific Group’s clinical guidelines or chemotherapy algorithm and is used in line with NICE TA171, NICE TA 322 or when funded via the Cancer Drug Fund.

See Letter Sent to Healthcare Professionals (Nov 2016): Lenalidomide (Revlimid®▼): New important advice regarding viral reactivation

Thalidomide
BNF | BNFC | SPC

50mg capsules

Only when used in line with a current chemotherapy protocol from the North of England Cancer Network in line with the appropriate Network Site Specific Group’s clinical guidelines or chemotherapy algorithm.

NICE TA228

Commissioner: NHS England - NICE TA228

MHRA Drug Safety Update (Dec 2015): Thalidomide: reduced starting dose in patients older than age 75 years

See Letter Sent to Healthcare Professionals (June 2016) - Thalidomide Celgene: risks of viral reactivation and pulmonary hypertension associated with Thalidomide (Celgene)

Mifamurtide
BNF | BNFC | SPC

4mg vial

Tertiary centre only

NICE TA235

Nivolumab▼
BNF | BNFC | SPC

10mg in 1ml concentrate for IV infusion (4ml & 10ml vials)

Commissioner: NHS England - Only when used in line with a current chemotherapy protocol from the North of England Cancer Network in line with the appropriate Network Site Specific Group’s clinical guidelines or chemotherapy algorithm and is used in line with NICE TA384 or NICE TA400 or NICE TA417  OR if indication funded from the Cancer Drugs Fund.

Talimogene Laherparepvec
BNF | BNFC | SPC

Commissioner: NHS England - Only when used in line with a current chemotherapy protocol from the North of England Cancer Network in line with the appropriate Network Site Specific Group’s clinical guidelines or chemotherapy algorithm and is used in line with NICE TA410

Treatment via tertiary centres.

Teriflunomide▼
BNF | BNFC | SPC

14mg film coated tablets

Commissioner: NHS England – tertiary centre only NICE TA303

Natalizumab▼
BNF | BNFC | SPC

300mg in 15ml (20mg/ml) vial for preparing infusions

Commissioner: NHS England - NICE TA127, Policy - D04/P/a

MHRA Drug Safety Update (April 2016): Natalizumab (Tysabri▼): progressive multifocal leukoencephalopathy—updated advice to support early detection

Dimethyl Fumarate
BNF | BNFC | SPC

120mg and 240mg capsules

Commissioner: NHS England in line with NICE TA320 – tertiary centre only

MHRA Drug Safety Update (March 2015): Dimethyl fumarate (Tecfidera): fatal PML in an MS patient with severe, prolonged lymphopenia

MHRA Drug Safety Update (April 2016): Dimethyl fumarate (Tecfidera): updated advice on risk of progressive multifocal leukoencephalopathy

Fingolimod▼
BNF | BNFC | SPC

500 microgram capsules

Commissioner: NHS England – Multiple Sclerosis - NICE TA254, Policy - D04/P/a - Tertiary centre only

See Letter Sent to Healthcare Professionals (Jan 2016) - Fingolimod (▼Gilenya): risks related to effects on the immune system.

See Letter Sent to Healthcare Professionals (April 2015) - Fingolimod (▼Gilenya): first reported case of progressive multifocal leukoencephalopathy (PML) in a multiple sclerosis patient taking Fingolimod without previous treatment with natalizumab or other immunosuppressive medicines

MHRA Drug Safety Update (April 2016): Fingolimod (Gilenya▼): risks of progressive multifocal leukoencephalopathy, basal-cell carcinoma, and opportunistic infections

MHRA Drug Safety Alert (April 2017): Multiple sclerosis therapies: signal of rebound effect after stopping or switching therapy

Glatiramer
BNF | BNFC | SPC

20mg prefilled syringe injection

Commissioner: NHS England - NICE TA32, Policy - D04/P/a

Interferon Beta-1a
BNF | BNFC | SPC

30 microgram (6 million units) prefilled pen (Avonex)
22 microgram (6 million units) & 44 microgram (12 million
units injections -(Rebif), 1.5ml cartridges containing 22
microgram and 44 microgram per 0.5ml for use in
Rebismart injection device
20 microgram prefilled pen (Rebidose) - approved for use when
the cartridges and prefilled syringes are unsuitable.

Commissioner: NHS England - NICE TA32, Policy - D04/P/a

MHRA Alert (October 2014):  risk of thrombotic microangiopathy and risk of nephrotic syndrome.

Peg Interferon Alfa-1a
BNF | BNFC | SPC

125 microgram pre-filled pen (Plegridy)

Interferon Alfa-1b
BNF | BNFC | SPC

Vials for preparing 750 microgram in 3ml injection
(Betaferon)
Vials for preparing 250 microgram in 1ml injection (Extavia)

Commissioner: NHS England - NICE TA32, Policy - D04/P/a

MHRA Alert (October 2014):  risk of thrombotic microangiopathy and risk of nephrotic syndrome.

Daclizumab▼
BNF | BNFC | SPC

150mg solution for injection

Commissioner: NHS England – Multiple Sclerosis - NICE TA441 - Tertiary centre only

Interferon Alfa-2b
BNF | BNFC | SPC

10 mega units & 30 mega units multidose pen injections

Commissioner: NHS England - NICE TA75

Peg Interferon Alfa-2a
BNF | BNFC | SPC

135 & 180 microgram injections in prefilled syringes & 135
&180 microgram prefilled pens

Commissioner: NHS England - NICE TA75, NICE TA96, NICE TA106, NICE TA200, NICE CG165

Peg Inteferon Alfa-2b
BNF | BNFC | SPC

50, 80, 100, 120, & 150 microgram prefilled inj pens

Aapproved for chronic hepatitis C as for peginterferon alfa 2a.

Canakinumab▼
BNF | BNFC | SPC

Commissioner: NHS England - via Specialist Services only

Canakinumab▼
BNF | BNFC | SPC

NHS England - not routinely commissioned.

Medroxyprogesterone Acetate
BNF | BNFC | SPC

100mg & 200mg tablets
500mg in 2.5ml injections

Specialist initiation Only

Megestrol Acetate
BNF | BNFC | SPC

Tablets - 160mg

Norethisterone
BNF | BNFC | SPC

5mg tablets

NICE TA112

Anastrozole
BNF | BNFC | SPC

Tablets - 1mg

Exemestane
BNF | BNFC | SPC

Tablets - 25mg

Letrozole
BNF | BNFC | SPC

Tablets - 2.5mg

Tamoxifen
BNF | BNFC | SPC

Tablets - 20mg

Fulvestrant
BNF | BNFC | SPC

250mg in 5ml (50mg/ml) injection in a prefilled syringe

Raloxifene
BNF | BNFC | SPC

Raloxifene 60mg tablets

NICE CG175: Prostate Cancer diagnosis & treatment

First Choice
Clinicians are encouraged to prescribe the least expensive product that is clinically
appropriate

Abiraterone Acetate
BNF | BNFC | SPC

Tablets - 250mg

Commissioner: NHS England - Only when used in line with a current chemotherapy protocol from the North of England Cancer Network in line with the appropriate Network Site Specific Group’s clinical guidelines or chemotherapy algorithm and funded from the Cancer Drug Fund.  NICE TA259 NICE TA387

Goserelin
BNF | BNFC | SPC

Implant - 3.6mg and 10.8mg

 

Bicalutamide
BNF | BNFC | SPC

Tablets - 50mg, 150mg

Cyproterone
BNF | BNFC | SPC

Tablets - 50mg

Flutamide
BNF | BNFC | SPC

Tablets - 250mg

Degarelix
BNF | BNFC | SPC

Injection - 80mg, 120mg

Approved for the first line treatment of advanced hormone dependant prostate cancer with a PSA > 20ng/l at presentation.

See also NICE TA404

Leuprorelin Acetate
BNF | BNFC | SPC

Injection - 3.75mg, 11.25mg

 

Enzalutamide▼
BNF | BNFC | SPC

40mg capsules

Commissioner: NHS England - Only when used in line with a current chemotherapy protocol from the North of England Cancer Network in line with the appropriate Network Site Specific Group’s clinical guidelines or chemotherapy algorithm and funded from the Cancer Drug Fund.  NICE TA316, NICE TA377

Triptorelin
BNF | BNFC | SPC

1st choice

3mg, 11.25mg and 22.5mg IM injection

Lanreotide Acetate
BNF | BNFC | SPC

30mg long-acting injection
60mg, 90mg & 120mg autogel injections

 

Octreotide
BNF | BNFC | SPC

50, 100 & 500 microg. in 1ml & 1mg in 5ml injections
10mg, 20mg & 30mg long-acting injections

Pasireotide▼
BNF | BNFC | SPC

Cushing's Disease

NHS England – Not routinely commissioned

Octreotide - palliative care use
BNF | BNFC | SPC

50, 100 & 500 microg. in 1ml & 1mg in 5ml injections

To be used on advice of palliative care team as per indications in Palliative Care Formulary.

Diethylstilbestrol (Stilboestrol)
BNF | BNFC | SPC

1mg tablets

Initiated with specialist advice.