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

OR

In accordance with the following NICE TA

TA216: Bendamustine for the first-line treatment of chronic lymphocytic leukaemia

Also approved for use in treatment of low grade lymphomas, mantle cell NHL or relapsed multiple myeloma funded from the Cancer Drugs Fund.

MHRA Drug Safety Update (July 2017):  Bendamustine (Levact): increased mortality observed in recent clinical studies in off-label use; monitor for opportunistic infections, hepatitis B reactivation

 

Busulfan
BNF | BNFC | SPC

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

Commissioner: NHS England

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


Bladder Installation
Commissioner: NHS England 

Only to be used in line with a current chemotherapy protocol from the North of England Cancer Alliance 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 to be used in line with a current chemotherapy protocol from the North of England Cancer Alliance 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 to be used in line with a current chemotherapy protocol from the North of England Cancer Alliance 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 to be used in line with a current chemotherapy protocol from the North of England Cancer Alliance 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 to be used in line with a current chemotherapy protocol from the North of England Cancer Alliance 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 – Multiple Sclerosis - as per NICE TA493

NHS England - not routinely commissioned - 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.

MHRA Drug Safety Alert (Dec 2017):  Cladribine (Litak, Leustat) for leukaemia: reports of progressive multifocal encephalopathy (PML); stop treatment if PML suspected 

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 to be used in line with a current chemotherapy protocol from the North of England Cancer Alliance 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 to be used in line with a current chemotherapy protocol from the North of England Cancer Alliance 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 to be used in line with a current chemotherapy protocol from the North of England Cancer Alliance 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 TA116NICE NG85, 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 to be used in line with a current chemotherapy protocol from the North of England Cancer Alliance 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 to be used in line with a current chemotherapy protocol from the North of England Cancer Alliance 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 to be used in line with a current chemotherapy protocol from the North of England Cancer Alliance in line with the appropriate Network Site Specific Group’s clinical guidelines or chemotherapy algorithm.

Trifluridine-tipiracil
BNF | BNFC | SPC

Commissioner: NHS England 

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

Approved for use in accordance with the following NICE TA:

NICE TA476: as a treatment option for untreated metastatic adenocarcinoma of the pancreas in adults, under the conditions specified within the TA

Not approved in accordance with the following NICE TA:

TA362: as a treatment option for adults with untreated non‑small‑cell lung cancer when potentially curative surgery or radiation therapy or both are unsuitable.

Afatinib▼
BNF | BNFC | SPC

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

Commissioner: NHS England

Approved for use in accordance with the following NICE TA

NICE TA310: as a treatment option in adults with locally advanced or metastatic non-small-cell lung cancer only if:

  • the tumour tests positive for the epidermal growth factor receptor tyrosine kinase (EGFR-TK) mutation and
  • the person has not previously had an EGFR-TK inhibitor and
  • the manufacturer provides afatinib with the discount agreed in the patient access scheme.
Aflibercept▼
BNF | BNFC | SPC

Commissioner: NHS England

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

Not approved in accordance with the following NICE TA:

NICE TA307: as a treatement option in combination with irinotecan and fluorouracil for metastatic colorectal cancer that is resistant to or has progressed after an oxaliplatin-containing regimen.

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

Approved for use in accordance with the following NICE TA:

NICE TA333: as a treatment option for adults with advanced renal cell carcinoma after failure of treatment with a first‑line tyrosine kinase inhibitor or a cytokine, only if the company provides axitinib with the discount agreed in the patient access scheme.

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

Blinatumomab▼
BNF | BNFC | SPC

38.5 micrograms powder for concentrate and solution for solution for infusion.

Commissioner: NHS England

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

OR

in accordance with following NICE TA

NICE TA450as a treatment option for Philadelphia-chromosome-negative relapsed or refractory precursor B-cell acute lymphoblastic leukaemia in adults, only if the company provides it with the discount agreed in the patient access scheme.

 

Bortezomib
BNF | BNFC | SPC

3.5mg injection

Commissioner: NHS England

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

Approved for use in accordance with the following NICE TAs OR if indication funded from the Cancer Drugs Fund :

  • NICE TA228: in combination with an alkylating agent and a corticosteroid as a treatment option for the first-line treatment of multiple myeloma under the circumstances specified within the TA
  • NICE TA129as a treatment option for progressive multiple myeloma in people who are at first relapse having received one prior therapy and who have undergone, or are unsuitable for, bone marrow transplantation, under the circumstances specified within the TA.
  • NICE TA311: as an induction treatment option in combination with dexamethasone, or with dexamethasone and thalidomide, in adults with previously untreated multiple myeloma, who are eligible for high-dose chemotherapy with haematopoietic stem cell transplantation.
  • NICE TA370: as a treatment option for previously untreated mantle cell lymphoma in adults for whom haematopoietic stem cell transplantation is unsuitable
Bosutinib▼
BNF | BNFC | SPC

Commissioner: NHS England

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

Approved for use in accordance with the following NICE TAs OR if indication funded from the Cancer Drugs Fund :

NICE TA401: as a treatment option for chronic, accelerated and blast phase Philadelphia chromosome positive chronic myeloid leukaemia in adults, when:

  • they have previously had 1 or more tyrosine kinase inhibitor and
  • imatinib, nilotinib and dasatinib are not appropriate and
  • the company provides bosutinib with the discount agreed in the patient access scheme (as revised in 2016).

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

Brentuximab▼
BNF | BNFC | SPC

Commissioner: NHS England

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

Approved for use in accordance with the following NICE TAs OR if indication funded from the Cancer Drugs Fund:

NICE TA446: as a treatment option for CD30-positive Hodgkin lymphoma in adults under the conditions specified within the TA.

NICE TA478: as a treatment option for relapsed or refractory systemic anaplastic large cell lymphoma in adults under the conditions specified within the TA.

Cabazitaxel
BNF | BNFC | SPC

40mg/1ml concentrate for IV infusion

Commissioner: NHS England

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

Approved for use in accordance with the following NICE TA

NICE TA391: as a treatment option in combination with prednisone or prednisolone for metastatic hormone‑relapsed prostate cancer in people whose disease has progressed during or after docetaxel chemotherapy under the circumstances specified within the TA.

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

Cabozantinib
BNF | BNFC | SPC

20mg, 40mg and 60mg tablets

Commissioner: NHS England

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

Approved for use in accordance with the following NICE TA

NICE TA463: as a treatment option for treating advanced renal cell carcinoma in adults after vascular endothelial growth factor (VEGF)-targeted therapy, only if the company provides cabozantinib with the discount agreed in the patient access scheme.

Carboplatin
BNF | BNFC | SPC

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

Commissioner: NHS England      

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

Carflizomib▼
BNF | BNFC | SPC

10 mg powder for solution for infusion
30 mg powder for solution for infusion
60 mg powder for solution for infusion

Commissioner: NHS England

Approved for use in accordance with the following NICE TA

NICE TA457: as a treatment option in combination with dexamethasone for multiple myeloma in adults under the circumstances specified within the TA

 

Ceritinib▼
BNF | BNFC | SPC

150mg capsule

Commissioner: NHS England

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

Approved for use in accordance with the following NICE TAs

NICE TA395:  as a treatment option for advanced anaplastic lymphoma kinase positive non‑small‑cell lung cancer in adults who have previously had crizotinib.only if the company provides it with a discount agrees in patient access scheme

NICE TA500: as a treatment option for untreated anaplastic lymphoma kinase (ALK)‑positive advanced non-small-cell lung cancer in adults, only if the company provides it with the discount agreed in the patient access scheme.

Cetuximab
BNF | BNFC | SPC

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

Commissioner: NHS England

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

Approved for use in accordance with the following NICE TAs

  • NICE TA145: as a treatment option in combination for radiotherapy for locally advanced squamous cell cancer of head and neck in patients who have a Karnofsky performance status of 90% or greater and when all forms of platinum based chemoradiotherapy are contraindicated. Patients are referred to tertiary centre for treatment
  • NICE TA439: as a treatment option for previously untreated EGFR-expressing, RAS wild-type metastatic colorectal cancer in combination with FOLFOX or FOLFIRI regimes only if companies provide them with discount under the commercial access scheme.
  • NICE TA473:  as a treatment option in combination with platinum-based chemotherapy for recurrent or metastatic squamous cell cancer of head and neck under conditions specified within the TA.

Not approved for use in accordance with the following NICE TA

NICE TA242: as a treatment option for monotherapy or combination therapy for metastatic colorectal cancer that has progressed after first-line chemotherapy.

MHRA Alerts

  • May 2012: Risk of keratitis and ulcerative keratitis.
  • February 2014: Importance of determining RAS mutation status in metastatic colorectal cancer
Cisplatin
BNF | BNFC | SPC

50mg in 50mL injection

Commissioner: NHS England

 

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

Cobimetinib
BNF | BNFC | SPC

Commissioner: NHS England

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

Not approved for use in accordance with the following NICE TA

NICE TA414: as a treatment option for unresectable or metastatic melanoma in adults with a BRAF V600 mutation.

Crizotinib▼
BNF | BNFC | SPC

Commissioner: NHS England

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

Approved for use in accordance with the following NICE TAs

  • NICE TA406: as a treatment option for untreated anaplastic lymphoma kinase-positive advanced non-small-cell lung cancer in adults only if the company provides it with the discount agreed in the patient access scheme.
  • NICE TA422: as a treatment option for previously treated anaplastic lymphoma kinase-positive advanced non-small-cell lung cancer in adults only if the company provides it with the discount agreed in the patient access scheme.

MHRA Alerts

November 2015: Risk of cardiac failure

Dacarbazine
BNF | BNFC | SPC

500mg injection

Commissioner: NHS England

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

Dasatinib
BNF | BNFC | SPC

Commissioner: NHS England

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

Approved for use in accordance with the following NICE TAs or in indication funded from Cancer Drugs Fund:              

  • NICE TA425: as a treatment option for chronic or accelerated phase Philadelphia-chromosome-positive CML in adults, if they cannot have imatinib, or their disease is imatinib-resistant and the manufacturer provides dasatinib with the discount agreed in the patient access scheme.
  • NICE TA426: as a treatment option for chronic phase Philadelphia-chromosome-positive CML, only if the manufacturer provides it with the discount agreed in the patient access scheme.

MHRA Alerts

May 2016: BCR-ABL tyrosine kinase inhibitors: risk of hepatitis B reactivation

 

Docetaxel
BNF | BNFC | SPC

20mg & 80mg injections

Commissioner: NHS England

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

Approved for use in accordance with the following NICE TAs

  • NICE TA101: as a treatment option for hormone-refractory metastatic prostate cancer only if the Karnofsky performance-status score is at least 60%
  • NICE TA109: as a treatment option in combination with doxorubicin and cyclophosphamide for adjuvant treatment of women with early node-positive breast cance
Erbulin
BNF | BNFC | SPC

Commissioner: NHS England

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

Approved for use in accordance with the following NICE TA or if indication funded through Cancer Drugs Fund

NICE TA423: as a treatment option for locally advanced or metastatic breast cancer under the conditions specified within the TA

Not approved for use in accordance with the following NICE TA

NICE TA515: as a treatment option for locally advanced or metastatic breast cancer in adults who have had only 1 chemotherapy regimen

Erlotinib
BNF | BNFC | SPC

25mg, 100mg & 150mg tablets

Commissioner: NHS England

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

Approved for use in accordance with the following NICE TAs

  • NICE TA258: as a treatment option for first-line treatment of people with locally advanced or metastatic non-small cell lung cancer (NSCLC) under the conditions specified within the TA.
  • NICE TA374: as a treatment option for locally advanced or metastatic non‑small‑cell lung cancer that has progressed after non‑targeted chemotherapy in patients with tumours of unknown epidermal growth factor receptor tyrosine kinase (EGFR‑TK) mutation status, only if all of the criteria specified within the TA are met

Not approved for use in accordance with the following NICE TA

NICE TA227: as a maintenance treatment option in people with locally advanced or metastatic non-small-cell lung cancer who have stable disease after platinum-based first-line chemotherapy

Roche Healthcare Professional Letter (January 2016): Tarceva® (erlotinib): First line maintenance indication now restricted to treatment of patients whose tumors harbor an EGFR-activating mutation

Everolimus
BNF | BNFC | SPC

Commissioner: NHS England

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

Approved for use in accordance with the following NICE TAs 

  • NICE TA421: as a treatment option in combination with exemestane for advanced human epidermal growth factor receptor 2 (HER2)-negative, hormone-receptor-positive breast cancer in postmenopausal women without symptomatic visceral disease that has recurred or progressed after a non-steroidal aromatase inhibitor. Condition of discount in accordance with local access schemes as specified within the TA applies.
  • NICE TA432: as a treatment option for advanced renal cell carcinoma that has progressed during or after treatment with vascular endothelial growth factor targeted therapy, only if the company provides it with the discount agreed in the patient access scheme.
  • NICE TA449: as a treatment option for the indications specified within the TA only when the company provides it with discount agreed in the patient access scheme.
  • NICE TA498: as a treatment option along with lenvatinib for advanced renal cell carcinoma in adults who have had 1 previous vascular endothelial growth factor (VEGF)-targeted therapy, only if their Eastern Cooperative Oncology Group (ECOG) performance status score is 0 or 1 and the company provides lenvatinib with the discount agreed in the patient access scheme.

Everolimus for the following indications is not routinely commissioned by NHS England

  • Preventing organ rejection in liver transplantation
  • Preventing organ rejection in heart transplantation
Gefitinib
BNF | BNFC | SPC

250mg tablets

Commissioner: NHS England once if used in accordance with NICE TA192

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

Approved for use in accordance with the following NICE TA

NICE TA192: as a first-line treatment option for locally advanced or metastatic non-small-cell lung cancer (NSCLC) if the conditions specified within the TA are met.

Not approved for use in accordance with the following NICE TA

NICE TA374: as a treatment option for locally advanced or metastatic non‑small‑cell lung cancer that has progressed after non‑targeted chemotherapy in people with tumours that are EGFR‑TK mutation‑positive.

Hydroxycarbamide
BNF | BNFC | SPC

500mg capsules

500mg in 5ml suspension u

Commissioner: NHS England

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

Approved for use in accordance with the following NICE TAs or if indication funded from the Cancer Drugs Fund 

  • NICE TA429: as atreatment option for chronic lymphocytic leukaemia in adults with 17p deletion or TP53 mutation under the conditions specified within the TA
  • NICE TA491: as a treatment option for Waldenstrom’s macroglobulinaemia in adults under the conditions specified within the TA. This indication is funded through Cancer Drugs Fund.
  • NICE TA502: as an option for treating relapsed or refractory mantle cell lymphoma in adults under the conditions specified within the TA.

 

Not approved for use in accordance with the following NICE TAs 

  • NICE TA437: as a treatment option with bendamustine and rituximab for relapsed or refractory chronic lymphocytic leukaemia after systemic therapy. NICE unable to make a recommendation as no eveidence submission was received from Jannssen-Cilag.
  • NICE TA452: as a treatment option for untreated chronic lymphocytic leukaemia without a 17p deletion or TP53 mutation because no evidence submission was received from Janssen–Cilag. The company has confirmed that it does not intend to make a submission.

MHRA Drug Safety Update (August 2017): Ibrutinib (Imbruvica▼): reports of ventricular tachyarrhythmia; risk of hepatitis B reactivation and of opportunistic infections

Idelalisib▼
BNF | BNFC | SPC

100mg & 150mg film coated tablets

Commissioner: NHS England

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

Approved for use in accordance with the following NICE TA

NICE TA359: as a treatment option with rituximab for the following indications only if the company provides the drug with discount agreed in the simple discount agreement

  • Untreated chronic lymphocytic leukaemia in adults with a 17p deletion or TP53 mutation
  • chronic lymphocytic leukaemia in adults when the disease has been treated but has relapsed within 24 months.

Not approved for use in accordance with the following NICE TAs

  • NICE TA328: as a treatment option for follicular lymphoma that is refractory to 2 prior lines of treatment because no evidence submission was received from Gilead Sciences.
  • NICE TA469: as a treatment option with ofatumumab for chronic lymphocytic leukaemia because no evidence submission was received from Gilead Sciences.

MHRA Alerts

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 (September 2016): Idelalisib (Zydelig▼): updated indications and advice on minimising the risk of infection  

Imatinib▼
BNF | BNFC | SPC

100mg & 400mg capsules

Commissioner: NHS England

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

Approved for use in accordance with the following NICE TAs

  • NICE TA70: as a treatment option for the following groups of patients:

          Philadelphia-chromosome-positive chronic myeloid leukaemia (CML) who initially present in the accelerated phase or           with blast crisis.

          Philadelphia-chromosome-positive chronic myeloid leukaemia (CML) who initially present in the chronic phase and               then progress to accelerated phase or blast crisis if they have not received imatinib before.

  • NICE TA86: as a treatment option for KIT (CD117)-positive unresectable and/or KIT (CD117)-positive metastatic gastro-intestinal stromal tumours (GISTs) under the conditions specified within the TA.
  • NICE TA326: as a treatment option for adjuvant treatment for up to 3 years for adults who are at high risk of relapse after surgery for KIT (CD117)‑positive gastrointestinal stromal tumours, as defined by the Miettinen 2006 criteria[1] (based on tumour size, location and mitotic rate).
  • NICE TA426: as a treatment option for untreated, chronic-phase Philadelphia-chromosome-positive chronic myeloid leukaemia in adults.

 

Not recommended for use in accordance with the following NICE TAs

  • NICE TA209: as a treatment option (600mg or 800mg per day dose) for unresectable and/or metastatic gastrointestinal stromal tumours whose disease has progressed after treatment with 400 mg per day imatinib.
  • NICE TA425: as a high dose (600mg in chronic phase and 800mg in accelerated and blast-crisis phases) treatment option for Philadelphia-chromosome-positive chronic myeloid leukaemia in adults whose disease is imatinib-resistant.

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

Approved in accordance with the following NICE TAs

NICE TA268: as a treatment option for advanced (unresectable or metastatic) melanoma in people who have received prior therapy, only if the manufacturer provides ipilimumab with the discount agreed in the patient access scheme. Patient are referred to tertiary centre for treatment.

NICE TA319: as a treatment option for previously untreated advanced (unresectable or metastatic) melanoma, only if the manufacturer provides ipilimumab with the discount agreed in the patient access scheme. Patients are referred to tertiary centre for treatment.

NICE TA400: as a treatment option with nivolumab for advanced (unresectable or metastatic) melanoma in adults, only when the company provides ipilimumab with the discount agreed in the patient access scheme. Patients are referred to tertiary centre for treatment.

MHRA Drug Safety Update (July 2017): Nivolumab (Opdivo▼), pembrolizumab (Keytruda▼): reports of organ transplant rejection

Related NICE guidance: NG14: Melanoma: assessment and management

Irinotecan
BNF | BNFC | SPC

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

Commissioner: NHS England

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

Irinotecan peglylated liposomal
BNF | BNFC | SPC

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

Not approved as per NICE TA440

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.

Lenvatinib▼ (Kisplyx)
BNF | BNFC | SPC

4mg and 10mg capsules

Commissioner: NHS England

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

Approved for use in accordance with the following NICE TA

NICE TA498:  as a treatment option along with everolimus for advanced renal cell carcinoma in adults who have had 1 previous vascular endothelial growth factor (VEGF)-targeted therapy, under the conditions specified within the TA.

Necitumumab
BNF | BNFC | SPC

Not approved for use in accordance with the following NICE TA

NICE TA411: as a treatment option along with gemcitabine for locally advanced or metastatic epidermal growth factor receptor (EGFR)-expressing squamous non-small-cell lung cancer that has not been treated with chemotherapy in adults.

Nilotinib
BNF | BNFC | SPC

150mg & 200mg capsules

Commissioner: NHS England

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

Approved for use in accordance with the following NICE TAs

  • NICE TA425: as a treatment option along with dasatinib for chronic- or accelerated-phase Philadelphia-chromosome-positive chronic myeloid leukaemia in adults, under the conditions specified within the TA
  • NICE TA426: as a treatment option along with dasatinib for untreated chronic-phase Philadelphia-chromosome-positive chronic myeloid leukaemia in adults only if the companies provide them with the discounts agreed in the relevant patient access schemes.

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

Approved for use in accordance with the following NICE TAs

NICE TA347: as a treatment option in combination with docetaxel for locally advanced, metastatic or locally recurrent non‑small‑cell lung cancer of adenocarcinoma histology that has progressed after first‑line chemotherapy, only if the company provides nintedanib with the discount agreed in the patient access scheme.

Also approved for use in idiopathic pulmonary fibrosis in accordance with the following TA.

Commissioned by NHS England

NICE TA379: as a treatment option for idiopathic pulmonary fibrosis under the conditions specified within the TA.

Olaparib▼
BNF | BNFC | SPC

50mg capsules

Commissioner: NHS England

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

Approved for use in accordance with the following NICE TA

NICE TA381: as a treatment option for adults with relapsed, platinum sensitive ovarian, fallopian tube or peritoneal cancer who have BRCA1 or BRCA2 mutations and whose disease has responded to platinum based chemotherapy under the conditions specified within the TA.

 

Olaratumab
BNF | BNFC | SPC

10mg/ml concentrate for infusion

Commissioner: NHS England (Cancer Drugs Fund)

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

Approved for use in accordance with the following NICE TA. Indication funded from Cancer Drugs Fund

NICE TA465: as a treatment option in combination with doxorubicin for advanced soft tissue sarcoma in adults, under the conditions specified within the TA

Osimertinib
BNF | BNFC | SPC

Commissioner: Cancer Drugs Fund

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

Approved for use in accordance with the following NICE TA. Indication funded from Cancer Drugs Fund

NICE TA416: as a treatment option for locally advanced or metastatic epidermal growth factor receptor (EGFR) T790M mutation-positive non-small-cell lung cancer in adults whose disease has progressed under the conditions specified within the TA.

Oxaliplatin
BNF | BNFC | SPC

50mg & 100mg injections

Commissioner: NHS England  

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

Approved for use in accordance with the following NICE TAs.

NICE TA100: as an adjuvant treatment option in combination with 5-flurouracil and folinic acid for stage III (Dukes' C) colon cancer following surgery for the condition.

 

Paclitaxel
BNF | BNFC | SPC

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

Commissioner: NHS England

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

Approved for use in accordance with the following NICE TAs.

  • NICE TA55: as an alternative treatment option to first-line chemotherapy for ovarian cancer in combination with a platinum-based compound (cisplatin or carboplatin) (usually following surgery)
  • NICE TA389: as a monotherapy treatment option or in combination with platinum for recurrent ovarian cancer
Palbociclib▼
BNF | BNFC | SPC

75mg, 100mg and 125mg capsules 

Commissioner: NHS England

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

Approved for use in accordance with the following NICE TA

NICE TA495: as a treatment option in combination with aromatase inhibitor for hormone receptor-positive, human epidermal growth factor receptor 2-negative, locally advanced or metastatic breast cancer as initial endocrine-based therapy in adults only if the company provides it with the discount agreed in the patient access scheme.

Panitumumab
BNF | BNFC | SPC

20mg/ml injection

Commissioner: NHS England

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

Approved for use in accordance with the following NICE TA

NICE TA439: as a treatment option for previously untreated RAS wild-type metastatic colorectal cancer in adults in combination with FOLFOX or FOLFIRI only when the companies provide them with the discount agreed in the patient access scheme

MHRA Alerts

Panobinostat▼
BNF | BNFC | SPC

10mg, 15mg and 20mg hard capsules

Commissioner: NHS England

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

Approved for use in accordance with the following NICE TA

NICE TA380: as a treatment option in combination with bortezomib and dexamethasone for relapsed or refractory multiple myeloma in patients who have received at least 2 prior regimens including bortezomib and an immunomodulatory agent when the manufacturer provides panobinostat with the discount agreed in the patient access scheme.

Pazopanib
BNF | BNFC | SPC

200mg & 400mg tablets

Commissioner: NHS England

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

Approved for use in accordance with the following NICE TA

NICE TA215: as a first-line treatment option for advanced renal cell carcinoma under the conditions specified within the TA.

Pegaspargase
BNF | BNFC | SPC

Commissioner: NHS England

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

Approved for use in accordance with the following NICE TA

NICE TA408: as part of antineoplastic combination therapy for treating acute lymphoblastic leukaemia only in patients with untreated newly diagnosed disease.

 

Pembrolizumab▼
BNF | BNFC | SPC

50mg vial for preparing IV infusion

Commissioner: NHS England

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

Approved for use in accordance with the following NICE TAs OR if indication funded from Cancer Drugs Fund

  • NICE TA357: as a treatment option for advanced (unresectable or metastatic) melanoma in adults under conditions specified within the TA
  • NICE TA366: as a treatment option for advanced (unresectable or metastatic) melanoma that has not been previously treated with ipilimumab, in adults, only when the company provides pembrolizumab in line with the commercial access agreement with NHS England.
  • NICE TA428: as a treatment option for locally advanced or metastatic PD‑L1‑positive non‑small‑cell lung cancer in adults who have had at least one chemotherapy (and targeted treatment if they have an epidermal growth factor receptor [EGFR]- or anaplastic lymphoma kinase [ALK]‑positive tumour), under conditions specified within the TA
  • NICE TA447: as a treatment option for ntreated PD-L1-positive metastatic non-small-cell lung cancer in adults, under conditions specified within the TA.

 

MHRA Drug Safety Update (July 2017): Nivolumab (Opdivo▼), pembrolizumab (Keytruda▼): reports of organ transplant rejection

Pentostatin
BNF | BNFC | SPC

Commissioner: NHS England

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

Pertuzumab▼
BNF | BNFC | SPC

Commissioner: NHS England

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

Approved for use in accordance with the following NICE TAs

  • NICE TA424: as a treatment option in combination with trastuzumab and chemotherapy for neoadjuvant treatment of adults with human epidermal growth factor receptor 2 (HER2)‑positive breast cancer; that is, in patients with HER2-positive, locally advanced, inflammatory or early-stage breast cancer at high risk of recurrence only if the company provides pertuzumab with the discount agreed in the patient access scheme.
  • NICE TA509: as a treatment option in combination with trastuzumab and docetaxel for HER2‑positive metastatic or locally recurrent unresectable breast cancer, in adults who have not had previous anti‑HER2 therapy or chemotherapy for their metastatic disease, only if the company provides pertuzumab within the agreed commercial access arrangement
Pomalidomide
BNF | BNFC | SPC

Commissioner: NHS England

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

Approved for use in accordance with the following NICE TA

NICE TA427: as a treatment option with low-dose dexamethasone for multiple myeloma in adults at third or subsequent relapse; that is, after 3 previous treatments including both lenalidomide and bortezomib, only when the company provides pomalidomide with the discount agreed in the patient access scheme.

Ponatinib▼
BNF | BNFC | SPC

Commissioner: NHS England

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

Approved for use in accordance with the following NICE TA

NICE TA451: as a treatment options for chronic-, accelerated or blast-phase chronic myeloid leukaemia and Philadelphia-chromosome-positive acute lymphoblastic leukaemia under conditions specified within the TA for each type of leukaemia.

MHRA Alerts

Procarbazine
BNF | BNFC | SPC

50mg capsules

Commissioner: NHS England

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

Approved for use in accordance with the following NICE TA or if indication funded from Cancer Drugs Fund

NICE TA412: as a treatment option for hormone-relapsed prostate cancer, symptomatic bone metastases and no known visceral metastases in adults, under conditions specified within the TA.

MHRA Drug Safety Update (December 2017): Radium-223 dichloride (Xofigo▼): do not use in combination with abiraterone and prednisone/prednisolone, following clinical trial signal of increased risk of death and fractures  

Ramucirumab▼
BNF | BNFC | SPC

Commissioner: NHS England (Not routinely commissioned)

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

Not approved for use in accordance with the following NICE TAs. Individual funding requests needed for commissioning

NICE TA378: as a treatment option in combination with paclitaxel for advanced gastric cancer or gastro–oesophageal junction adenocarcinoma previously treated with chemotherapy.

NICE TA403: as a treatment option in combination with docetaxel for locally advanced or metastatic non-small-cell lung cancer in adults whose disease has progressed after platinum-based chemotherapy

 

 

 

Regorafenib▼
BNF | BNFC | SPC

40mg tablets

Commissioner: NHS England

 

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

Approved for use in accordance with the following NICE TA

 

NICE TA488: as a treatment option for unresectable or metastatic gastrointestinal stromal tumours in adults whose disease has progressed on, or who are intolerant to, prior treatment with imatinib and sunitinib, under the conditions specified within the TA.

 

Not approved for use in accordance with the following NICE TAs

 

NICE TA334: as a treatment option for metastatic colorectal cancer  after treatment for metastatic disease as no evidence was received from Bayer.

 

NICE TA4514: as a treatment option for advanced unresectable hepatocellular carcinoma in adults who have had sorafenib.

 

 

 

Ribococlib▼
BNF | BNFC | SPC

200mg tablet

Commissioner: NHS England

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

Approved for use in accordance with the following NICE TA

NICE TA496: as a treatment option with an aromatase inhibitor for hormone receptor-positive, human epidermal growth factor receptor 2‑negative, locally advanced or metastatic breast cancer as initial endocrine-based therapy in adults. only if the company provides it with the discount agreed in the patient access scheme.

 

Ruxolitinib▼
BNF | BNFC | SPC

5mg, 15mg and 20mg tablets

Commissioner: NHS England

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

Approved for use in accordance with the following NICE TA

 

NICE TA386: as a treatment option for disease-related splenomegaly or symptoms in adults with primary myelofibrosis (also known as chronic idiopathic myelofibrosis), post polycythaemia vera myelofibrosis or post essential thrombocythaemia myelofibrosis, under conditions specified within the TA.

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

Commissioner: NHS England

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

Approved for use in accordance with the following NICE TA

 

NICE TA474: as a treatment option for dvanced hepatocellular carcinoma only for people with Child-Pugh grade A liver impairment, only if the company provides sorafenib within the agreed commercial access arrangement.

Streptozocin
BNF | BNFC | SPC

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

Commissioner: NHS England

 

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

Sunitinib
BNF | BNFC | SPC

12.5 mg, 25mg, 37.5mg and 50mg hard capsules

Commissioner: NHS England

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

Approved for use in accordance with the following NICE TAs

NICE TA169: as a first-line treatment option for advanced and/or metastatic renal cell carcinoma who are suitable for immunotherapy and have an Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1 under the conditions specified within the TA.

NICE TA179: as a treatment option for people with unresectable and/or metastatic malignant gastrointestinal stromal tumours under conditions specified within the TA.

NICE TA449: as a treatment option for well- or moderately differentiated unresectable or metastatic neuroendocrine tumours (NETs) of pancreatic origin in adults with progressive disease.

MHRA Drug Safety Update (January 2011): Bevacizumab and sunitinib: risk of osteonecrosis of the jaw.

Temsirolimus
BNF | BNFC | SPC

Commissioner: NHS England

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

Topotecan
BNF | BNFC | SPC

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

Commissioner: NHS England

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

Approved for use in accordance with the following NICE TAs

NICE TA183: as a treatment option in combination with cisplatin for recurrent or stage IVB cervical cancer only if they have not previously received cisplatin. Patients are referred to tertiary centre for treatment.

NICE TA184: as a oral treatment option for relapsed small-cell lung cancer under conditions specified within the TA

Not to be used in accordance with the following NICE TA

NICE TA389: as a treatment option for recurrent platinum‑resistant or platinum‑refractory ovarian cancer.

Trabectedin
BNF | BNFC | SPC

250microgram injection

Commissioner: NHS England

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

Approved for use in accordance with the following NICE TA

NICE TA185: as a treatment option for advanced soft tissue sarcoma under conditions specified within the TA. Patients are referred to tertiary centre for treatment.

Trametinib▼
BNF | BNFC | SPC

500microgram and 2mg film coated tablets

Commissioner: NHS England

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

Approved for use in accordance with the following NICE TA

NICE TA396: as a treatment option in combination with dabrafenib for unresectable or metastatic melanoma in adults with a BRAF V600 mutation only when the company provides trametinib and dabrafenib with the discounts agreed in the patient access schemes.

MHRA Drug Safety Update (May 2016): Trametinib (Mekinist▼): risk of gastrointestinal perforation and colitis.

Trastuzumab
BNF | BNFC | SPC

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

Commissioner: NHS England

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

Approved for use in accordance with the following NICE TAs

NICE TA34: as a treatment option for the following cancers under the conditions specified within the TA

  • In combination with paclitaxel for tumours expressing human epidermal growth factor receptor 2 (HER2) scored at levels of 3+
  • as monotherapy for tumours expressing HER2 scored at levels of 3+ who have received at least two chemotherapy regimens for metastatic breast cancer.

NICE TA107: as a treatment option for women with early-stage HER2-positive breast cancer following surgery, chemotherapy (neoadjuvant or adjuvant) and radiotherapy (if applicable) under conditions specified within the TA.

NICE TA208: as a treatment option for human epidermal growth factor receptor 2 (HER2)-positive metastatic adenocarcinoma of the stomach or gastro-oesophageal junction under conditions specified within the TA.

Trastuzumab Emtansine▼
BNF | BNFC | SPC

100 mg powder for concentrate for solution for infusion.
160 mg powder for concentrate for solution for infusion.

Commissioner: NHS England

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

Approved for use in accordance with the following NICE TA

NICE TA458: as a treatment option for human epidermal growth factor receptor 2 (HER2)‑positive, unresectable, locally advanced or metastatic breast cancer in adults under conditions specified within the TA.

Tretinoin
BNF | BNFC | SPC

10mg capsules

Commissioner: NHS England

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

Ventoclax▼
BNF | BNFC | SPC

10mg, 50mg and 100mg tablets

Commissioner: NHS England (Cancer Drugs Fund)

Only to be used in line with a current chemotherapy protocol from the North of England Cancer Alliance in line with the appropriate Network Site Specific Group’s clinical guidelines or chemotherapy algorithm. Indication funded via Cancer Drugs Fund

NICE TA487: as a treatment option for chronic lymphocytic leukaemia, that is, in adults under conditions specified within the TA.

 

Temozolomide
BNF | BNFC | SPC

NHS England – Not routinely commissioned

Protein kinase inhibitors
BNF | BNFC | SPC

NHS England – Not routinely commissioned

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

1400 mg solution for subcutaneous injection

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, NICE TA472 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

MHRA Drug Safety Alert (Nov 2017): Oral tacrolimus products: reminder to prescribe and dispense by brand name only

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 NICE TA481 and NICE TA482

 

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

NICE TA481 and NICE TA482

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

MHRA Drug Safety Alert (Nov 2017): Oral tacrolimus products: reminder to prescribe and dispense by brand name only

NICE TA481 and NICE TA482

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 NICE TA462  or NICE TA490 or NICE TA483 or NICE TA484 OR if indication funded from the Cancer Drugs Fund.

MHRA Drug Safety Update (July 2017): Nivolumab (Opdivo▼), pembrolizumab (Keytruda▼): reports of organ transplant rejection

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

Atezolizumab
BNF | BNFC | SPC

1.2g/2ml conc for soln 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 OR if indication funded from the Cancer Drugs Fund


NICE TA492

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

500mcg hard capsules

Commissioner – NHS England

Approved for use in accordance with the following NICE TA

NICE TA254: as a treatment option for highly active relapsing–remitting multiple sclerosis in adults under conditions specified within the TA.

Also approved for use in accordance with NHS England Policy NHS ENGLAND / D04/P/b for management of multiple sclerosis within a tertiary centre.

MHRA Drug Alerts and Safety Updates

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

Letter sent to healthcare professionals (January 2016): Fingolimod (Gilenya▼): risks related to effects on the immune system

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

Drug Safety Update April 2017: Multiple sclerosis therapies: signal of rebound effect after stopping or switching therapy

Drug Safety Update December 2017: Fingolimod (Gilenya▼): new contraindications in relation to cardiac risk

Drug Safety Update December 2017: Fingolimod (Gilenya▼): updated advice about risk of cancers and serious infections

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

 

MHRA Drug Safety Update (March 2018): Daclizumab (Zinbryta▼): suspension and recall for safety reasons; review patients as soon as possible and start alternative therapy

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

Not approved as per NICE TA503

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

MHRA Drug Safety Alert (Feb 2015): Drugs and driving: blood concentration limits set for certain drugs

See letter sent to healthcare professionals in August 2017: Decapeptyl SR (Triptorelin) 11.25 mg: change in salt

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.

Etelcalcetide▼
BNF | BNFC | SPC

2.5 mg/0.5ml, 5mg/1ml and 10mg/2ml solution for injection

To be used as per NICE TA448 for treating secondary hyperparathyroidism in adults with chronic kidney disease on haemodialysis.

Diethylstilbestrol (Stilboestrol)
BNF | BNFC | SPC

1mg tablets

Initiated with specialist advice.