Pan Mersey
Area Prescribing Committee
 
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8 Malignant disease and immunosuppression

Coronavirus guidance

Guidance to support primary care prescribers and pharmacists is available from the MLCSU Coronavirus guidance resource page. Links are provided to national resources and regional documents produced by MLCSU, RDTC, and SPS for use by Pan Mersey APC, LSCMMG, and GMMMG.

The list of resources will be updated as new material becomes available so please check back regularly for updates.

The Pan Mersey APC supports the use of COVID-specific guidance issued by NICE, and NHS England and NHS Improvement. During the COVID pandemic this will supersede any APC advice.

Malignant disease and immunosuppression

Review date: January 2022

Non-formulary drugs: Any drug or formulation not listed in the formulary is deemed to be non-formulary.

Off-label use: Drugs are included in the formulary for their licensed indications – where inclusion of off-label use is considered to be included in the formulary this is specifically stated in the formulary entry for the drug N.B. also see Paediatrics note below.

Paediatrics: Drugs are included in the formulary for paediatric use for their BNF for Children recommended indications (indicated by symbol View childrens BNF) which may be off-label, unless otherwise stated. All drugs are deemed to have the same RAG status as they have for adults unless stated otherwise.

NHS England Specialised Commissioning
Drugs carrying the NHS England logo are commissioned by them. Links to key documents, national programmes of care, and clinical reference groups are found below.

NHSE NHS England Specialised Commissioning: Key documents

NHSE NHS England Specialised Commissioning: National programmes of care and clinical reference groups

Medications which are indicated for medically assisted reproduction, including ovulation induction (e.g. clomifene, letrozole and tamoxifen) and assisted reproduction, such as In Vitro Fertilisation or Ex Vitro Fertilisation (e.g. gonadotrophins) are restricted to use by specialist secondary care physicians, and are categorised as RED drugs for these purposes.

08-03-04-02 Anti-androgens

Abiraterone acetate
Formulary

Tablets 500mg

NHS NHSE commissioned drug - see Specialised Commissioning: Key documents

Link   Abiraterone for castration-resistant metastatic prostate cancer previously treated with a docetaxel-containing regime (TA259), National Institute for Health and Care Excellence Technology Appraisal
Link  NICE TA387: Abiraterone for treating metastatic hormone-relapsed prostate cancer before chemotherapy is indicated
 

Red View adult BNF  View SPC online
Bicalutamide
Formulary

Tablets 50mg, 150mg

Red for the prevention of tumour flare in patients being initiated on a gonadorelin analogue by the specialist for the treatment of prostate cancer.

NB:Amber initiated if a course of treatment is prescribed by the GP to cover reinstatement of gonadorelin analogue therapy if doses of the latter have been missed by 3 months or more.

Link  Pan Mersey Gonadorelin analogues prescribing support information
 

Amber Initiated View adult BNF  View SPC online
Cyproterone acetate
Formulary

Tablets 50 mg, 100 mg

 

Red for the prevention of tumour flare in patients being initiated on a gonadorelin analogue by the specialist for the treatment of prostate cancer.

N.B. Amber Initiated if a course of treatment is prescribed by the GP to cover reinstatement of gonadorelin analogue therapy if doses of the latter have been missed by three months or more.

Link  Pan Mersey (2019). Gonadorelin Analogues (triptorelin, goserelin, leuprorelin).
Link  EMA (2020). Restrictions in use of cyproterone due to meningioma risk.
 

Amber Initiated View adult BNF  View SPC online
Enzalutamide
Formulary
Capsules 40mg
NHS NHSE commissioned drug - see Specialised Commissioning: Key documents
Link  Enzalutamide for metastatic hormone‑relapsed prostate cancer previously treated with a docetaxel‑containing regimen (TA316), National Institute for Health and Care Excellence Technology Appraisal
Link  NICE TA377: Enzalutamide for treating metastatic hormone-relapsed prostate cancer before chemotherapy is indicated
Link  NICE TA580: Enzalutamide for hormone-relapsed non-metastatic prostate cancer
 

Red View adult BNF  View SPC online
Flutamide
Formulary
Tablets 250mg

Amber Initiated View adult BNF  View SPC online