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.

08-03-04-01 Breast cancer

Anastrozole Arimidex®
Formulary

Tablets 1mg

See NICE CG164 for recommendation on use in patients at moderate - high risk in familial breast cancer.


Amber Recommended View adult BNF  View SPC online
Exemestane
Formulary
Tablets 25mg

Amber Recommended View adult BNF  View SPC online
Fulvestrant
Formulary

Injection 250mg

NHS NHSE commissioned drug (or via Cancer Drugs Fund) when used in conjuction with other agents - see Specialised Commissioning: Key documents, and relevant NICE TAs

Black for use as monotherapy

Link  NICE TA239 (2011): Fulvestrant for the treatment of locally advanced or metastatic breast cancer
Link  NICE TA503 (2018): Fulvestrant for untreated locally advanced or metastatic oestrogen-receptor positive breast cancer
Link  NICE TA579 (2019): Abemaciclib with fulvestrant for treating hormone receptor-positive, HER2-negative advanced breast cancer after endocrine therapy
Link  NICE TA619 (2020): Palbociclib with fulvestrant for treating hormone receptor-positive, HER2-negative, advanced breast cancer
Link  NICE TA652 (2020): Alpelisib with fulvestrant for treating hormone-receptor positive, HER2-negative, PIK3CA-positive advanced breast cancer (terminated appraisal)
Link  NICE TA687 (2021): Ribociclib with fulvestrant for treating hormone receptor-positive, HER2-negative advanced breast cancer after endocrine therapy
 

Red View adult BNF  View SPC online
Letrozole
Formulary

Tablets 2.5mg

RED Letrozole is RED for fertility treatment (unlicensed)


Amber Recommended View adult BNF  View SPC online
Tamoxifen
Formulary

Tablets 10mg, 20mg, 40mg; oral solution 10mg/5mL

REDTamoxifen is RED for fertility treatment (unlicensed)
See NICE CG164 for recommendation on use in patients at moderate - high risk in familial breast cancer.

 


Amber Recommended View adult BNF  View SPC online
Toremifene
Formulary
Tablets 60mg

Red View adult BNF  View SPC online