822 Cytotoxic responsive malignancy - Milton Keynes Formulary

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8.2.2 Cytotoxic responsive malignancy

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First line drugs

Second line drugs

Specialist drugs

Secondary care drugs

Traffic light status (TLS) explained:

• Green: Routine prescribing within licensed indication
• Amber 1: specialist recommendation followed by GP initiation and continuation
• Amber 2: specialist or GP initiation in line with local guideline after 1st line failure followed by GP continuation
• Amber 3: specialist initiation and stabilisation followed by GP continuation
• Amber SCG: specialist initiation and stabilisation followed by GP continuation in line with an agreed shared care guideline
• Red: Hospital or specialist prescribing only

 

 

Alkylating Agents (Antineoplastic drugs)

 

Bendamustine Hydrochloride

• Injection 25mg, 100mg vials

Notes: 

• Use as per NICE TA472: Obinutuzumab with bendamustine for treating follicular lymphoma refractory to rituximab (August 2017)

 

• Use as per NICE TA216: Bendamustine for the first-line treatment of chronic lymphocytic leukaemia (February 2011)      

 

 

Busulfan

• Myleran^® Tablets 2mg     

 

 

Carmustine

• BiCNU® injection, powder for reconstitution 100mg vial   U

Note:

• Use as per NICE TA121: Carmustine implants and temozolomide for the treatment of newly diagnosed high grade glioma (June 2007)

 

 

Chlorambucil

• Tablets 2mg       

 

 

Cyclophosphamide (Amber 3)

• Injection 500mg vial, 1g vial (Hospital only)
• Tablets 50mg

     

 

Dacarbazine

• Injection, powder for reconstitution 100mg, 200mg, 500mg, 1g vial   

 

 

Ifosfamide

• Injection, 1g vial, 2g vial   

 

 

Lomustine

• CCNU^® capsules 40mg 

 

 

Melphalan

• Tablets 2mg
• Injection, 50mg vial 

 

 

Temozolomide

• Capsule 5mg, 20mg, 100mg, 140mg, 180mg, 250mg 

Notes:

• Use as per NICE TA121: Carmustine implants and temozolomide for the treatment of newly diagnosed high grade glioma (June 2007)

 

• Use as per NICE TA23: Guidance on the use of temozolomide for the treatment of recurrent malignant glioma (brain cancer) (April 2001) 

 

 

Thiotepa

• Injection, 15mg vial    

 

 

Treosulfan

• Capsules 250mg
• Injection 1g, 5g in vials

 

 

Antineoplastic drugs: Anthracyclines and related drugs

 

Daunorubicin

• Injection, powder for reconstitution 20mg vial     

 

 

Daunorubicin with Cytarabine

• Vyxeos® 44mg/100mg powder for concentrate for solution for infusion, vials

Notes:

• Use as per NICE TA552: Liposomal cytarabine–daunorubicin for untreated acute myeloid leukaemia (December 2018)

 

 

Doxorubicin 

• Injection 10mg in 5mL, 50mg in 25mL vial   

 

    

Doxorubicin hydrochloride, pegylated liposomal

• Caelyx^® Injection,  2mg/mL concentrate for solution for infusion

Note:

• Use as per NICE TA389: Topotecan, pegylated liposomal doxorubicin hydrochloride, paclitaxel, trabectedin and gemcitabine for treating recurrent ovarian cancer (April 2016)
  

 

 

Epirubicin hydrochloride

• Injection 10mg in 5mL vial, 50mg in 25mL vial   

 

 

Idarubicin

• Capsules 5mg, 10mg
• Injection, powder for reconstitution 5mg vial, 10mg vial    

 

 

Mitoxantrone

• Concentrate for IV infusion 20mg in 10mL, 30mg in 15mL  

 

 

 

Pixantrone

• Pixuvrion^®  powder for concentrate for solution for infusion 29mg

Note:

• Use as per NICE TA306: Pixantrone monotherapy for treating multiply relapsed or refractory aggressive non-Hodgkin's B?cell lymphoma (February 2014) 

 

 

Antineoplastic drugs: Antimetabolites

 

Azacitidine

• Injection, powder for reconstitution 100mg vial

Note: 

• Use as per NICE TA218: Azacitidine for the treatment of myelodysplastic syndromes, chronic myelomonocytic leukaemia and acute myeloid leukaemia (March 2011)

 

 

 

Capecitabine

• Tablets 150mg, 500mg       

Notes: 

• Use as per NICE TA61: Capecitabine and tegafur with uracil for metastatic cancer (May 2003)

 

• Use as per NICE TA100: Capecitabine and oxaliplatin in the adjuvant treatment of stage III (Duke’s C) colon cancer (April 2006)

 

• Use as per NICE TA191: Capecitabine for the treatment of advanced gastric cancer (July 2010)

 

 

Cytarabine

• Injection 100mg in 5mL, 500mg in 5mL, 500mg in 25mL, 1g in 10mL, 2g in 20mL
• DepoCyte^® lipid formulation intrathecal injection 50mg vial    

 

 

Fludarabine phosphate

• Tablets 10mg
• Injection, powder for reconstitution 50mg vial       

Notes:

• Use as per NICE TA119: Fludarabine monotherapy for the first-line treatment of chronic lymphocytic leukaemia (February 2007)  

 

• Use as per Nice TA29: Fludarabine for the treatment of B-cell chronic lymphocytic leukaemia (September 2001)

 

 

Fluorouracil

• Capsules 250mg (named patient only)  U
• Injection 250mg/10mL vial   

 

 

Gemcitabine

• Injection, powder for reconstitution 200mg vial, 1g vial       

Notes:

• Use as per Clinical Commissioning Policy: Gemcitabine and capecitabine following surgery for pancreatic cancer (all ages) Dec 2018

 

• Use as per NICE TA116: Gemcitabine for the treatment of metastatic breast cancer (January 2007)

 

• Use as per NICE TA25: Gemcitabine for the treatment of pancreatic cancer (May 2001)

 

• Use as per NICE TA389: Topotecan, pegylated liposomal doxorubicin hydrochloride, paclitaxel, trabectedin and gemcitabine for treating recurrent ovarian cancer (April 2016)

 

 

Mercaptopurine (Amber 3)

• Tablets 50mg
• Tablets 10mg U
• Suspension 100mg in 5mL 

Note:

• Avoid concomitant use of mercaptopurine with allopurinol, unless supervised by an appropriate specialist.       

 

 

Methotrexate (for malignant conditions)

Methotrexate (Amber SCG for non-malignant conditions)

• Tablets 2.5mg, 10mg
• Injection 50mg in 2mL
• Metoject^® PEN solution for injection in pre-filled pen (all strengths) 

Notes:

Guideline for oral methotrexate.

• The 10mg tablets are reserved for Haematology and Oncology use only
• In the treatment of non-cancer conditions (eg. rheumatology and dermatology), methotrexate must be given once a week or once a month.
• Staff that encounter methotrexate prescriptions must ensure the correct dosing interval is given.
• In Patients who experience mucosal or gastro-intestinal side effects with methotrexate, folic acid 5mg each week may help reduce the frequency of such side effects.
• Methotrexate-induced mucositis or myelosuppression. Folinic acid (given as calcium folinate) is used to counteract the folate-antagonist action of methotrexate and so facilitate recovery from methotrexate-induced mucositis or myelosuppression.    

 

 

Pemetrexed

• Alimta^® Injection, powder for solution for infusion 100mg, 500mg vials

Notes: 

• Use as per NICE TA190: Pemetrexed for the maintenance treatment of non-small-cell lung cancer (Last updated: August 2017)

 

• Use as per NICE TA402: Pemetrexed maintenance treatment for non-squamous non-small-cell lung cancer after pemetrexed and cisplatin (August 2016) 

 

• Use as per NICE TA181: Pemetrexed for the first-line treatment of non-small-cell lung cancer (September 2009)

 

• Use as per NICE TA135: Pemetrexed for the treatment of malignant pleural mesothelioma (January 2008)

 

• Use as per NICE TA124: Pemetrexed for the treatment of non-small-cell lung cancer (August 2007)

 

 

 

Tegafur/gimeracil/oteracil 

• Teysuno^® Capsules 15mg/4.35mg/11.8mg, 20mg/5.8mg/15.8mg

Note: 

• Use as per NICE TA61: Guidance on the use of capecitabine and tegafur with uracil for metastatic colorectal cancer (May 2003)

 

 

Tioguanine (Thioguanine)

• Tablets 40mg
• Capsules 10mg  U
• Suspension 10mg in 1mL  U

 

 

Trifluridine/tipiracil

Lonsurf^® Tablets film-coated, 15mg/6.14mg, 20mg/8.19mg

Notes:

• Children: Not recommended
• Use as per NICE TA405: Trifluridine–tipiracil for previously treated metastatic colorectal cancer (August 2016)

 

 

  

Antineoplastic drugs: Cytotoxic Antibiotics & Related Substances

 

Bleomycin

• Bleo-Kyowa^® 15,000unit powder for solution for injection vials     

Note: 

• Letters sent to healthcare professionals (November 2017)

 

Dactinomycin

• Injection, powder for reconstitution 500 microgram vial (Available by special order)  

 

 

Mitomycin

• Injection, powder for reconstitution 20mg, 40mg vial     

 

 

Pentostatin

• Injection, powder for reconstitution 10mg vial   

 

 

Trabectedin

• Yondelis^® Injection, powder for concentrate for solution for infusion, 250 microgram, 1mg vials 

Notes:

• Use as per NICE TA389: Topotecan, pegylated liposomal doxorubicin hydrochloride, paclitaxel, trabectedin and gemcitabine for treating recurrent ovarian cancer (April 2016)

 

• Use as per NICE TA185: Trabectedin for the treatment of advanced soft tissue sarcoma (February 2010)

 

 

 

 

Antineoplastic drugs: Platinum Compounds

 

Carboplatin

• Injection 50mg in 5mL, 450mg in 45mL, 600mg in 60mL  

Notes:

• Use as per NICE TA284: Bevacizumab in combination with paclitaxel and carboplatin for first-line treatment of advanced ovarian cancer (May 2013)

 

• Use as per NICE TA285: Bevacizumab in combination with gemcitabine and carboplatin for treating the first recurrence of platinum-sensitive advanced ovarian cancer (May 2013)

 

 

Cisplatin

• Injection 10mg in 10mL, 50mg in 50mL, 100mg in 100mL  

 

 

Oxaliplatin

• Injection 50mg, 100mg vial

Notes:

• Use as per NICE TA100: Capecitabine and oxaliplatin in the adjuvant treatment of stage III (Dukes' C) colon cancer (April 2006)   

 

• Use as per NICE CG131: Colorectal cancer - diagnosis and management (Last updated: December 2014)  

 

 

Antineoplastic drugs: Podophyllotoxin Derivatives

 

Etoposide

• Concentrate for IV infusion 100mg in 5mL, 500mg in 25mL
• Capsules 50mg, 100mg     

 

 

Antineoplastic drugs: Taxanes

 

Cabazitaxel

• Jevtana^® 40mg/mL, (60mg/1.5-mL) Concentrate and solvent for solution for infusion vials

Notes: 

• Incompatible with PVC.
• Solvent contains ethanol
• Use as per NICE TA391: Cabazitaxel for hormone-relapsed metastatic prostate cancer treated with docetaxel (May 2016)

 

 

Docetaxel

• Concentrate for IV infusion 80mg in 2mL       

Notes: 

• Dexamethasone by mouth 8mg bd for 3 days, starting on the day before each course of docetaxel, is recommended for reducing fluid retention and hypersensitivity reactions.

 

• Use as per NICE TA109: Docetaxel for the adjuvant treatment of early node-positive breast cancer (September 2006)

 

• Use as per NICE TA101: Docetaxel for the treatment of hormone-refractory metastatic prostate cancer (June 2006)

 

 

Paclitaxel - Albumin Bound Formulation (Nab-paclitaxel) 

• Infusion 6mg/mL: 5mL, 16.7mL, 25mL, 50mL vials
• Abraxane^® Intravenous infusion, powder for reconstitution, 100mg vials 

Notes:

• Use as per NICE TA476:  Paclitaxel as albumin-bound nanoparticles with gemcitabine for untreated metastatic pancreatic cancer (September 2017)

 

• Use as per NICE TA389: Topotecan, pegylated liposomal doxorubicin hydrochloride, paclitaxel, trabectedin and gemcitabine for treating recurrent ovarian cancer (April 2016)

 

• Use as per NICE TA284: Bevacizumab in combination with paclitaxel and carboplatin for first-line treatment of advanced ovarian cancer (May 2013)

 

• Use as per NICE TA108: Paclitaxel for the adjuvant treatment of early node-positive breast cancer (September 2006)

 

• Use as per NICE TA55: Guidance on the use of paclitaxel in the treatment of ovarian cancer (Last updated: May 2005)

 

 

 

Antineoplastic drugs: Topoisomerase I inhibitors      

Topotecan

• Hycamtin^® Capsule 250 microgram, 1mg
• Hycamtin^® IV Infusion, powder for reconstitution, 1mg, 4mg vials
• Concentrate for Intravenous Infusion 1mg/mL: 1mL, 4mL vials

Notes:

• Use as per NICE TA389: Topotecan, pegylated liposomal doxorubicin hydrochloride, paclitaxel, trabectedin and gemcitabine for treating recurrent ovarian cancer (April 2016) 

 

• Use as per NICE TA184: Topotecan for the treatment of relapsed small-cell lung cancer(November 2009)

 

• Use as per NICE TA183: Topotecan for the treatment of recurrent and stage IVB cervical cancer (October 2009)

 

 

Vinca Alkaloids 

Note: 

• Vinblastine, vincristine, vindesine and vinorelbine are for intravenous administration only. They are not for intrathecal administration because of severe neurotoxicity, which is usually fatal. 

  

Vinblastine sulfate

• Injection 10mg in 10mL        

 

 

Vincristine sulfate

• Injection 1mg in 1mL, 2mg in 2mL        

 

 

Vindesine sulfate

• Injection, powder for reconstitution 5mg vial        

 

 

Vinflunine

• Javlor^® Injection, 25mg/mL concentrate for solution for infusion in vial

Note: 

• Use as per NICE TA272: Vinflunine for the treatment of advanced or metastatic transitional cell carcinoma of the urothelial tract (January 2013)

 

 

Vinorelbine

• Injection concentrate 10mg in 1mL, 50mg in 5mL

 

 

Other Cytotoxic drugs

Amsacrine

• Concentrate for IV infusion 75mg in 1.5mL        

 

 

Arsenic trioxide

• Trisenox^® Injection 10mg/10mL concentrate for solution for infusion ampoules

Note:

• Use as per NICE TA526: Arsenic trioxide for treating acute promyelocytic leukaemia (June 2018)

 

 

Crisantaspase

• Injection, powder for reconstitution 10000 unit vial       

 

 

Eribulin

• Halaven^® Injection, 0.44mg/mL solution in vial

Note:

• Use as per NICE TA423: Eribulin for treating locally advanced or metastatic breast cancer after 2 or more chemotherapy regimens (December 2016)  

 

 

Hydroxycarbamide (Amber 3)

• Capsule 500mg

Note:

• To be prescribed generically for all indications    

 

 

Niraparib

• Zejula^® Capsules 100mg

Note:

• Use as per NICE TA528: Niraparib for maintenance treatment of relapsed, platinum-sensitive ovarian, fallopian tube and peritoneal cancer (July 2018)

 

 

Panobinostat

• Farydak^® Capsule 10mg, 15mg, 20mg 

Note:

• Use as per NICE TA380: Panobinostat for treating multiple myeloma after at least 2 previous treatments (January 2016)

 

 

Pegaspargase

• Oncasper^® Injection 5mL, equivalent to 3750 iu L-asparaginase       

Note:

• Use as per NICE TA408: Pegaspargase for treating acute lymphoblastic leukaemia (September 2016)

 

 

Procarbazine

• Capsule 50mg       

Note: 

• Procarbazine is a mild monoamine-oxidase inhibitor but dietary restriction is not considered necessary. Alcohol ingestion may cause a disulfiram-like reaction.  

 

 

Raltitrexed 

• Tomudex^® Injection, 2mg Powder for solution for infusion in vial 

Note:

• Use as per NICE: CG131 Colorectal cancer: diagnosis and management (Last updated: December 2014)

 

Retinoid and related drugs

Tretinoin

• Capsule 10mg       

 

 

 

 

 

Traffic light status (TLS) explained:

• Green: Routine prescribing within licensed indication
• Amber 1: specialist recommendation followed by GP initiation and continuation
• Amber 2: specialist or GP initiation in line with local guideline after 1st line failure followed by GP continuation
• Amber 3: specialist initiation and stabilisation followed by GP continuation
• Amber SCG: specialist initiation and stabilisation followed by GP continuation in line with an agreed shared care guideline
• Red: Hospital or specialist prescribing only

 

Return to Chapter: 8. Immune System and Malignant Disease

Last updated by: Dupe Fagbenro on 19-02-2019 16:14