8.2.5 Hormone responsive malignancy
| 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
Anti-androgens
Cyproterone acetate
- Tablets 50mg, 100mg
Note:
- Hepatotoxicity: Direct hepatic toxicity including jaundice, hepatitis and hepatic failure has been reported (usually after several months) in patients treated with cyproterone acetate 200-300 mg daily. Liver function tests should be performed before treatment and whenever symptoms suggestive of hepatotoxicity occur-if confirmed cyproterone should normally be withdrawn. Cyproterone is no longer recommended for long term use.
Bicalutamide (Amber 2)
- Tablets 50mg, 150mg
Note:
- Casodex® brand is 20 times more expensive than the non-proprietary Bicalutamide. Bicalutamide is the only anti-androgen licensed as a single agent for monotherapy in a patient with locally advanced disease. The dosage of bicalutamide is 150mg od as a single agent, or 50mg od when given in conjunction with gonadorelin analogue injection therapy. Care should be taken to ensure correct choice of dose.
Abiraterone
- Zytiga® Tablets 500mg
Notes:
- Use as per NICE TA387: Abiraterone for treating metastatic hormone-relapsed prostate cancer beforechemotherapy is indicated (April 2016)
- Use as per NICE TA259: Abiraterone for castration-resistant metastatic prostate cancer previously treated with a docetaxel-containing regimen (June 2012)
Flutamide (Amber 2)
- Tablets 250mg
Note:
- Flutamide is given to counter tumour flare with initial gonadorelin therapy.
- Used for up to 3 weeks in patients with symptomatic and advanced prostatic carcinoma only.
Enzalutamide
- Capsules 40mg
Notes:
- Use as per NICE TA580: Enzalutamide for hormone-relapsed non-metastatic prostate cancer (May 2019)
- Use as per NICE TA377: Enzalutamide for treating metastatic hormone-relapsed prostate cancer before chemotherapy is indicated (January 2016)
- Use as per NICE TA316: Enzalutamide for metastatic hormone relapsed prostate cancer previously treated with a docetaxel containing regimen (July 2014)
Gonadotrophin-releasing hormone antagonists
Degarelix
- Firmagon® Injection, powder and solvent for solution 80mg, 120mg
Notes:
- Under 18 years, not recommended
- Use as per NICE TA404: Degarelix for treating advanced hormone-dependent prostate cancer (August 2016)
Oestrogens
Diethystilbestrol (TLS: Amber 3)
- Tablets 1mg, 5mg
Note:
- Thrombosis may occur with diethylstilbestrol, concomitant aspirin 75mg may be given. Fluid retention together with weight gain, gynaecomastia may occur. Lowering of libido may occur during treatment.
Ethinylestradiol (TLS: Amber 1)
- Tablets 10 micrograms, 50 micrograms, 1mg
Progestogens
Medroxyprogesterone acetate (Amber 1)
- Tablets 100mg, 200mg, 400mg
Megestrol acetate (Amber 1)
- Tablets 160mg
Norethisterone
- Tablets 5mg
Somatostatin analogues
Octreotide as acetate - Sandostatin®
- Injection 50 micrograms in 1mL amps
- Injection 100 micrograms in 1mL amps
- Injection 500 micrograms in 1mL amps
Octreotide as acetate - Sandostatin LAR®
- Injection vial 10mg
- Injection vial 20mg
- Injection vial 30mg
Notes:
- Octreotide injection is licensed for acromegaly and carcinoid syndrome.
- It is also used in hospital for short bowel/inoperable bowel obstruction and fistulae (unlicensed use).
Pasireotide
- Solution for injection
- Powder and solvent for suspension for injection
Notes:
- Use as per NHS England Clinical Commisioning Policy: Pasireotide diaspartate: an injectable medical therapy for the treatment of Cushings’ Disease (Dec 2016)
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: Sheila Wood on 31-07-2019 10:46
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BNF
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NICE
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Summary of product characteristics
