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Guy's and St Thomas' NHS Foundation Trust
Kings College Hospital NHS Foundation Trust
Lewisham and Greenwich NHS Trust
 
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 Formulary Chapter 8: Malignant disease and immunosuppression - Full Chapter
Notes:

Please also refer to the Cancer Drugs Fund list

Where a formulary entry does not detail a medicine’s indications for use, the medicine can be assumed to be approved for all licensed indications.

Formulary approved "off-label" use is detailed separately.

 Details...
08.01  Cytotoxic drugs
 note  Cytotoxic chemotherapy for malignant disease should only be prescribed by a specialist registrar or consultant with adequate experience in this area
08.01  Side-effects of cytotoxic drugs
Amifostine injection
Unlicensed Drug Unlicensed
Red
Prevention of cumulative renal toxicity associated with repeated administration of cisplatin 
   
08.01  Drugs for cytotoxic-induced side-effects
Calcium folinate tabs, injection
View adult BNF View SPC online
Formulary
Red
 
   
Calcium levofolinate injection
View adult BNF View SPC online
Formulary
Red
 
   
Disodium folinate injection
View adult BNF View SPC online
Formulary
Red
 
   
Glucarpidase injection
Restricted Drug Restricted
Red
High Cost Medicine
Use in accordance with NHS England Clinical Commissioning Policy B15/P/a 
Link  NHSE Commissioning Policy Glucarpidase for the urgent treatment of methotrexate-induced renal dysfunction
   
Mesna tabs, injection
View adult BNF View SPC online
Formulary
Red
 
   
08.01.01  Alkylating drugs
 note  Use in accordance with local guidelines
Cytotoxic Drug Cyclophosphamide tabs, injection
View adult BNF View SPC online
Formulary
Red
 
   
Cytotoxic Drug Cyclophosphamide injection (CIDP - off-label)
View adult BNF View SPC online
Restricted Drug Restricted
Red

Approved off-label indication:

Chronic inflammatory demyelinating polyradiculoneuropathy

Prescribing restricted to Dr Hadden in accordance with locally agreed protocol

 
   
Cytotoxic Drug Cyclophosphamide tabs (haemophilia - off-label)
View adult BNF View SPC online
Formulary
Red

Approved off-label indication:

Induction of remission in acquired haemophilia. Dose = 50 mg - 100 mg daily, usual course length 6-8 weeks

Consultant specialist use only

 
   
Bendamustine injection
View adult BNF View SPC online
Formulary
Red
Cancer Drugs Fund
BlueTeq

Approved for use as per indications and criteria in the Cancer Drugs Fund and NICE TA216.

See also separate NHSE policies for use with rituximab (link below)

 

 
Link  Clinical commissioning policy: Bendamustine with rituximab for first line treatment of advanced indolent non-Hodgkin’s lymphoma (all ages) (170055P)
Link  Clinical Commissioning Policy: Bendamustine with rituximab for first line treatment of mantle cell lymphoma (all ages) (17088P)
Link  Clinical Commissioning Policy: Bendamustine with rituximab for relapsed and refractory mantle cell lymphoma (all ages) (170054P)
Link  MHRA Jul 2017: Bendamustine (Levact): increased mortality observed in recent clinical studies in off-label use; monitor for opportunistic infections, hepatitis B reactivation
Link  NICE TA216: Bendamustine for the first-line treatment of chronic lymphocytic leukaemia
   
Cytotoxic Drug Busulfan tabs
View adult BNF View SPC online
Formulary
Red
 
   
Cytotoxic Drug Carmustine implant
View adult BNF View SPC online
Formulary
Red

 
Link  NICE TA121: Carmustine implants and temozolomide for the treatment of newly diagnosed high-grade glioma
   
Cytotoxic Drug Chlorambucil tabs
View adult BNF View SPC online
Formulary
Red
 
   
Cytotoxic Drug Cyclophosphamide tabs (Anti-GBM vasculitis - off-label)
View adult BNF View SPC online
Formulary
Red

Approved off-label indication:

Anti-GBM vasculitis.

Dose = 2-3 mg/kg daily for 2-3 months, dose reduced in the elderly.

Consultant specialist use only

 
   
Cytotoxic Drug Cyclophosphamide tabs (immune checkpoint inhibitor therapy related adverse events - off-label)
View adult BNF View SPC online
Formulary
Red

Approved off-label indication:

Management of immune-related adverse events including pneumonitis in patients treated with immune checkpoint inhibitor therapy

 
   
Cytotoxic Drug Ifosfamide injection
View adult BNF View SPC online
Formulary
Red
 
   
Cytotoxic Drug Lomustine caps
View adult BNF View SPC online
Formulary
Red
 
   
Cytotoxic Drug Melphalan tabs, injection
View adult BNF View SPC online
Formulary
Red
 
   
Cytotoxic Drug Thiotepa injection
View adult BNF View SPC online
Formulary
Red
 
   
Venetoclax tabs
View adult BNF View SPC online
Formulary
Red
High Cost Medicine
Cancer Drugs Fund
Approved for use as per NICE technology appraisal guidance below  
Link  NICE TA487: Venetoclax for treating chronic lymphocytic leukaemia
Link  NICE TA561: Venetoclax with rituximab for previously treated chronic lymphocytic leukaemia
   
Cytotoxic Drug Cyclophosphamide pre-filled syringe 1000mg in 50mL
View adult BNF View SPC online
Unlicensed Drug Unlicensed
Red
Chronic lymphocytic leukaemia; lymphomas; solid tumours 
   
Cytotoxic Drug Carmustine 0.04% ointment
Unlicensed Drug Unlicensed
Red

Treatment of mycosis fungoides.

Continuation of therapy and monitoring is provided by secondary care (PIL available on GTi)

Restricted to Consultant Dermatologists specialising in the treatment of skin tumours only

 
   
Cytotoxic Drug Carmustine injection
Unlicensed Drug Unlicensed
Red
BEAM autograft for lymphoma, uric acid nephropathy, neoplastic disease and metabolic disorders 
   
Cytotoxic Drug Mustine injection
Unlicensed Drug Unlicensed
Red
Haematological emergency for a newly diagnosed patient with bulky lymphoma 
   
08.01.02  Anthracyclines and other cytotoxic antibiotics to top
 note  Use in accordance with local guidelines
Cytotoxic Drug Bleomycin injection (licensed use)
View adult BNF View SPC online
Formulary
Red

 
   
Cytotoxic Drug Dactinomycin injection
View adult BNF View SPC online
Formulary
Red
 
   
Cytotoxic Drug Daunorubicin injection
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Formulary
Red
 
   
Cytotoxic Drug Daunorubicin liposomal injection
View adult BNF View SPC online
Formulary
Red
 
   
Cytotoxic Drug Doxorubicin hydrochloride injection
View adult BNF View SPC online
Formulary
Red
 
   
Cytotoxic Drug Doxorubicin hydrochloride pegylated liposomal injection
View adult BNF View SPC online
Formulary
Red
High Cost Medicine
 
Link  NICE TA389: Topotecan, pegylated liposomal doxorubicin hydrochloride, paclitaxel, trabectedin and gemcitabine for treating recurrent ovarian cancer
   
Cytotoxic Drug Epirubicin hydrochloride injection
View adult BNF View SPC online
Formulary
Red
 
   
Cytotoxic Drug Idarubicin hydrochloride caps, injection
View adult BNF View SPC online
Formulary
Red
 
   
Cytotoxic Drug Mitomycin injection
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Formulary
Red
For intravenous or intravesical administration, depending on indication, as per manufacturer's instructions 
   
Cytotoxic Drug Mitoxantrone (Mitozantrone) injection
View adult BNF View SPC online
Formulary
Red
 
   
Cytotoxic Drug Pixantrone injection
View adult BNF View SPC online
Formulary
Red
High Cost Medicine
 
Link  NICE TA306: Pixantrone monotherapy for treating multiply relapsed or refractory aggressive non-Hodgkin’s B‑cell lymphoma
   
Cytotoxic Drug Bleomycin injection (venous and lymphatic malformations - off-label)
View adult BNF View SPC online
Formulary
Red

Approved off-label indication:

Via intralesional injection for scleropathy of lymphatic and low flow (venous) malformations

  • Consultant interventional radiologist use only
  • Dose depends on lesion size.  Maximum 15,000 units per session
  • Not to exceed maximum lifetime cummulative dose of 360,000 units

 

 
   
08.01.03  Antimetabolites
 note  Use in accordance with local guidelines
Cytotoxic Drug Azacitidine injection
View adult BNF View SPC online
Restricted Drug Restricted
Red
High Cost Medicine
CONSULTANT SPECIALISTS ONLY 
Link  NICE TA218: Azacitidine for the treatment of myelodysplastic syndromes, chronic myelomonocytic leukaemia and acute myeloid leukaemia
   
Cytotoxic Drug Capecitabine tabs
View adult BNF View SPC online
Formulary
Red
  • First-line for metastatic colorectal cancer
  • Third- or fourth-line for locally advanced or metastatic breast cancer (where previous therapy with anthracyclines and taxanes had failed) 
  • Link  NICE CG81: Advanced breast cancer: diagnosis and treatment
    Link  NICE TA100: Capecitabine and oxaliplatin in the adjuvant treatment of stage III (Dukes’ C) colon cancer
    Link  NICE TA191: Capecitabine for the treatment of advanced gastric cancer
    Link  NICE TA61: Guidance on the use of capecitabine and tegafur with uracil for metastatic colorectal cancer
       
    Cytotoxic Drug Capecitabine tabs (off-label uses)
    View adult BNF View SPC online
    Formulary
    Red

    Approved off-label indications:

    • Adjuvant use in pancreatic cancer (with gemcitabine) as per NHSE Commissioning Policy 170101P
    • Unresectable or metastatic pancreatic neuroendocrine tumours (in combination with temozolomide). Follow local protocol for use.
     
       
    Cytotoxic Drug Capecitabine tabs (pancreatic cancer - off-label)
    View adult BNF View SPC online
    Formulary
    Red

    Approved off-label indication:

    Adjuvant use in pancreatic cancer (with gemcitabine) as per NHSE Commissioning Policy 170101P

     
    Link  NHSE Clinical Commissioning Policy 170101P: Gemcitabine and capecitabine following surgery for pancreatic cancer (all ages)
       
    Cytotoxic Drug Cladribine injection (haematology oncology )
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine

    For haematology oncology indications

     
       
    Cytotoxic Drug Cytarabine and daunorubicin (liposomal) injection (Vyxeos®)
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine

    Approved as per NICE technology appraisal guidance 552

     
    Link  NICE TA 552: Liposomal cytarabine–daunorubicin for untreated acute myeloid leukaemia
       
    Cytotoxic Drug Cytarabine injection
    View adult BNF View SPC online
    Formulary
    Red
     
       
    Cytotoxic Drug Fludarabine tabs, injection
    View adult BNF View SPC online
    Formulary
    Red
     
    Link  NICE TA29: Guidance on the use of fludarabine for B-cell chronic lymphocytic leukaemia
       
    Cytotoxic Drug Fluorouracil injection (oncology indications)
    View adult BNF View SPC online
    Formulary
    Red

     
       
    Cytotoxic Drug Gemcitabine injection
    View adult BNF View SPC online
    Formulary
    Red
     
    Link  NICE TA116: Gemcitabine for the treatment of metastatic breast cancer
    Link  NICE TA25:Guidance on the use of gemcitabine for the treatment of pancreatic cancer
       
    Cytotoxic Drug Gemcitabine injection (pancreatic cancer - off-label)
    View adult BNF View SPC online
    Formulary
    Red

    Approved off-label indication:

    Adjuvant use in pancreatic cancer (with capecitabine) as per NHSE Commissioning Policy 170101P

     
    Link  NHSE Clinical Commissioning Policy 170101P: Clinical Commissioning Policy: Gemcitabine and capecitabine following surgery for pancreatic cancer (all ages)
       
    Cytotoxic Drug Mercaptopurine tabs (oncology indications)
    View adult BNF View SPC online
    Formulary
    Red

     
       
    Cytotoxic Drug Methotrexate tabs injection (oncology)
    View adult BNF View SPC online
    Formulary
    Red

    For oncology indications

    Refer to BNF for highlighted cautions for blood count, and gastro-intestinal, liver and pulmonary toxicities

     
       
    Cytotoxic Drug Pemetrexed injection
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
    BlueTeq

     
    Link  NICE TA135: Pemetrexed for the treatment of malignant pleural mesothelioma
    Link  NICE TA181: Pemetrexed for the first-line treatment of non-small-cell lung cancer
    Link  NICE TA190: Pemetrexed for the maintenance treatment of non-small-cell lung cancer
    Link  NICE TA402: Pemetrexed maintenance treatment for non-squamous non-small-cell lung cancer after pemetrexed and cisplatin
       
    Cytotoxic Drug Tioguanine tabs
    View adult BNF View SPC online
    Formulary
    Red
     
       
    Trifluridine–tipiracil tablets
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
    BlueTeq

     
    Link  NICE TA405: Trifluridine–tipiracil for previously treated metastatic colorectal cancer
       
    08.01.04  Vinca alkaloids and etoposide
     note  Use in accordance with local guidelines
    Cytotoxic Drug Etoposide caps, injection
    View adult BNF View SPC online
    Formulary
    Red
     
       
    Cytotoxic Drug Vinblastine injection
    View adult BNF View SPC online
    Formulary
    Red
     
       
    Cytotoxic Drug Vincristine injection
    View adult BNF View SPC online
    Formulary
    Red
     
       
    Cytotoxic Drug Vindesine injection
    View adult BNF View SPC online
    Formulary
    Red
     
       
    Cytotoxic Drug Vinorelbine caps, injection
    View adult BNF View SPC online
    Formulary
    Red
     
       
    08.01.05  Other antineoplastic drugs
     note  Use in accordance with local guidelines
    Abemaciclib tabs
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
    Cancer Drugs Fund

    Approved as per NICE technology appraisal guidance

     
    Link  NICE TA563: Abemaciclib with an aromatase inhibitor for previously untreated, hormone receptor-positive, HER2-negative, locally advanced or metastatic breast cancer
    Link  NICE TA579: Abemaciclib with fulvestrant for treating hormone receptor-positive, HER2-negative advanced breast cancer after endocrine therapy
       
    Alectinib caps
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine

    Approved as per NICE Technology Appraisal guidance

     
    Link  NICE TA536: Alectinib for untreated ALK-positive advanced non-small-cell lung cancer
       
    Arsenic trioxide injection
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine

    Approved as per NICE Technology Appraisal guidance

    Approved as per licensed dosing, or dosing in the AML17 trial protocol (off-label). Refer to local guidelines and treatment protocols.

     
    Link  NICE TA526: Arsenic trioxide for treating acute promyelocytic leukaemia
       
    Atezolizumab injection (lung cancer indications)
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine

    Approved for use as per NICE technology appraisal guidance below

     
    Link  NICE TA520: Atezolizumab for treating locally advanced or metastatic non-small-cell lung cancer after chemotherapy
    Link  NICE TA584: Atezolizumab in combination for treating metastatic non-squamous non-small-cell lung cancer
       
    Atezolizumab injection (urothelial cancer indications)
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
    Cancer Drugs Fund

    Approved for use as per NICE technology appraisal guidance below

     
    Link  NICE TA492: Atezolizumab for untreated locally advanced or metastatic urothelial cancer when cisplatin is unsuitable
    Link  NICE TA525: Atezolizumab for treating locally advanced or metastatic urothelial carcinoma after platinum-containing chemotherapy
       
    Avelumab injection
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
    Cancer Drugs Fund

     Approved for use as per NICE technology appraisal guidance (see links below):

     
    Link  NICE TA517: Avelumab for treating metastatic Merkel cell carcinoma
       
    Axicabtagene ciloleucel cells dispersion for infusion
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
    Cancer Drugs Fund

    Approved for use as per NICE technology appraisal guidance

    A minimum of four doses of tocilizumab are required to be available for use in the event of cytokine release syndrome and emergency equipment must be available prior to infusion.

    Refer to SPC for information on management of cytokine release syndrome.

     
    Link  NICE TA559: Axicabtagene ciloleucel for treating diffuse large B-cell lymphoma and primary mediastinal large B-cell lymphoma after 2 or more systemic therapies
       
    Axitinib tabs
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine

    Approved for use as per NICE technology appraisal guidance (see links below):

     
    Link  NICE TA333: Axitinib for treating advanced renal cell carcinoma after failure of prior systemic treatment
       
    Binimetinib tabs
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine

    Approved as per NICE technology appraisal guidance

     
    Link  NICE TA562: Encorafenib with binimetinib for unresectable or metastatic BRAF V600 mutation-positive melanoma
       
    Bosutinib tabs
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
    BlueTeq

    Approved as per NICE Technology Appraisal guidance

     
    Link  NICE TA401: Bosutinib for previously treated chronic myeloid leukaemia
       
    Brentuximab injection
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
    Cancer Drugs Fund
    BlueTeq

    Approved as per NICE Technology Appraisal guidance

     
    Link  NICE TA478: Brentuximab vedotin for treating relapsed or refractory systemic anaplastic large cell lymphoma
    Link  NICE TA524: Brentuximab vedotin for treating CD30-positive Hodgkin lymphoma
    Link  NICE TA577: Brentuximab vedotin for treating CD30-positive cutaneous T-cell lymphoma
       
    Brigatinib tabs
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine

    Approves as per NICE technology appraisal guidance

     
    Link  NICE TA571: Brigatinib for treating ALK-positive advanced non-small-cell lung cancer after crizotinib
       
    Carfilzomib injection
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
    BlueTeq

    Approved for use as per NICE technology appraisal guidance (see links below):

     
    Link  MHRA Aug 2019: Carfilzomib (Kyprolis▼): reminder of risk of potentially fatal cardiac events
    Link  NICE TA457: Carfilzomib for previously treated multiple myeloma
       
    Cemiplimab injection
    View adult BNF View SPC online
    Formulary
    Red
    Cancer Drugs Fund
    BlueTeq

    Approved for treating metastatic or locally advanced cutaneous squamous cell carcinoma as per NICE TA592 (see link below)

     
    Link  NICE TA592: Cemiplimab for treating metastatic or locally advanced cutaneous squamous cell carcinoma
       
    Ceritinib caps
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
    BlueTeq

    Approved for use as per NICE Technology Appraisal guidance (see links below):

     
    Link  NICE TA395: Ceritinib for previously treated anaplastic lymphoma kinase positive non-small-cell lung cancer
    Link  NICE TA500: Ceritinib for untreated ALK-positive non-small-cell lung cancer
       
    Dabrafenib caps
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine

    Approved for use as per NICE technology appraisal guidance (see links below):

     
    Link  NICE TA 544: Dabrafenib with trametinib for adjuvant treatment of resected BRAF V600 mutation-positive melanoma
    Link  NICE TA321: Dabrafenib for treating unresectable or metastatic BRAF V600 mutation‑positive melanoma
       
    Dacomitinib caps
    View adult BNF View SPC online
    Formulary
    Red

    Approved for untreated EGFR mutation-positive non-small-cell lung cancer as per NICE TA595 (see link below)

     
    Link  NICE TA595: Dacomitinib for untreated EGFR mutation-positive non-small-cell lung cancer
       
    Durvalumab injection
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
    Cancer Drugs Fund

    Approved for use as per NICE technology appraisal guidance (see links below):

     
    Link  NICE TA578: urvalumab for treating locally advanced unresectable non-small-cell lung cancer after platinum-based chemoradiation
       
    Encorafenib caps
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine

    Approved as per NICE technology appraisal guidance

     
    Link  NICE TA562: Encorafenib with binimetinib for unresectable or metastatic BRAF V600 mutation-positive melanoma
       
    Eribulin injection
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
    BlueTeq

    Approved for use as per NICE technology appraisal guidance (see links below):

     
    Link  NICE TA423: Eribulin for treating locally advanced or metastatic breast cancer after 2 or more chemotherapy regimens
       
    Ibrutinib caps
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
    Cancer Drugs Fund
    BlueTeq

    Approved for use as per NICE technology appraisal guidance below

     
    Link  MHRA Aug 17: Ibrutinib (Imbruvica▼): reports of ventricular tachyarrhythmia; risk of hepatitis B reactivation and of opportunistic infections
    Link  NICE TA429: Ibrutinib for previously treated chronic lymphocytic leukaemia and untreated chronic lymphocytic leukaemia with 17p deletion or TP53 mutation
    Link  NICE TA491: Ibrutinib for treating Waldenstrom’s macroglobulinaemia
    Link  NICE TA502: Ibrutinib for treating relapsed or refractory mantle cell lymphoma
       
    Idelalisib tabs
    View adult BNF View SPC online
    Formulary
    Red

    Approved for use as per NICE technology appraisal guidance (see links below):

     
    Link  NICE TA359: Idelalisib for treating chronic lymphocytic leukaemia
       
    Inotuzumab ozogamicin injection
    View adult BNF View SPC online
    Formulary
    Red

    Approved for use as per NICE technology appraisal guidance (see links below):

     
    Link  NICE TA541: Inotuzumab ozogamicin for treating relapsed or refractory B-cell acute lymphoblastic leukaemia
       
    Ketoconazole tabs
    View adult BNF View SPC online
    Restricted Drug Restricted
    Red

    Approved off-label indication:

    Management of castration refractory prostate cancer

    Dose = 200-400mg three times daily

     
       
    Lutetium (177Lu) oxodotreotide injection
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine

    Approved for use as per NICE technology appraisal guidance (see links below):

     
    Link  NICE TA539: Lutetium (177Lu) oxodotreotide for treating unresectable or metastatic neuroendocrine tumours
       
    Midostaurin caps
    View adult BNF View SPC online
    Formulary
    Red

    Approved as per NICE Technology Appraisal guidance

     
    Link  NICE TA523: Midostaurin for untreated acute myeloid leukaemia
       
    Niraparib caps
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
    Cancer Drugs Fund

    Approved for use as per NICE technology appraisal guidance (see links below):

     
    Link  NICE TA528: Niraparib for maintenance treatment of relapsed, platinum-sensitive ovarian, fallopian tube and peritoneal cancer
       
    Nivolumab injection (haematological cancer)
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
    BlueTeq

    Approved for use as per NICE technology appraisal guidance below

     
    Link   MHRA Oct 19: Nivolumab (Opdivo): reports of cytomegalovirus (CMV) gastrointestinal infection or reactivation
    Link  MHRA Jul 17: Nivolumab (Opdivo▼), pembrolizumab (Keytruda▼): reports of organ transplant rejection
    Link  NICE TA462: Nivolumab for treating relapsed or refractory classical Hodgkin lymphoma
       
    Nivolumab injection (lung and urothelial cancer)
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
    Cancer Drugs Fund
    BlueTeq

    Approved for use as per NICE technology appraisal guidance below

     
    Link  MHRA Oct 19: Nivolumab (Opdivo): reports of cytomegalovirus (CMV) gastrointestinal infection or reactivation
    Link  MHRA Jul 17: Nivolumab (Opdivo▼), pembrolizumab (Keytruda▼): reports of organ transplant rejection
    Link  NICE TA483: Nivolumab for previously treated squamous non-small-cell lung cancer
    Link  NICE TA484: Nivolumab for previously treated non-squamous non-small-cell lung cancer
    Link  NICE TA530: Nivolumab for treating locally advanced unresectable or metastatic urothelial cancer after platinum-containing chemotherapy
       
    Nivolumab injection (skin, head and neck and renal cancers)
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
    Cancer Drugs Fund
    BlueTeq

    Approved for use as per NICE technology appraisal guidance below

     
    Link  MHRA Oct 19: Nivolumab (Opdivo): reports of cytomegalovirus (CMV) gastrointestinal infection or reactivation
    Link  MHRA Jul 17: Nivolumab (Opdivo▼), pembrolizumab (Keytruda▼): reports of organ transplant rejection
    Link  NICE TA384: Nivolumab for treating advanced (unresectable or metastatic) melanoma
    Link  NICE TA400: Nivolumab in combination with ipilimumab for treating advanced melanoma
    Link  NICE TA417: Nivolumab for previously treated advanced renal cell carcinoma
    Link  NICE TA490: Nivolumab for treating squamous cell carcinoma of the head and neck after platinum-based chemotherapy
    Link  NICE TA558: Nivolumab for adjuvant treatment of completely resected melanoma with lymph node involvement or metastatic disease
    Link  NICE TA581: Nivolumab with ipilimumab for untreated advanced renal cell carcinoma
       
    Olaparib caps, tabs
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine

    Approved for use as per NICE technology appraisal guidance (see links below)

    Due to differences in dosing and bioavailability, capsules and tablets should not be substituted on a milligram-to-milligram basis.

    To avoid medication errors, prescribers should specify formulation and dose on each prescription.

     
    Link  NICE TA598: Olaparib for maintenance treatment of BRCA mutation-positive advanced ovarian, fallopian tube or peritoneal cancer after response to first-line platinum-based chemotherapy
       
    Palbociclib tabs
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
    Approved for use as per NICE technology appraisal guidance below 
    Link  NICE TA495: Palbociclib with an aromatase inhibitor for previously untreated, hormone receptor-positive, HER2-negative, locally advanced or metastatic breast cancer
       
    Panitumumab injection
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
    BlueTeq

    Approved as per restrictions in the NICE guidance

     
    Link  NICE TA439: Cetuximab and panitumumab for previously untreated metastatic colorectal cancer
       
    Panobinostat caps
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine

    Approved for use as per NICE technology appraisal guidance (see links below):

     
    Link  NICE TA380: Panobinostat for treating multiple myeloma after at least 2 previous treatments
       
    Pegaspargase injection
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine

    Approved for use as per NICE technology appraisal guidance (see links below):

     
    Link  NICE TA408: Pegaspargase for treating acute lymphoblastic leukaemia
       
    Pembrolizumab injection (Hodgkin lymphoma)
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
    Cancer Drugs Fund

    Approved for use as per NICE Technology appraisals below

     
    Link  NICE TA540: Pembrolizumab for treating relapsed or refractory classical Hodgkin lymphoma
       
    Pembrolizumab injection (lung cancer indications)
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
    Cancer Drugs Fund
    BlueTeq

    For non-small-cell lung cancer as per NICE Technology appraisals below

     
    Link  MHRA Jul 17: Nivolumab (Opdivo▼), pembrolizumab (Keytruda▼): reports of organ transplant rejection
    Link  NICE TA428: Pembrolizumab for treating PD-L1-positive non-small-cell lung cancer after chemotherapy
    Link  NICE TA531: Pembrolizumab for untreated PD-L1-positive metastatic non-small-cell lung cancer
    Link  NICE TA557: Pembrolizumab with pemetrexed and platinum chemotherapy for untreated, metastatic, non-squamous non-small-cell lung cancer
    Link  NICE TA600: Pembrolizumab with carboplatin and paclitaxel for untreated metastatic squamous non-small-cell lung cancer
       
    Pembrolizumab injection (skin cancer indications)
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine

    For skin cancer indications as per NICE technology appraisals below

     
    Link  MHRA Jul 17: Nivolumab (Opdivo▼), pembrolizumab (Keytruda▼): reports of organ transplant rejection
    Link  NICE TA 553: Pembrolizumab for adjuvant treatment of resected melanoma with high risk of recurrence
    Link  NICE TA357: Pembrolizumab for treating advanced melanoma after disease progression with ipilimumab
    Link  NICE TA366: Pembrolizumab for advanced melanoma not previously treated with ipilimumab
       
    Pembrolizumab injection (urothelial cancer indications)
    View adult BNF View SPC online
    Formulary
    Red
    Cancer Drugs Fund

    For urothelial cancer indications as per NICE Technology appraisals below

     
    Link  NICE TA519: Pembrolizumab for treating locally advanced or metastatic urothelial carcinoma after platinum-containing chemotherapy
    Link  NICE TA522: Pembrolizumab for untreated PD-L1-positive locally advanced or metastatic urothelial cancer when cisplatin is unsuitable
       
    Pertuzumab injection
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
    BlueTeq

    Approved for use as per NICE technology appraisal guidance (see links below):

     
    Link  NICE TA424: Pertuzumab for the neoadjuvant treatment of HER2-positive breast cancer
    Link  NICE TA509: Pertuzumab with trastuzumab and docetaxel for treating HER2-positive breast cancer
    Link  NICE TA569: Pertuzumab for adjuvant treatment of HER2-positive early stage breast cancer
       
    Ponatinib tabs
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
    BlueTeq

    Approved for CML and ALL as per NICE TA451

     
    Link  MHRA Apr 2017: Ponatinib (Iclusig▼): risk of vascular occlusive events—updated advice on possible dose reduction
    Link  MHRA Oct 2018: Ponatinib (Iclusig▼): reports of posterior reversible encephalopathy syndrome
    Link  NICE TA451: Ponatinib for treating chronic myeloid leukaemia and acute lymphoblastic leukaemia
       
    Regorafenib tabs (gastrointestinal stromal tumours)
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine

    Approved for use as per NICE technology appraisal guidance below

     
    Link  NICE TA488: Regorafenib for previously treated unresectable or metastatic gastrointestinal stromal tumours
       
    Regorafenib tabs (hepatocellular carcinoma)
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine

    Approved for use as per NICE technology appraisal guidance below

     
    Link  NICE TA555: Regorafenib for previously treated advanced hepatocellular carcinoma
       
    Ribociclib tabs
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine

    Approved for use as per NICE technology appraisal guidance below

     
    Link  NICE TA593: Ribociclib with fulvestrant for treating hormone receptor-positive, HER2-negative, advanced breast cancer
    Link  NICE TA496: Ribociclib with an aromatase inhibitor for previously untreated, hormone receptor-positive, HER2-negative, locally advanced or metastatic breast cancer
       
    Ruxolitinib tabs
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine

    Approved for use as per NICE technology appraisal guidance (see links below):

     
    Link  NICE TA386: Ruxolitinib for treating disease-related splenomegaly or symptoms in adults with myelofibrosis
       
    Talimogene laherparepvec injection
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine

    Approved for use as per NICE TA guidance

     
    Link  NICE TA410: Talimogene laherparepvec for treating unresectable metastatic melanoma
       
    Tisagenlecleucel cells dispersion for infusion
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
    Cancer Drugs Fund

    Approved for use as per NICE technology appraisal guidance

    A minimum of four doses of tocilizumab are required to be available for use in the event of cytokine release syndrome and emergency equipment must be available prior to infusion.

    Refer to SPC for information on management of cytokine release syndrome.

     
    Link  NICE TA554: Tisagenlecleucel for treating relapsed or refractory B-cell acute lymphoblastic leukaemia in people aged up to 25 years
    Link  NICE TA567:Tisagenlecleucel for treating relapsed or refractory diffuse large B-cell lymphoma after 2 or more systemic therapies
       
    Trametinib tabs
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
    BlueTeq

    Approved for use as per NICE technology appraisal guidance (see links below):

     
    Link  NICE TA396: Trametinib in combination with dabrafenib for treating unresectable or metastatic melanoma
    Link  NICE TA544: Dabrafenib with trametinib for adjuvant treatment of resected BRAF V600 mutation-positive melanoma
       
    Streptozocin injection
    View adult BNF View SPC online
    Unlicensed Drug Unlicensed
    Red

    Locally advanced and metastatic neuroendocrine tumours (predominantly pancreas but also small/large bowel and lung)

    For named supervising consultants only in accordance with the prescribing protocol and proforma

     
       
    08.01.05  Amsacrine
    Cytotoxic Drug Amsacrine injection
    View adult BNF View SPC online
    Formulary
    Red
     
       
    08.01.05  Bevacizumab to top
    Bevacizumab injection
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine

    Approved off-label indication:

    Treatment of neurofibromatosis type 2

    For consultant specialists in accordance with a nationally commissioned service protocol

     
       
    Bevacizumab injection
    View adult BNF View SPC online
    Formulary
    Red
    Cancer Drugs Fund

    Approved as per indications in the Cancer Drugs Fund

     
       
    08.01.05  Bexarotene
    Bexarotene caps
    View adult BNF View SPC online
    Formulary
    Red
    Use in accordance with LCNDG guidance 
       
    08.01.05  Bortezomib
    Cytotoxic Drug Bortezomib injection
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
    Cancer Drugs Fund

    For relapsed multiple myeloma as per criteria in the Cancer Drugs Fund

     
    Link  NICE TA129: Bortezomib monotherapy for relapsed multiple myeloma
    Link  NICE TA228: Bortezomib and thalidomide for the first‑line treatment of multiple myeloma
    Link  NICE TA311: Bortezomib for induction therapy in multiple myeloma before high-dose chemotherapy and autologous stem cell transplantation
    Link  NICE TA370: Bortezomib for previously untreated mantle cell lymphoma
    Link  NICE TA573: Daratumumab with bortezomib and dexamethasone for previously treated multiple myeloma
       
    08.01.05  Cetuximab
    Cetuximab injection (colorectal cancer)
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
    BlueTeq

    Approved for use as per NICE technology appraisal guidance (see links below)

     
    Link  MHRA Feb 2014: Cetuximab: Importance of establishing wild type RAS (KRAS and NRAS) status before treatment of metastatic colorectal cancer
    Link  NICE TA439: Cetuximab and panitumumab for previously untreated metastatic colorectal cancer
       
    Cetuximab injection (head and neck cancer)
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
    BlueTeq

    Approved for use as per NICE technology appraisal guidance (see links below)

     
    Link  NICE TA145: Cetuximab for the treatment of locally advanced squamous cell cancer of the head and neck
    Link  NICE TA473: Cetuximab for treating recurrent or metastatic squamous cell cancer of the head and neck
       
    08.01.05  Crisantaspase
    Crisantaspase injection
    View adult BNF View SPC online
    Formulary
    Red
     
       
    Asparaginase injection
    View adult BNF View SPC online
    Unlicensed Drug Unlicensed
    Red
    Acute lymphoid leukaemia 
       
    08.01.05  Dacarbazine and Temozolomide to top
    Cytotoxic Drug Dacarbazine injection
    View adult BNF View SPC online
    Formulary
    Red
     
       
    Cytotoxic Drug Temozolomide caps (licensed use)
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine

    Approved as per NICE technology appraisal guidance

     
    Link  NICE TA121: Carmustine implants and temozolomide for the treatment of newly diagnosed high-grade glioma
    Link  NICE TA23: Guidance on the use of temozolomide for the treatment of recurrent malignant glioma (brain cancer)
       
    Cytotoxic Drug Temozolomide caps (pancreatic neuroendocrine tumours - off-label)
    View adult BNF View SPC online
    Restricted Drug Restricted
    Red

    Approved off-label indication:

  • Unresectable or metastatic pancreatic neuroendocrine tumours (in combination with capecitabine). Follow local protocol for use. 
  •    
    Cytotoxic Drug Temozolomide caps (pituitary adenomas - off-label)
    View adult BNF View SPC online
    Restricted Drug Restricted
    Red

    Approved off-label indication:

    Treatment of pituitary adenomas refractory to surgery and radiotherapy

    Initiation restricted to Consultant Endocrinologists who are part of the Trust MDM, in accordance with a treatment protocol at KCH

     
       
    08.01.05  Erlotinib
    Erlotinib tabs
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine

     
    Link  NICE TA258: Erlotinib for the first-line treatment of locally advanced or metastatic EGFR-TK mutation-positive non-small-cell lung cancer
    Link  NICE TA374: Erlotinib and gefitinib for treating non-small-cell lung cancer that has progressed after prior chemotherapy
       
    08.01.05  Hydroxycarbamide
    Cytotoxic Drug Hydroxycarbamide caps, tabs
    View adult BNF View SPC online
    Formulary

    Red Traffic Light Cancer indications

    Amber Traffic Light Non-cancer licensed indications

     
       
    08.01.05  Imatinab
    Imatinib tabs (licensed commissioned use)
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine

    Approved as per NICE TA guidance (links below)

    Also approved for newly diagnosed Philadelphia chromosome positive acute lymphoblastic leukaemia (Ph+ ALL) (NHSE commissioned)

     
    Link  NICE TA326: Imatinib for the adjuvant treatment of gastrointestinal stromal tumours
    Link  NICE TA426: Dasatinib, nilotinib and imatinib for untreated chronic myeloid leukaemia
    Link  NICE TA70: Guidance on the use of imatinib for chronic myeloid leukaemia
    Link  NICE TA86: Imatinib for the treatment of unresectable and/or metastatic gastro-intestinal stromal tumours
       
    Imatinib tabs (Graft vs Host Disease - off-label)
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine

    Approved off-label indication:

    Treatment of Graft vs Host Disease (GvHD) following Haematopoietic Stem Cell Transplantation as per NHSE policy 16069/P

     

     
    Link  NHS England Clinical Commissioning Policy 16069/P: Treatments for Graft versus Host Disease (GvHD) following Haematopoietic Stem Cell Transplantation
       
    08.01.05  Ipilimumab
    Ipilimumab injection
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine

    Approved as per NICE TA Guidance (see links below)

     
    Link  MHRA Jan 2019: Ipilimumab (Yervoy): reports of cytomegalovirus (CMV) gastrointestinal infection or reactivation
    Link  NICE TA268: Ipilimumab for previously treated advanced (unresectable or metastatic) melanoma
    Link  NICE TA319: Ipilimumab for previously untreated advanced (unresectable or metastatic) melanoma
    Link  NICE TA400: Nivolumab in combination with ipilimumab for treating advanced melanoma
    Link  NICE TA581: Nivolumab with ipilimumab for untreated advanced renal cell carcinoma
       
    08.01.05  Mitotane to top
    Mitotane tabs
    View adult BNF View SPC online
    Restricted Drug Restricted
    Red

    Treatment of patients with:

    • Biochemical or radiological evidence of persistent or relapsed adrenocortical carcinoma
    • Apparent complete resection of adrenocortical carcinoma for adjuvant therapy
     
       
    08.01.05  Pentostatin
    Cytotoxic Drug Pentostatin injection (Graft vs Host Disease - off-label)
    View adult BNF View SPC online
    Formulary
    Red

    Approved off-label indication:

    Treatment of Graft vs Host Disease (GvHD) following Haematopoietic Stem Cell Transplantation as per NHSE policy 16069/P

     

     
    Link  NHS England Clinical Commissioning Policy 16069/P: Treatments for Graft versus Host Disease (GvHD) following Haematopoietic Stem Cell Transplantation
       
    Cytotoxic Drug Pentostatin injection (licensed use)
    View adult BNF View SPC online
    Formulary
    Red

     
       
    08.01.05  Platinum compounds
    Cytotoxic Drug Carboplatin injection
    View adult BNF View SPC online
    Formulary
    Red
     
       
    Cytotoxic Drug Cisplatin injection
    View adult BNF View SPC online
    Formulary
    Red
     
       
    Cytotoxic Drug Oxaliplatin injection
    View adult BNF View SPC online
    Formulary
    Red
     
    Link  NICE CG131: Colorectal cancer: diagnosis and management
    Link  NICE TA100: Capecitabine and oxaliplatin in the adjuvant treatment of stage III (Dukes’ C) colon cancer
       
    08.01.05  Procarbazine
    Cytotoxic Drug Procarbazine caps
    View adult BNF View SPC online
    Formulary
    Red
     
       
    08.01.05  Protein kinase inhibitors
    Afatinib tabs
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
     
    Link  NICE TA310: Afatinib for treating epidermal growth factor receptor mutation-positive locally advanced or metastatic non-small-cell lung cancer
       
    Cabozantinib caps (Cometriq - thyroid cancer)
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine

    Approved as per NICE Technology Appraisal guidance (see links below): 

     

     
    Link  NICE TA516: Cabozantinib for treating medullary thyroid cancer
       
    Cabozantinib tablets (Cabometyx - renal carcinoma)
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
    BlueTeq

    Approved as per NICE Technology Appraisal guidance (see links below): 

     

     
    Link  NICE TA463: Cabozantinib for previously treated advanced renal cell carcinoma
    Link  NICE TA542: Cabozantinib for untreated advanced renal cell carcinoma
       
    Crizotinib caps
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
    BlueTeq

    Approved for use as per NICE technology appraisal guidance (see links below):


     
    Link  NICE TA406: Crizotinib for untreated anaplastic lymphoma kinase-positive advanced non-small-cell lung cancer
    Link  NICE TA422: Crizotinib for previously treated anaplastic lymphoma kinase-positive advanced non-small-cell lung cancer
    Link  NICE TA529: Crizotinib for treating ROS1-positive advanced non-small-cell lung cancer
       
    Dasatinib tabs
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
    BlueTeq

     
    Link  NICE TA425: Dasatinib, nilotinib and high-dose imatinib for treating imatinib-resistant or intolerant chronic myeloid leukaemia
    Link  NICE TA426: Dasatinib, nilotinib and imatinib for untreated chronic myeloid leukaemia
       
    Everolimus tabs (breast cancer)
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
    BlueTeq

    Approved as per NICE TA guidance (see links below)

     
    Link  NICE TA421: Everolimus with exemestane for treating advanced breast cancer after endocrine therapy
       
    Everolimus tabs (neuroendocrine tumours)
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
    BlueTeq

    Approved for use in neuroendocrine tumours as per NICE TA449

     
    Link  NICE TA449: Everolimus and sunitinib for treating unresectable or metastatic neuroendocrine tumours in people with progressive disease
       
    Everolimus tabs (renal cancer)
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
    BlueTeq

    Approved as per NICE TA guidance (see links below)

     
    Link  NICE TA432: Everolimus for advanced renal cell carcinoma after previous treatment
    Link  NICE TA498: Lenvatinib with everolimus for previously treated advanced renal cell carcinoma
       
    Everolimus tabs (seizures associated with tuberous sclerosis complex)
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine

    Approved for use in refractory seizures associated with tuberous sclerosis complex as per NHSE Clinical Commissioning Policy

     
    Link  NHSE Clinical Commissioning Policy 170093P: Everolimus for refractory focal onset seizures associated with tuberous sclerosis complex
       
    Gefitinib tabs
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine

    Approved for use as per NICE technology appraisal guidance (see links below):

     
    Link  NICE TA192: Gefitinib for the first-line treatment of locally advanced or metastatic non-small-cell lung cancer
       
    Lenvatinib caps (hepatocellular carcinoma - Lenvima®)
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine

    Approved for use as per NICE technology appraisal guidance below

     
    Link  NICE TA551: Lenvatinib for untreated advanced hepatocellular carcinoma
       
    Lenvatinib caps (renal cancer - Kisplyx®)
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine

    Approved as per NICE TA guidance (see links below)

     

     
    Link  NICE TA498: Lenvatinib with everolimus for previously treated advanced renal cell carcinoma
       
    Lenvatinib caps (thyroid cancer - Lenvima®)
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine

    Approved for use as per NICE technology appraisal guidance below

     
    Link  NICE TA535: Lenvatinib and sorafenib for treating differentiated thyroid cancer after radioactive iodine
       
    Nilotinib caps
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
    BlueTeq

     
    Link  NICE TA425: Dasatinib, nilotinib and high-dose imatinib for treating imatinib-resistant or intolerant chronic myeloid leukaemia
    Link  NICE TA426: Dasatinib, nilotinib and imatinib for untreated chronic myeloid leukaemia
       
    Nintedanib caps (Vargatef® Non-small-cell lung cancer)
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine

    Approved for use in NSCLC as per NICE TA347

     
    Link  NICE TA347: Nintedanib for previously treated locally advanced, metastatic, or locally recurrent non‑small‑cell lung cancer
       
    Osimertinib tabs
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
    Cancer Drugs Fund

     
    Link  NICE TA416: Osimertinib for treating locally advanced or metastatic EGFR T790M mutation-positive non-small-cell lung cancer
       
    Pazopanib tabs
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
     
    Link  NICE TA215: Pazopanib for the first-line treatment of advanced renal cell carcinoma
       
    Sorafenib tablets (Hepatocellular carcinoma)
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
    BlueTeq

    Approved as per NICE Technology Appraisal guidance

     
    Link  NICE TA474: Sorafenib for treating advanced hepatocellular carcinoma
       
    Sorafenib tablets (thyroid cancer)
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine

    Approved as per NICE Technology Appraisal guidance

     
    Link  NICE TA535: Lenvatinib and sorafenib for treating differentiated thyroid cancer after radioactive iodine
       
    Sunitinib caps (neuroendocrine tumours)
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
    BlueTeq

    Approved for use in neuroendocrine tumours as per NICE TA449

     
    Link  MHRA Jan 2011: Bevacizumab and sunitinib: risk of osteonecrosis of the jaw
    Link  NICE TA449: Everolimus and sunitinib for treating unresectable or metastatic neuroendocrine tumours in people with progressive disease
       
    Sunitinib caps (renal cell, and gastrointestinal stromal tumours)
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
    Approved for use in renal cell and gastrointestinal stromal tumours as per NICE TA169 and NICE TA179 
    Link  MHRA Jan 2011: Bevacizumab and sunitinib: risk of osteonecrosis of the jaw
    Link  NICE TA169: Sunitinib for the first-line treatment of advanced and/or metastatic renal cell carcinoma
    Link  NICE TA179: Sunitinib for the treatment of gastrointestinal stromal tumours
       
    Tivozanib caps
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine

    Approved as per NICE TA guidance (see links below)

     
    Link  NICE TA512: Tivozanib for treating advanced renal cell carcinoma
       
    Vemurafenib tabs
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
     
    Link  NICE TA269: Vemurafenib for treating locally advanced or metastatic BRAF V600 mutation‑positive malignant melanoma
       
    08.01.05  Taxanes to top
    Cytotoxic Drug Cabazitaxel injection
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
    BlueTeq

     
    Link  NICE TA391: Cabazitaxel for hormone-relapsed metastatic prostate cancer treated with docetaxel
       
    Cytotoxic Drug Docetaxel injection
    View adult BNF View SPC online
    Formulary
    Red
     
    Link  NICE TA101: Docetaxel for the treatment of hormone-refractory metastatic prostate cancer
    Link  NICE TA109: Docetaxel for the adjuvant treatment of early node-positive breast cancer
       
    Cytotoxic Drug Paclitaxel albumin injection (Abraxane)
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
    BlueTeq

    Approved as per NICE Technology Appraisal guidance

     
    Link  NICE TA476: Paclitaxel as albumin-bound nanoparticles with gemcitabine for untreated metastatic pancreatic cancer
       
    Cytotoxic Drug Paclitaxel injection
    View adult BNF View SPC online
    Formulary
    Red

     
    Link  NICE TA389: Topotecan, pegylated liposomal doxorubicin hydrochloride, paclitaxel, trabectedin and gemcitabine for treating recurrent ovarian cancer
    Link  NICE TA55: Guidance on the use of paclitaxel in the treatment of ovarian cancer
       
    08.01.05  Topoisomerase I inhibitors
    Cytotoxic Drug Irinotecan Hydrochloride injection
    View adult BNF View SPC online
    Formulary
    Red
     
    Link  NICE CG131: Colorectal cancer: diagnosis and management
       
    Cytotoxic Drug Topotecan injection
    View adult BNF View SPC online
    Formulary
    Red

     
    Link  NICE TA183: Topotecan for the treatment of recurrent and stage IVB cervical cancer
    Link  NICE TA184: Topotecan for the treatment of relapsed small-cell lung cancer
       
    08.01.05  Trabectedin
    Cytotoxic Drug Trabectedin injection
    View adult BNF View SPC online
    Formulary
    Red
     
    Link  NICE TA185: Trabectedin for the treatment of advanced soft tissue sarcoma
       
    08.01.05  Trastuzumab
    Cytotoxic Drug Trastuzumab emtansine injection
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
    BlueTeq

     
    Link  NICE TA458: Trastuzumab emtansine for treating HER2-positive advanced breast cancer after trastuzumab and a taxane
       
    Cytotoxic Drug Trastuzumab injection
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine

    Biosimilar products available, to be prescribed by brand name.

    Contact pharmacy department for advice on brand for routine prescribing if unsure

     
    Link  NICE TA107: Trastuzumab for the adjuvant treatment of early-stage HER2-positive breast cancer
    Link  NICE TA208: Trastuzumab for the treatment of HER2-positive metastatic gastric cancer
    Link  NICE TA34: Guidance on the use of trastuzumab for the treatment of advanced breast cancer
       
    08.01.05  Tretinoin
    Tretinoin caps
    View adult BNF View SPC online
    Formulary
    Red
     
       
    08.02  Drugs affecting the immune response to top
    08.02.01  Antiproliferative immunosuppressants
    Cytotoxic Drug Azathioprine tabs (neurology indications, including off-label use)
    View adult BNF View SPC online
    Formulary
    Amber 3

    Refer to SE London immunomodulatory shared care guidance for list of indications (link below at end of BNF section)

     
       
    Ciclosporin caps, oral solution (neurology indications - off-label)
    View adult BNF View SPC online
    Formulary
    Amber 3

    Refer to SE London immunomodulatory shared care guidance for list of indications (link below at end of BNF section)

     
       
    Hydroxychloroquine tabs (neurology indications - off-label)
    View adult BNF View SPC online
    Formulary
    Amber 3

    Refer to SE London immunomodulatory shared care guidance for list of indications (link below at end of BNF section)

     
       
    Leflunomide tabs (neurology indications - off-label)
    View adult BNF View SPC online
    Formulary
    Amber 3

    Refer to SE London immunomodulatory shared care guidance for list of indications (link below at end of BNF section)

     
       
    Cytotoxic Drug Methotrexate tabs (neurology indications - off-label)
    View adult BNF View SPC online
    Formulary
    Amber 3

    Refer to SE London immunomodulatory shared care guidance for list of indications (link below at end of BNF section)

     
       
    Mycophenolate mofetil tabs, caps, suspension (neurology indications - off-label)
    View adult BNF View SPC online
    Formulary
    Amber 3

    Refer to SE London immunomodulatory shared care guidance for list of indications (link below at end of BNF section)

     
       
    Cytotoxic Drug Azathioprine tabs (liver transplant)
    View adult BNF View SPC online
    Formulary

    Immunosuppression in liver transplant Red Traffic Light for new patients

    Amber Traffic Light for patients currently receiving prescriptions in primary care (see shared care link below)

     
    Link  SE London APC Shared Care Guideline: Azathioprine in adult liver transplant patients
       
    Cytotoxic Drug Azathioprine tabs, injection (renal transplant)
    View adult BNF View SPC online
    Formulary
    Red

    Immunosuppression in renal transplant

    10mg capsules are also available for patients who require smaller doses (unlicensed product).

     
       
    Mycophenolate mofetil tabs, caps, suspension, injection (liver transplant)
    View adult BNF View SPC online
    Formulary

    Imunnosupressant in liver transplant patients Red Traffic Light for new patients

    Amber Traffic Light for patients currently receiving prescriptions in primary care (see shared care link below)

     
    Link  SE London APC Shared Care Guidance: Mycophenolate mofetil in liver transplant patients
       
    Mycophenolate mofetil tabs, caps, suspension, injection (renal transplant)
    View adult BNF View SPC online
    Formulary
    Red

    Imunnosupressant in renal transplant patients

     
    Link  NICE TA481: Immunosuppressive therapy for kidney transplant in adults
    Link  NICE TA482: Immunosuppressive therapy for kidney transplant in children and young people
       
    Mycophenolate sodium tablets (renal transplant)
    View adult BNF View SPC online
    Restricted Drug Restricted
    Red
    High Cost Medicine

    Only approved for continuing treatment of renal transplant patients

    Prescribers who want to initiate mycophenolic acid for other indications must first discuss with, and get agreement from, the patient’s GP about arrangements for ongoing prescribing

     
       
    Mepacrine tabs (discoid lupus)
    View adult BNF
    Unlicensed Drug Unlicensed
    Red

    Discoid lupus erythematosus (lupus consultants only)

    Dose: from 50 mg three times a week to a maximum dose of 100 mg three times a day

    PIL available on GTi at GSTFT

     
       
    08.02.02  Corticosteroids and other immunosuppressants
    Antithymocyte immunoglobulin injection (ATG)
    View adult BNF
    Formulary
    Red
    High Cost Medicine

    Approved off-label indication:

    Aplastic anaemia

     
       
    Antithymocyte immunoglobulin injection (ATG)
    View adult BNF
    Formulary
    Red
    High Cost Medicine
    Renal transplantation and graft rejection 
       
    Basiliximab injection
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
    Use as per NICE guidance for immunosuppressive therapy for renal transplantation 
    Link  NICE TA481: Immunosuppressive therapy for kidney transplant in adults
    Link  NICE TA482: Immunosuppressive therapy for kidney transplant in children and young people
       
    Ciclosporin caps, oral liquid, injection (renal transplant)
    View adult BNF View SPC online
    Formulary
    Red

    Immunosuppression in renal transplant

     
       
    Mycophenolate mofetil tabs, caps, suspension (Graft vs Host Disease - off-label)
    View adult BNF View SPC online
    Formulary
    Red

    Approved off-label indication:

    Treatment of Graft vs Host Disease (GvHD) following Haematopoietic Stem Cell Transplantation as per NHSE policy 16069/P

     
    Link  NHS England Clinical Commissioning Policy 16069/P: Treatments for Graft versus Host Disease (GvHD) following Haematopoietic Stem Cell Transplantation
       
    Mycophenolate mofetil tabs, caps, suspension (immune checkpoint inhibitor therapy related adverse events - off-label)
    View adult BNF View SPC online
    Formulary
    Red

    Approved off-label indication:

    Management of immune-related adverse events including hepatotoxicity, pneumonitis and cardiac toxicity in patients treated with immune checkpoint inhibitor therapy

     
       
    Sirolimus tabs (Graft vs Host Disease - off-label)
    View adult BNF View SPC online
    Formulary
    Red

    Approved off-label indication:

    Treatment of Graft vs Host Disease (GvHD) following Haematopoietic Stem Cell Transplantation as per NHSE policy 16069/P

     
    Link  NHS England Clinical Commissioning Policy 16069/P: Treatments for Graft versus Host Disease (GvHD) following Haematopoietic Stem Cell Transplantation
       
    Sirolimus tabs, oral solution (renal transplant)
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine

     
    Link  NICE TA481: Immunosuppressive therapy for kidney transplant in adults
    Link  NICE TA482: Immunosuppressive therapy for kidney transplant in children and young people
       
    Tacrolimus caps (Graft vs Host Disease - off-label)
    View adult BNF View SPC online
    Formulary
    Red

    Approved off-label indication:

    Treatment of Graft vs Host Disease (GvHD) following Haematopoietic Stem Cell Transplantation as per NHSE policy 16069/P

     
    Link  NHS England Clinical Commissioning Policy 16069/P: Treatments for Graft versus Host Disease (GvHD) following Haematopoietic Stem Cell Transplantation
       
    Tacrolimus caps (immune checkpoint inhibitor therapy related adverse events - off-label)
    View adult BNF View SPC online
    Formulary
    Red

    Approved off-label indication:

    Management of immune-related adverse events including hepatotoxicity in patients treated with immune checkpoint inhibitor therapy

     
       
    Tacrolimus m/r caps (Advagraf®, Prograf® - liver transplant)
    View adult BNF View SPC online
    Formulary

    Must be prescribed by brand name

    For prevention of transplant rejection in liver transplant

    Red Traffic Light for new patients

    Amber Traffic Light for patients currently receiving prescriptions in primary care (see shared care link below)

     
    Link  MHRA advice: oral tacrolimus products: prescribe and dispense by brand. June 2012
    Link  MHRA Nov 2017: Oral tacrolimus products: reminder to prescribe and dispense by brand name only
    Link  SE London APC Shared Care Guideline: Continuation of Advagraf (tacrolimus MR caps) in liver transplant patients
    Link  SE London APC Shared Care Guideline: Continuation of Prograf (tacrolimus caps) in liver transplant patients
       
    Tacrolimus m/r caps, injection (Advagraf®, Prograf®, Adoport® Envarsus® View adult BNF View SPC online Formulary
    Red

    Must be prescribed by brand name

    Envarsus brand restricted to use in patients who have failed to tolerate, or had persistently low tacrolimus levels with Adoport and generic once daily tacrolimus preparations

    For prevention of transplant rejection in renal transplant

     
    Link  MHRA advice: oral tacrolimus products: prescribe and dispense by brand. June 2012
    Link  MHRA Nov 2017: Oral tacrolimus products: reminder to prescribe and dispense by brand name only
    Link  NICE TA481: Immunosuppressive therapy for kidney transplant in adults
    Link  NICE TA482: Immunosuppressive therapy for kidney transplant in children and young people
       
    08.02.03  Anti-lymphocyte monoclonal antibodies
    Alemtuzumab injection (multiple sclerosis)
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
    BlueTeq

    Use in accordance with NHSE commissioning policy for disease modifying therapies for patients with Multiple Sclerosis (see link below)

    A separate NHSE treatment algorithm for Multiple Sclerosis Disease-modifying Therapies is also provided below.

     
    Link  MHRA Drug Safety Update May 19: Lemtrada (alemtuzumab) and serious cardiovascular and immune-mediated adverse reactions: new restrictions to use and strengthened monitoring requirements
    Link  NHSE Policy D04/P/b: Disease Modifying Therapies for Patients with Multiple Sclerosis (MS)
    Link  NHSE Treatment Algorithm for Multiple Sclerosis Disease-modifying Therapies
    Link  NHSE Treatment Algorithm for Multiple Sclerosis Disease-modifying Therapies: Graphic
    Link  NICE TA312: Alemtuzumab for treating relapsing‑remitting multiple sclerosis
       
    Blinatumomab injection
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
    BlueTeq

    Approved as per NICE technology appraisal guidance (see links below)

     
    Link  NICE TA450: Blinatumomab for previously treated Philadelphia-chromosome-negative acute lymphoblastic leukaemia
    Link  NICE TA589: Blinatumomab for treating acute lymphoblastic leukaemia in remission with minimal residual disease activity
       
    Obinutuzumab injection
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
    Cancer Drugs Fund
    Approved for use as per NICE technology appraisal guidance 
    Link  NICE TA343: Obinutuzumab in combination with chlorambucil for untreated chronic lymphocytic leukaemia
    Link  NICE TA472: Obinutuzumab with bendamustine for treating follicular lymphoma refractory to rituximab
    Link  NICE TA513: Obinutuzumab for untreated advanced follicular lymphoma
       
    Ofatumumab injection
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
     
    Link  NICE TA344: Ofatumumab in combination with chlorambucil or bendamustine for untreated chronic lymphocytic leukaemia
       
    Rituximab injection (haematological malignancies)
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine

    Use approved as per NICE TA guidance links below.

    Also approved for HIV associated Castleman's disease (NHSE commissioned)

    Biosimilar products available, to be prescribed by brand name.

    Contact pharmacy department for advice on brand for routine prescribing if unsure

    See also separate NHSE policies for use with bendamustine (link below)

     
    Link  Clinical commissioning policy: Bendamustine with rituximab for first line treatment of advanced indolent non-Hodgkin’s lymphoma (all ages) (170055P)
    Link  Clinical Commissioning Policy: Bendamustine with rituximab for first line treatment of mantle cell lymphoma (all ages) (17088P)
    Link  Clinical Commissioning Policy: Bendamustine with rituximab for relapsed and refractory mantle cell lymphoma (all ages) (170054P
    Link  NICE TA137: Rituximab for the treatment of relapsed or refractory stage III or IV follicular non-Hodgkin’s lymphoma
    Link  NICE TA174: Rituximab for the first-line treatment of chronic lymphocytic leukaemia
    Link  NICE TA193: Rituximab for the treatment of relapsed or refractory chronic lymphocytic leukaemia
    Link  NICE TA226: Rituximab for the first-line maintenance treatment of follicular non-Hodgkin’s lymphoma
    Link  NICE TA243: Rituximab for the first-line treatment of stage III-IV follicular lymphoma
       
    Rituximab injection (TTP - off-label)
    View adult BNF View SPC online
    Restricted Drug Restricted
    Red
    High Cost Medicine

    Approved off-label indication (haematology only):

    Thrombotic thrombocytopenic purpura (TTP) with neurological, cardiac or renal pathology

    Dose = 375 mg/m2 every 7 days for 4 doses

    Biosimilar products available, to be prescribed by brand name.

    Contact pharmacy department for advice on brand for routine prescribing if unsure

     
       
    Rituximab subcutaneous injection (haematological malignancies)
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine

    Maintenance single agent treatment (as per NHSE circular) for:

    • Follicular Lymphoma
    • Mantle cell lymphoma
    • Marginal zone lymphoma
    • Lymphoplasmacytic lymphoma

    Biosimilar products available, to be prescribed by brand name.

    Contact pharmacy department for advice on brand for routine prescribing if unsure

     
       
    Gemtuzumab ozogamicin infusion
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine

    Approved for use as per NICE Technology Appraisal guidance 545

     
    Link  NICE TA545: Gemtuzumab ozogamicin for untreated acute myeloid leukaemia
       
    Rituximab injection (Graft vs Host Disease - off-label)
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine

    Approved off-label indication:

    Treatment of Graft vs Host Disease (GvHD) following Haematopoietic Stem Cell Transplantation as per NHSE policy 16069/P

     
    Link  NHS England Clinical Commissioning Policy 16069/P: Treatments for Graft versus Host Disease (GvHD) following Haematopoietic Stem Cell Transplantation
       
    Rituxmab injection (anti-NMDAR autoimmune encephalitis - off-label)
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine

    Approved off-label indication:

    anti-NMDAR autoimmune encephalitis (second line) as per criteria in NHSE Commissioning Policy 170039P

    Biosimilar product to be used and prescribed by brand name.

    Contact pharmacy department for advice on brand for routine prescribing if unsure

     
    Link  NHSE Clinical Commissioning Policy 170039P: Rituximab for second line treatment for anti-NMDAR autoimmune encephalitis (all ages)
       
    Rituximab injection (renal transplant - off-label)
    View adult BNF View SPC online
    Restricted Drug Restricted
    Red
    High Cost Medicine

    Approved off-label indications:

    • Management of antibody mediated rejection in adult renal transplant patients
    • For ABO blood group and HLA antibody incompatible renal transplantation

    Use in accordance with local guidelines at GSTFT Biosimilar products available, to be prescribed by brand name.

    Contact pharmacy department for advice on brand for routine prescribing if unsure

     
       
    Alemtuzumab injection (use in renal and/or pancreas transplant)
    View adult BNF View SPC online
    Unlicensed Drug Unlicensed
    Red

    Induction immunosuppression:

    • For human leukocyte antigen antibody incompatible renal and/or pancreas transplantation
    • In high risk recipients who have previously exhibited significant donor specific antibody but are presently negative by flow cytometry crossmatch

    Use in accordance with local guideline at GSTFT

     
    Link  MHRA Drug Safety Update May 19: Lemtrada (alemtuzumab) and serious cardiovascular and immune-mediated adverse reactions: new restrictions to use and strengthened monitoring requirements
       
    08.02.04  Other immunomodulating drugs
     note  USE UNDER SPECIALIST SUPERVISION ONLY
    BCG bladder instillation
    View adult BNF View SPC online
    Formulary
    Red
    Use in accordance with the “Protocol for the administration of intravesicular chemo or immuno-therapeutic drugs” at GSTFT 
       
    Cytotoxic Drug Cladribine tabs (multiple sclerosis)
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
    BlueTeq

    Use in accordance with NHSE commissioning policy for disease modifying therapies for patients with Multiple Sclerosis (see links below)

    A separate NHSE treatment algorithm for Multiple Sclerosis Disease-modifying Therapies is also provided below.

     
    Link  NICE TA493: Cladribine tablets for treating relapsing–remitting multiple sclerosis
       
    Daratumumab injection
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
    Cancer Drugs Fund

    Approved for use as per NICE technology appraisal guidance (links below)

     
    Link  MHRA Aug 19: Daratumumab (Darzalex▼): risk of reactivation of hepatitis B virus
    Link  NICE TA510: Daratumumab monotherapy for treating relapsed and refractory multiple myeloma
    Link  NICE TA573: Daratumumab with bortezomib and dexamethasone for previously treated multiple myeloma
       
    Dimethyl fumarate caps (Tecfidera - multiple sclerosis)
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
    BlueTeq

    Use in accordance with NHSE commissioning policy for disease modifying therapies for patients with Multiple Sclerosis (see links below)

    A separate NHSE treatment algorithm for Multiple Sclerosis Disease-modifying Therapies is also provided below.

     
    Link  NICE TA320: Dimethyl fumarate for treating relapsing‑remitting multiple sclerosis
       
    Fingolimod caps
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
    BlueTeq

    Use in accordance with NHSE commissioning policy for disease modifying therapies for patients with Multiple Sclerosis (see links below)

    A separate NHSE treatment algorithm for Multiple Sclerosis Disease-modifying Therapies is also provided below.

     
    Link  MHRA Apr 2016: Fingolimod: risks of progressive multifocal leukoencephalopathy, basal-cell carcinoma, and opportunistic infections
    Link  MHRA Apr 2017: MS therapies; rebound effect after stopping or switching therapies
    Link  MHRA Jan 2013: Fingolimod: bradycardia and heart block
    Link  MHRA May 2012: Fingolimod: not recommended for patients at known risk of cardiovascular adverse events
    Link  MHRA Sept 2019: Fingolimod (Gilenya▼): increased risk of congenital malformations; new contraindication during pregnancy and in women of childbearing potential not using effective contraception
    Link  NICE TA254: Fingolimod for highly active relapsing remitting multiple sclerosis
       
    Ixazomib caps
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
    Cancer Drugs Fund

    Approved for use as per NICE Technology Appraisal guidance (see links below):

     
    Link  NICE TA505: Ixazomib with lenalidomide and dexamethasone for treating relapsed or refractory multiple myeloma
       
    Lenalidomide caps
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine

    Approved for use as per NICE Technology Appraisal guidance (see links below):

     
    Link  NICE TA171: Lenalidomide for the treatment of multiple myeloma in people who have received at least one prior therapy
    Link  NICE TA322: Lenalidomide for treating myelodysplastic syndromes associated with an isolated deletion 5q cytogenetic abnormality
    Link  NICE TA586: Lenalidomide plus dexamethasone for multiple myeloma after 1 treatment with bortezomib
    Link  NICE TA587: Lenalidomide plus dexamethasone for previously untreated multiple myeloma
       
    Lenalidomide caps
    View adult BNF View SPC online
    Restricted Drug Restricted
    Red
    High Cost Medicine

    Approved off-label indication (consultant haematologist only):

    Treatment of relapsed/refractory B cell and T cell lymphoma in accordance with agreed compassionate use scheme

     
       
    Mifamurtide injection
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
     
    Link  NICE TA235: Mifamurtide for the treatment of osteosarcoma
       
    Ocrelizumab injection
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
    BlueTeq

    Approved for use as per NICE technology appraisal guidance (links below)

     
    Link  NICE TA533: Ocrelizumab for treating relapsing–remitting multiple sclerosis
    Link  NICE TA585: Ocrelizumab for treating primary progressive multiple sclerosis
       
    Pomalidomide caps
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
    BlueTeq

     
    Link  NICE TA427: Pomalidomide for multiple myeloma previously treated with lenalidomide and bortezomib
       
    Teriflunomide tablets
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
    BlueTeq

    Use in accordance with NHSE commissioning policy for disease modifying therapies for patients with Multiple Sclerosis (see links below)

    A separate NHSE treatment algorithm for Multiple Sclerosis Disease-modifying Therapies is also provided below.

     
    Link  NICE TA303: Teriflunomide for treating relapsing–remitting multiple sclerosis
       
    Thalidomide caps (multiple myeloma)
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
     
    Link  NICE TA228: Bortezomib and thalidomide for the first‑line treatment of multiple myeloma
       
    Thalidomide caps (off-label haematology indications)
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
    Approved off-label indications (consultant haematologist only):
  • Relapsed multiple myeloma (use in accordance with Local Cancer Network Protocol)
  • Myelofibrosis (use in accordance with local guideline at GSTFT) 
  •    
    08.02.04  Interferon Alfa to top
     note  USE UNDER SPECIALIST SUPERVISION ONLY
    Interferon alfa-2a injection
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
     
       
    Interferon alfa-2b injection
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
     
       
    Peginterferon alfa-2a injection
    View adult BNF View SPC online
    Restricted Drug Restricted
    Red
    High Cost Medicine

    SPECIALIST USE ONLY

    See entry in chapter 5 and NHSE and NICE guidance below

     
       
    Peginterferon alfa-2a injection
    (myeloproliferative disease)
    View adult BNF View SPC online
    Restricted Drug Restricted
    Red
    High Cost Medicine
    NHS England

    Approved off-label indication (consultant heamatologist only):

    Myeloproliferative disease as per the Pan-London Haemato-Oncology Myeloproliferative Neoplasm Guideline

     

     
       
    Peginterferon alfa-2b injection (chronic hep C)
    View adult BNF View SPC online
    Restricted Drug Restricted
    Red
    High Cost Medicine

    SPECIALIST USE ONLY

    See entry in chapter 5 and NHSE and NICE guidance below

     
       
    08.02.04  Interferon beta
     note  USE UNDER SPECIALIST SUPERVISION ONLY
    Interferon beta-1a injection (multiple sclerosis )
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
    BlueTeq

    Use in accordance with NHSE commissioning policy for disease modifying therapies for patients with Multiple Sclerosis (see links above)

    A separate NHSE treatment algorithm for Multiple Sclerosis Disease-modifying Therapies is also provided above.

     
    Link  NICE TA527: Beta interferons and glatiramer acetate for treating multiple sclerosis
       
    Interferon beta-1b injection (multiple sclerosis )
    View adult BNF View SPC online
    Formulary
    Red
    BlueTeq

    Use in accordance with NHSE commissioning policy for disease modifying therapies for patients with Multiple Sclerosis (see links above).

    A separate NHSE treatment algorithm for Multiple Sclerosis Disease-modifying Therapies is also provided above.

    Note: ONLY Interferon beta‑1b (Extavia) is recommended as an option for treating multiple sclerosis under certain criteria. Interferon beta‑1b (Betaferon) is NOT recommended. 

     
    Link  NICE TA527: Beta interferons and glatiramer acetate for treating multiple sclerosis
       
    Peginterferon beta-1a injection
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
    BlueTeq

    For use in line with NHSE SSC 1534 Multiple Sclerosis: First line disease modifying agents

     
       
    08.02.04  Aldesleukin
    Aldesleukin injection
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
     
       
    08.02.04  Glatiramer acetate
     note  USE UNDER SPECIALIST SUPERVISION ONLY
    Glatiramer acetate injection
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
    BlueTeq

    Use in accordance with NHSE commissioning policy for disease modifying therapies for patients with Multiple Sclerosis (see links above)

    A separate NHSE treatment algorithm for Multiple Sclerosis Disease-modifying Therapies is also provided above.

     
    Link  NICE TA527: Beta interferons and glatiramer acetate for treating multiple sclerosis
       
    08.02.04  Natalizumab
     note  USE UNDER SPECIALIST SUPERVISION ONLY
    Natalizumab injection
    View adult BNF View SPC online
    Restricted Drug Restricted
    Red
    High Cost Medicine
    BlueTeq

    Use in accordance with NHSE commissioning policy for disease modifying therapies for patients with Multiple Sclerosis (see links above)

    A separate NHSE treatment algorithm for Multiple Sclerosis Disease-modifying Therapies is also provided above.

    NAMED SPECIALIST CONSULTANTS ONLY

     
    Link  NICE TA127: Natalizumab for the treatment of adults with highly active relapsing–remitting multiple sclerosis
       
    08.03  Sex hormones and hormone antagonists in malignant disease to top
    08.03.01  Oestrogens
    Diethylstilbestrol tabs
    View adult BNF View SPC online
    Formulary
    Amber 2

     
       
    Ethinylestradol tabs
    View adult BNF View SPC online
    Formulary  
       
    08.03.02  Progestogens
    Medroxyprogesterone acetate tabs
    View adult BNF View SPC online
    Formulary
    Amber 2
     
       
    Megestrol acetate tabs
    View adult BNF View SPC online
    Formulary
    Amber 2
     
       
    08.03.03  Androgens
    08.03.04  Hormone antagonists
    08.03.04.01  Breast cancer to top
    Anastrozole tabs
    View adult BNF View SPC online
    Formulary
    Amber 1
     
       
    Exemestane tabs
    View adult BNF View SPC online
    Restricted Drug Restricted
    Amber 1

    Restricted to use in patients intolerant to letrozole or anastrozole

     
       
    Letrozole tabs
    View adult BNF View SPC online
    Formulary
    Amber 1
     
       
    Letrozole tabs
    View adult BNF View SPC online
    Formulary

    Approved off-label indication:

    Fertility preservation in patients undergoing ovarian stimulation prior to chemotherapy in oestrogen receptor postive breast cancer

    Consultant specialists in oncology and fertility only

    Dose = 5 mg daily for 10-15 days during the course of ovarian stimulation

     
       
    Tamoxifen tabs, oral solution
    View adult BNF View SPC online
    Formulary

    Amber Traffic Light For all licensed indications

    Red Traffic Light Gynaecomastia:

    • SPECIALIST USE ONLY
    • Usual course length = 3 months
     
       
    08.03.04.02  Prostate cancer and gonadorelin analogues
    08.03.04.02  Gonadorelin analogues
    Degarelix injection
    View adult BNF View SPC online
    Formulary
    Red
     
    Link  NICE TA404: Degarelix for treating advanced hormone-dependent prostate cancer
       
    08.03.04.02  Anti-androgens
    Leuprorelin acetate prolonged release injection (oncology indications)
    View adult BNF View SPC online
    First Choice
    Amber 1

    Initiation on recommendation of consultant specialist only

    Hospital use = one month injection only (3.75mg) First-line gonadorelin analogue for use in prostate cancer

     
    Abiraterone tabs
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
    BlueTeq

     
    Link  NICE TA259: Abiraterone for castration-resistant metastatic prostate cancer previously treated with a docetaxel-containing regimen
    Link  NICE TA387: Abiraterone for treating metastatic hormone-relapsed prostate cancer before chemotherapy is indicated
       
    Bicalutamide tabs
    View adult BNF View SPC online
    Formulary
    Amber 1
     
       
    Buserelin injection, nasal spray (Suprefact® - prostate cancer)
    View adult BNF View SPC online
    Formulary
    Red
    For prostate carcinoma 
       
    Cyproterone acetate tabs
    View adult BNF View SPC online
    Formulary
    Amber 2
     
       
    Enzalutamide tabs
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine

    Approved as per NICE technology appraisal guidance (see links below)

     
    Link  NICE TA316: Enzalutamide for metastatic hormone‑relapsed prostate cancer previously treated with a docetaxel‑containing regimen
    Link  NICE TA377: Enzalutamide for treating metastatic hormone-relapsed prostate cancer before chemotherapy is indicated
       
    Flutamide tabs
    View adult BNF View SPC online
    Formulary
    Amber 2
     
       
    Goserelin implant (oncology indications)
    View adult BNF View SPC online
    Formulary
    Amber 1

    Initiation on recommendation of consultant specialist only

    Hospital use = one month injection only (3.6mg)

     
       
    Triptorelin SR injection (oncology indications)
    View adult BNF View SPC online
    Formulary
    Amber 1

    Initiation on recommendation of consultant specialist only

    Hospital use = one month injection only

     
       
    08.03.04.03  Somatostatin analogues
    Lanreotide injection
    View adult BNF View SPC online
    Formulary
    High Cost Medicine

    Red Traffic Light For all new patients

    Amber Traffic Light For existing patients managed in primary care

     
       
    Octreotide injection (palliative care)
    View adult BNF View SPC online
    Formulary
    Amber 1

    GPs may be asked to prescribe octreotide injections as part of palliative care in the community setting

    Palliative care recommendation only, with clear instructions on dosing

     
       
    Octreotide injection, depot injection
    View adult BNF View SPC online
    Formulary
    High Cost Medicine

    Red Traffic Light For all new patients

    Amber Traffic Light For existing patients managed in primary care

     
       
    Pasireotide injection
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
    BlueTeq

    Approved for:

    • Cushing's Disease Use as per criteria in NHSE Policy 16052/P
     
    Link  NHSE16052/P: Pasireotide for Cushings ’ Disease
       
    Octreotide injection
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine

    Approved for all licensed indications, and the following off-label uses:

     

    Variceal haemorrhage:

    50 micrograms in 5mL sodium chloride 0.9% bolus IV injection over 2 minutes, then IV infusion of 50 micrograms per hour (500micrograms made up to 50mL with sodium chloride 0.9% and run at 5mL per hour

     

    High output ileostomy, palliative management of intestinal obstruction, diarrhoea associated with malignancy:

    50-200 micrograms subcutaneously three times a day

     

    Chylothorax:

    50-100 micrograms three times a day for up to 14 days

     
    Link  SEL APC recommendation: Octreotide for chylothorax in adults
       
    08.04  Miscellaneous preparations to top
     note 
    Gliolan powder for oral solution
    View SPC online
    Formulary
    Red

     

     
       
    Indocyanine green (ICG) dye
    Formulary
    Red

    Approved off label indications:

    • Detection of sentinal nodes in breast surgery.  Added to 9mTc nanocolloid. 50 microlitres of 5 mg/mL injected at tumour site, 2 hours before surgery
    • Intra operative imaging of pulmonary and mediastinal vasculature in thoracic surgery.  Dose = 0.1 - 0.5 mg/kg (usually a 25 mg or 50 mg vial)
     
       
    Acid citrate glucose infusion
    Unlicensed Drug Unlicensed
    Red

    Anticoagulant used during apheresis

     
       
    Cold storage solution
    Unlicensed Drug Unlicensed
    Red
    Perfusion solution for liver grafts from Non Heart Beating Donors 
       
    Intrinsic factor caps
    Unlicensed Drug Unlicensed
    Red
    Part 2 of Schilling test for vitamin B12 deficiency 
       
    Muromonab-CD3 injection (monoclonal (OKT3))
    Unlicensed Drug Unlicensed
    Red
    Liver and renal graft rejection 
       
     ....
     Non Formulary Items
    Cytotoxic Drug  Azacitidine injection

    View adult BNF View SPC online
    Non Formulary
    Grey

    Not approved for use in SE London for treating acute myeloid leukaemia with more than 30% bone marrow blasts as per NICE Technology appraisal guidance (see link below)

    Link  NICE TA399: Azacitidine for treating acute myeloid leukaemia with more than 30% bone marrow blasts
     
    Enzalutamide caps

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    Non Formulary
    Grey
    High Cost Medicine

    Enzalutamide is not recommended in SE London for treating high-risk hormone-relapsed non-metastatic prostate cancer in adults, in accordance with NICE Technology Appraisal guidance (see link below) 

    Link  NICE TA580: Enzalutamide for hormone-relapsed non-metastatic prostate cancer
     
    Eribulin injection

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    Non Formulary
    Grey

    Not approved for use in SE London for treating locally advanced or metastatic breast cancer after 1 chemotherapy regimen as per NICE Technology appraisal guidance (see link below)

    Link  NICE TA515: Eribulin for treating locally advanced or metastatic breast cancer after 1 chemotherapy regimen
     
    Fulvestrant injection

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    Non Formulary
    Grey

    Not approved for use in SE London for untreated locally advanced or metastatic oestrogen-receptor positive breast cancer as per NICE Technology appraisal guidance (see link below) 

    Link  NICE TA503: Fulvestrant for untreated locally advanced or metastatic oestrogen-receptor positive breast cancer
     
    Necitumumab injection

    View adult BNF View SPC online
    Non Formulary
    Grey

    Not approved for use in SE London for untreated advanced or metastatic squamous non-small-cell lung cancer as per NICE Technology appraisal guidance (see link below)

    Link  NICE TA411: Necitumumab for untreated advanced or metastatic squamous non-small-cell lung cancer
     
    Padeliporfin injection

    View adult BNF View SPC online
    Non Formulary
    Grey

    Not approved for use in SE London for untreated localised prostate cancer as per NICE TA546 (see link below)

    Link  NICE TA546: Padeliporfin for untreated localised prostate cancer
     
    Cytotoxic Drug  Pegylated liposomal irinotecan injection

    View adult BNF View SPC online
    Non Formulary
    Grey

    Not approved for use in SE London for treating pancreatic cancer as per NICE Technology appraisal guidance (see link below)

    Link  MHRA Mar 19: Onivyde (irinotecan, liposomal formulations): reports of serious and fatal thromboembolic events
    Link  NICE TA440: Pegylated liposomal irinotecan for treating pancreatic cancer after gemcitabine
     
    Vandetanib tabs

    View adult BNF View SPC online
    Non Formulary
    Grey

    Not approved for use in SE London for treating medullary thyroid cancer as per NICE TA550 (see link below)

    Link  NICE TA550: Vandetanib for treating medullary thyroid cancer
     
    Vismodegib caps

    View adult BNF View SPC online
    Non Formulary
    Grey

    Not approved for use in SE London for treating symptomatic metastatic basal cell carcinoma, or locally advanced basal cell carcinoma that is inappropriate for surgery or radiotherapyas per NICE Technology appraisal guidance (see link below)

    Link  NICE TA489: Vismodegib for treating basal cell carcinoma
     
      
    Key
    note Notes
    Section Title Section Title (top level)
    Section Title Section Title (sub level)
    First Choice Item First Choice item
    Non Formulary Item Non Formulary section
    Restricted Drug
    Restricted Drug
    Unlicensed Drug
    Unlicensed
    Track Changes
    Display tracking information
    click to search medicines.org.uk
    Link to adult BNF
    click to search medicines.org.uk
    Link to SPCs
    SMC
    Scottish Medicines Consortium
    Cytotoxic Drug
    Cytotoxic Drug
    CD
    Controlled Drug
    High Cost Medicine
    High Cost Medicine
    Cancer Drugs Fund
    Cancer Drugs Fund
    NHSE
    NHS England
    Homecare
    Homecare
    CCG
    CCG

    Traffic Light Status Information

    Status Description

    Red

    Specialist or hospital prescribing only. The responsibility for prescribing, monitoring, dose adjustment and review should remain with the specialist or hospital. In very exceptional circumstances a specialist may discuss individual patient need for a RED drug to be prescribed by a GP and the GP should consider informing the Medicines Management team before a decision is made to prescribe for individual patients.   

    Amber 1

    Treatment can be initiated in primary care after a recommendation from an appropriate specialist  

    Amber 2

    Specialist initiation followed by maintenance prescribing in primary care  

    Amber 3

    Specialist initiation with ongoing monitoring required. After dose stabilisation GPs can be requested to take over prescribing responsibilities using the approved APC shared care documentation  

    Green

    Specialist and non-specialist initiation  

    Grey

    Not recommended for prescribing  

    netFormulary