South East London Joint Medicines Formulary Formulary

	South East London Joint Medicines Formulary
	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 and NHSE interim treatment change options during the COVID pandemic

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...

08.03.04.01

Breast cancer

Anastrozole tabs

Formulary

Exemestane tabs

Restricted

Restricted to use in patients intolerant to letrozole or anastrozole

Fulvestrant injection

Formulary

Approved for use as part of combination therapy as per NICE Technology Appraisal guidane. See links below.

NICE TA579: Abemaciclib with fulvestrant for treating hormone receptor-positive, HER2-negative advanced breast cancer after endocrine therapy (CDF)

NICE TA593: Ribociclib with fulvestrant for treating hormone receptor-positive, HER2-negative, advanced breast cancer (CDF)

NICE TA619: Palbociclib with fulvestrant for treating hormone receptor-positive, HER2-negative, advanced breast cancer (CDF)

Letrozole tabs

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

Letrozole tabs

Formulary

Tamoxifen tabs, oral solution

Formulary

Amber Traffic Light For all licensed indications

Red Traffic Light Gynaecomastia:

SPECIALIST USE ONLY
Usual course length = 3 months

NICE CG164: Familial Breast Cancer

NICE CG81: Breast cancer (advanced)

NICE NG101: Early and locally advanced breast cancer

NICE TA112: Breast cancer (early) - hormonal treatments

....

Non Formulary Items

Fulvestrant injection

Non Formulary

Not approved for use in SE London as monotherapy as per NICE Technology appraisal guidance (see links below).

See section above for approved formulary uses

NICE TA239: Fulvestrant for the treatment of locally advanced or metastatic breast cancer

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

Key

	Notes
	Section Title (top level)
	Section Title (sub level)
	First Choice item
	Non Formulary section
	Restricted Drug
	Unlicensed
	Display tracking information
	Link to adult BNF
	Link to SPCs
	Scottish Medicines Consortium

	Cytotoxic Drug
	Controlled Drug
	High Cost Medicine
	Cancer Drugs Fund
	NHS England
	Homecare
	CCG

Traffic Light Status Information

Status	Description
	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.
	Treatment can be initiated in primary care after a recommendation from an appropriate specialist
	Specialist initiation followed by maintenance prescribing in primary care
	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
	Specialist and non-specialist initiation
	Not recommended for prescribing