Formulary Chapter 8: Malignant disease and immunosuppression - Full Chapter
Further information on specific drugs available locally and the pathways used is available from the East Midlands Cancer Network. This includes drugs reviewed as part of NICE technology appraisals
The East Midlands has adopted the Palliative Adult Network Guidelines(PANG) as the single guideline across the region to conform with the requirement for a single guideline within a cancer network. These are freely available to healthcare professionals.
The NICE clinical guidance on prostate cancer does not recommend which GnRHa should be prescribed.
There is no conclusive evidence to suggest that one GnRHa is more effective or has fewer side effects than other analogues for the treatment of prostate cancer.
Taking this into account, the first line formulary choice in Leicestershire and Rutland is: Triptorelin (Decapeptyl SRŪ ) every 6 months.
Existing patients in primary care with a stable PSA may be switched to
Triptorelin pamoate 22.5mg every 6 months (Decapeptyl SRŪ ) even if this is different from that recommended by secondary care.
Intramuscular injection available as a one, three and six monthly preparation. Patients in primary care with a stable PSA may be switched to the six monthly preparation even if this is different from that recommended by secondary care.
Subcutaneous injection for patients with a contraindication to intramuscular injection
This preparation can be given by subcutaneous injection for patients with a contraindication to intramuscular injection.
Where there is an acute need for immediate testosterone suppression.
Recommended as an option for treating advanced hormone-dependent prostate cancer in patients with spinal metastases in line with NICE TA 404.
Drugs not recommended for use in the Leicestershire Health Community because of lack of evidence of clinical effectiveness, cost prioritization or concerns over safety.
All new drugs will be black until they have been through the appropriate approval process - then they will appear as a specific entry
Drugs which should be prescribed only by hospital specialists (clinical review by specialist as appropriate and annually as a minimum).
Drugs which would initially be prescribed by a hospital specialist and then by a GP where full agreement to share the care of each specific patient has been reached under a LMSG Shared Care Agreement (SCA). Specific patient monitoring or intervention required.
Drugs suitable to be initiated and prescribed in primary care only after specialist assessment and recommendation. A shared care agreement is not required.
Drugs for which GPs are able to take full responsibility for prescribing and monitoring subject to specified conditions e.g. prescribing in line with agreed LMSG guidance or able to demonstrate suitable competence see comments under individual entries.
Drugs for which GPs would normally take full responsibility for prescribing and monitoring. Drugs included in this list have been specifically considered by LMSG.