netFormulary
Data extracted : 24/11/2017
 Formulary Section 8: Malignant disease and immunosuppression
Notes:
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.
 Details...
08.01 Cytotoxic drugs
See East Midlands Cancer Network website and Palliative Adult Network Guidelines
08.02.01 Antiproliferative immunosuppressants
Section in development - currently contains only drugs supported by TAS since 2000
Restricted Drug  Mycophenolic acid  (Myfortic®)
Specialist renal use in renal transplant only
08.02.02 Corticosteroids and other immunosuppressants
Section in development
Currently includes high cost drugs excluded to tariff only plus drugs considered by TAS since 2000
Restricted Drug  Basiliximab 
Specialist prescribing only in Renal Transplant in line with NICE TA 85 and TA 99
High cost drug excluded to tariff, NHSE commissioned
Restricted Drug  Tacrolimus  (Adoport®, Prograf® or Modigraf®)
Immunosuppression post renal transplant - prescribe by brand name only as different brands are not interchangeable. Specialist renal initiation only
Shared care request is mandatory
Restricted Drug  Tacrolimus SR  (Envarsus®)
Once daily preparation. Prophylaxis of transplant rejection in adult kidney transplants. Must be prescribed by brand and not interchangeable with other brands. Total required daily dose is different to other brands of tacrolimus so must not be substituted with other brands
Restricted Drug  Antithymocyte immunoglobulin (rabbit) 
Specialist use only
High cost drug excluded to tariff, commissioned by NHSE in line with BCSH Guidelines only
08.02.03 Anti-lymphocyte monoclonal antibodies
Restricted Drug  Rituximab  
Specialist use only
Supported in line with NICE TA 308 only
High Cost Drug excluded to tariff, commmissioned by NHSE for this indication
08.02.04 Other immunomodulating drugs
For drugs used in cancer please see EM Cancer Network website.
Link   NHSE Commissioning Policy: Multiple Sclerosis
Link   NICE CG 186: Multiple Sclerosis: Management of multiple sclerosis in primary and secondary care
Link   NICE TA 32: Beta interferon and glatiramer acetate for the treatment of multiple sclerosis
Restricted Drug  Glatiramer Acetate  (Copaxone®)
Specialist Neurology prescribing only
High Cost Drug excluded to tariff (NHSE)
See HSC 2002/004 below for conditions of use
Co-paxone 40mg/ml 3 x weekly supported by NHSE and TAS
Blueteq prior approval required before initiation
Restricted Drug  Interferon alfa 
Specialist prescribing only in Hepatitis B&C
High cost drug excluded to tariff. Commissioned by NHSE in line with NICE TA 75 only
Restricted Drug  Interferon beta 
Specialist Neurology prescribing only
Includes Avonex®,Rebif® and Betaferon ®(Interferon beta-1b)
High cost drug excluded to tariff (NHSE)
Blueteq prior approval required before initiation
See HSC 2002/004 below for conditions of use
Restricted Drug  Peginterferon alfa  
Hepatitis B&C treatment
High cost drug excluded to tariff. Commissioned by NHSE in line with NICE TA75, TA96, TA106, TA200, TA 300, CG165
Restricted Drug  Peginterferon beta 1a  (Plegridy ®)
Specialist Neurology prescribing only
High cost drug excluded to tariff (NHSE)
Two weekly administration
See HSC 2002/004 for conditions of use
Restricted Drug  Dimethyl Fumarate  
Supported in line with NICE TA 320 only.
Specialist neurology prescribing
Blueteq prior approval required before initiation

Date decision added to Formulary: November 2014
Restricted Drug  Teriflunomide   (Aubagio®)
Specialist Neurology prescribing only in line with NICE TA 303
High Cost Drug excluded to tariff (NHSE)
Blueteq prior approval required before initiation

Date of entry of decision to Formulary: April 2014
Restricted Drug  Alemtuzumab 
Supported by TAS in line with NICE TA 312.

Blueteq prior approval required before initiation

Date decision added to Formulary: August 14
Restricted Drug  Daclizumab  
Supported by TAS in line with NICE TA 441

Blueteq prior approval required before initiation

Date decision added to Formulary: July 17
Restricted Drug  Natalizumab   (Tysabri®)
Specialist Neurology prescribing only in line with NICE TA 127.
High cost drug excluded to tariff (NHSE)
Blueteq prior approval required before initiation
Restricted Drug  Fingolimod  (Gilyena®)
Specialist Neurology prescribing only in line with NICE TA 254
High cost drug excluded to tariff (NHSE)
Blueteq prior approval required before initiation

Date of entry of decision to Formulary: July 2012
08.03.04 Hormone antagonists
08.03.04.01 Breast cancer
Link   Simple Amber List: Aromatase inhibitors anastrozole, exemestane & Letrozole
Anastrozole 
Exemestane 
Letrozole 
Tamoxifen 
Fulvestrant  
08.03.04.02 Prostate cancer and gonadorelin analogues

08.03.04.02 Gonadorelin analogues
  • 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 SR® ) every 6 months.
  • Existing patients in primary care with a stable PSA may be switched to
    Triptorelin pamoate 22.5mg every 6 months (Decapeptyl SR® ) even if this is different from that recommended by secondary care.
Link   Leicestershire Guidelines: Prescribing Gonadorelin Releasing Hormone Analogues (GnRHa) in Primary Care
First Choice:
Triptorelin 
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.
Restricted Drug  Goserelin 
Subcutaneous injection for patients with a contraindication to intramuscular injection
Restricted Drug  Leuprorelin acetate 
This preparation can be given by subcutaneous injection for patients with a contraindication to intramuscular injection.
08.03.04.02 Gonadotrphin-releasing hormone antagonists
Restricted Drug  Bicalutamide 
For prostate cancer
Restricted Drug  Degarelix 
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.
08.03.04.03 Somatostatin analogues
Restricted Drug  Lanreotide  
For Acromegaly
Red for new patients
Restricted Drug  Octreotide  
For Acromegaly
Red for new patients
 ....