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 Formulary Chapter 8: Malignant disease and immunosuppression - Full Chapter
Notes:
All Chemotherapy in HDFT is prescribed using the ChemoCare electronic prescribing system.  Only Consultants or Registrars may initiate chemotherapy.

If any patients are admitted to the Trust on oral chemotherapy the admitting doctor must contact the Oncology/Haemtology team to determine whether the treatment should be continued.

If the original prescriber is not available or cannot be contacted the oral anticancer medicine must be not be prescribed or administered until it is confirmed that it is clinically appropriate and safe to do so.

Further guidance on oral chemotherapy can be found in the Oral Anti-Cancer Medicines Handbook on the Trust Intranet.

Guidance on symptom management in palliative care can be found in The Yorkshire Cancer Network and North East Yorkshire & Humber Clinical Alliance guidelines.

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08.01  Cytotoxic drugs
Venetoclax (Venclyxto® )
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Formulary
Red
High Cost Medicine
Cancer Drugs Fund
BlueTeq
 
   
08.01  Side-effects of cytotoxic drugs
08.01  Drugs for cytotoxic-induced side-effects
Calcium Folinate
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Formulary Injection 50mg/5ml 
   
Mesna (Uromitxan®)
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Formulary  
   
08.01.01  Alkylating drugs
Busulfan (Myleran®)
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Formulary  
   
Cytotoxic Drug Carmustine (BiCNU®)
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Formulary  
   
Cytotoxic Drug Chlorambucil (Leukeran®)
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Formulary Tablets 2mg 
   
Cytotoxic Drug Cyclophosphamide
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Formulary Tablets 50mg 
   
Cytotoxic Drug Ifosfamide (Mitoxana®)
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Formulary  
   
Cytotoxic Drug Lomustine
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Formulary  
   
Cytotoxic Drug Melphalan (Alkeran®)
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Formulary Tablets 2mg 
   
08.01.02  Anthracyclines and other cytotoxic antibiotics to top
Cytotoxic Drug Bleomycin
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Formulary  
   
Cytotoxic Drug Daunorubicin
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Formulary  
   
Cytotoxic Drug Doxorubicin Hydrochloride
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Formulary  
   
Cytotoxic Drug Epirubicin hydrochloride
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Formulary  
   
Cytotoxic Drug Mitomycin (Mitomycin C Kyowa®)
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Formulary  
   
Cytotoxic Drug Mitoxantrone (Mitozantrone)
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Formulary  
   
08.01.03  Antimetabolites
Cytotoxic Drug Azacitidine (Vidaza®)
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Formulary  
   
Cytotoxic Drug Capecitabine (Xeloda®)
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Formulary  
   
Cytotoxic Drug Cladribine
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Formulary  
Link  Drug Safety Update - stop treatment if PML is suspected
   
Cladribine (Litak®)
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Formulary  
Link  Drug Safety Update - stop treatment if PML suspected
   
Cytotoxic Drug Cytarabine
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Formulary  
   
Cytotoxic Drug Fludarabine Phosphate (Fludara®)
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Formulary  
   
Cytotoxic Drug Fluorouracil
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Formulary  
   
Cytotoxic Drug Gemcitabine (Gemzar®)
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Formulary  
   
Cytotoxic Drug Mercaptopurine (Puri-Nethol®)
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Formulary  
   
Cytotoxic Drug Methotrexate
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Formulary Tablets 2.5mg
Injection 10mg, 12.5mg, 15mg, 17.5mg, 20mg, 22.5mg, 25mg, 30mg, 50mg, 75mg 
   
Cytotoxic Drug Pemetrexed (Alimta®)
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Formulary  
Link  TA190 (updated from June 2010) - Pemetrexed for the maintenance treatment of non-small-cell lung cancer
   
08.01.04  Vinca alkaloids and etoposide
Cytotoxic Drug Etoposide
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Formulary  
   
Cytotoxic Drug Vinblastine Sulphate
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Formulary  
   
Cytotoxic Drug Vincristine Sulphate
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Formulary  
   
Cytotoxic Drug Vinorelbine
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Formulary  
   
08.01.05  Other antineoplastic drugs
Cytotoxic Drug Aflibercept (Zaltrap®)
(25mg/ml concentrate for intravenous infusion)
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Restricted Drug Restricted
Red
Cancer Drugs Fund
NICE TA307: Aflibercept in combination with irinotecan and fluorouracil-based therapy for treating metastatic colorectal cancer that has progressed following prior oxaliplatin-based chemotherapy 
   
Cytotoxic Drug PembrolizumabBlack Triangle (Keytruda® )
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Restricted Drug Restricted
Red
High Cost Medicine
Cancer Drugs Fund
NHS England
BlueTeq
 
Link  NICE TA540 Pembrolizumab for treating relapsed or refractory classical Hodgkin lymphoma
   
Cytotoxic Drug Trifluridine / Tipiracil  (Lonsurf®)
(15mg/6.14mg or 20mg/8.19mg strength tablets)
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Formulary
Red
NICE TA405: Trifluridine–tipiracil for previously
treated metastatic colorectal cancer 
   
08.01.05  Amsacrine
08.01.05  Arsenic trioxide to top
08.01.05  Bevacizumab
Bevacizumab (Avastin®)
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Restricted Drug Restricted  
   
08.01.05  Bexarotene
08.01.05  Bortezomib
08.01.05  Brentuximab vedotin
 note 

NICE TA446: Brentuximab vedotin for treating CD30-positive Hodgkin lymphoma

08.01.05  Cetuximab to top
Cetuximab (Erbitux®)
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Restricted Drug Restricted  
Link  NICE TA439 - Cetuximab and panitumumab for previously untreated metastatic colorectal cancer
   
08.01.05  Crisantaspase
08.01.05  Dacarbazine and Temozolomide
08.01.05  Erlotinib
08.01.05  Hydroxycarbamide
Cytotoxic Drug Hydroxycarbamide
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Restricted Drug Restricted  
   
08.01.05  Imatinib to top
08.01.05  Mitotane
08.01.05  Panitumumab
Panitumumab (®)
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Restricted Drug Restricted
Grey
High Cost Medicine
 
   
08.01.05  Pentostatin
08.01.05  Platinum compounds
Cytotoxic Drug Cisplatin
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Restricted Drug Restricted  
   
Cytotoxic Drug Oxaliplatin
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Restricted Drug Restricted  
   
08.01.05  Porfimer sodium and temoporfin to top
08.01.05  Procarbazine
08.01.05  Protein kinase inhibitors
Dabrafenib (Tafinlar®)
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Formulary
Red
Patients are referred to Leeds Teaching Hospitals 
Link  NICE TA321: Dabrafenib for treating unresectable or metastatic BRAF V600 mutation-positive melanoma
   
Dasatinib (Sprycel®)
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Restricted Drug Restricted  
   
Erlotinib (Tarceva®)
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Restricted Drug Restricted  
   
Gefitinib (Iressa®)
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Restricted Drug Restricted  
   
Cytotoxic Drug Ibrutinib (Imbruvica®)
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Restricted Drug Restricted
Red
High Cost Medicine
Cancer Drugs Fund
Approved under the Cancer Drugs Fund, February 2015.

Available in 90 and 120 capsule pack-sizes 
Link  NICE TA 429
Link  NICE TA502
   
Nilotinib (Tasigna®)
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Restricted Drug Restricted  
   
08.01.05  Tezanes
Cytotoxic Drug Paclitaxel
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Restricted Drug Restricted  
   
08.01.05  Topoisimerase I inhibitors
08.01.05  Trabectedin to top
08.01.05  Trastuzumab
Cytotoxic Drug Trastuzumab (Herceptin®)
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Restricted Drug Restricted
Red
High Cost Medicine
 
   
Cytotoxic Drug Trastuzumab emtansine (Kadcyla® )
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Restricted Drug Restricted
Red
High Cost Medicine
Approved in February 2014 as per Cancer Drugs Fund (CDF)guidelines 
Link  TA458 - Trastuzumab emtansine for treating HER2-positive advanced breast cancer after trastuzumab and a taxane
   
08.01.05  Tretinoin
Tretinoin
(10mg capsules)
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Restricted Drug Restricted
Red
One box stored in Pharmacy EMCU.
Out of Hours; please contact the on-call pharmacist 
Link  Guidelines for Acute Promyelocytic Leukaemia
   
08.01.05  Vismodegib
08.02  Drugs affecting the immune response
08.02  Immunosuppressant therapy to top
08.02.01  Antiproliferative immunosuppressants
Azathioprine
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Restricted Drug Restricted
Amber Shared Care

Tablets 25mg, 50mg

 
Link  HaRD Azathioprine Shared Care Guidelines
   
Mycophenolate Mofetil
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Formulary
Amber Shared Care
Prescribe generically 
Link  Drug Safety Update: Mycophenolate mofetil, mycophenolic acid: updated contraception advice for male patients
Link  HaRD Mycophenolate Shared Care Guidelines
   
08.02.02  Corticosteroids and other immunosuppressants
Ciclosporin
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Restricted Drug Restricted
Amber Shared Care
Due to differences in bioavailability, patients must remain on the same brand of immunosuppressant except on the advice of specialist clinician. MUST be prescribed by brand. 
Sirolimus (Rapamune®)
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Restricted Drug Restricted
Amber Shared Care
 
   
Tacrolimus (Adoport®)
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Restricted Drug Restricted
Amber Shared Care
Prescribe by brand 
   
Tacrolimus (Prograf®)
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Restricted Drug Restricted
Amber Shared Care
Capsules 500micrograms, 1mg

Prescribe by brand due to interpatient variability 
   
Tacrolimus (Advagraf®)
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Restricted Drug Restricted
Amber Shared Care
Capsules 500micrograms, 1mg

Prescribe by brand

For use by Renal Unit only 
   
08.02.03  Anti-lymphocyte monoclonal antibodies
Alemtuzumab (MabCampath®)
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Formulary
Red
High Cost Medicine
Commissioned by NHS England for the treatment of multiple sclerosis, pre-transplant immunosupression and chronic lymphocytic luekemia (CLL) 
   
Ofatumumab (Arzerra®)
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Restricted Drug Restricted
Red
Cancer Drugs Fund
Approved by the HaRD Area Prescribing Committee, March 2015 
   
Cytotoxic Drug Rituximab (Truxima®)
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Formulary
Red
 
   
08.02.04  Other immunomodulating drugs
Lenalidomide (Revlimid® )
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Formulary Patient authorisation form must be sent with each prescription

Capsules 10mg, 15mg, 25mg 
Link  NICE TA322: Lenalidomide for treating myelodysplastic syndromes associated with an isolated deletion 5q cytogenetic abnormality
   
Pomalidomide (Imnovid®)
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Restricted Drug Restricted
Red
Cancer Drugs Fund
 
Link  NICE TA338: Pomalidomide for relapsed and refractory multiple myeloma previously treated with lenalidomide and bortezomib
   
Thalidomide (Pharmion®)
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Restricted Drug Restricted Capsules 50mg

Patient authorisation form must be sent with each prescription 
   
08.02.04  Interferon Alfa to top
08.02.04  Interferon beta
08.02.04  Interferon gamma
08.02.04  Aldesleukin
08.02.04  BCG bladder instillation
08.02.04  Canakinumab to top
08.02.04  Dimethyl fumarate
08.02.04  Fingolimod
08.02.04  Glatiramer acetate
08.02.04  Histamine
08.02.04  Lenalidomide, pomalidomide, and thalidomide to top
08.02.04  Mifamurtide
08.02.04  Natalizumab
08.02.04  Teriflunomide
08.03  Sex hormones and hormone antagonists in malignant disease
08.03.01  Oestrogens to top
Diethylstilbestrol
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Formulary  
   
08.03.02  Progestogens
Medroxyprogesterone Acetate (Provera®)
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Formulary  
   
Megestrol Acetate (Megace®)
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Formulary  
   
Norethisterone
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Formulary  
   
08.03.03  Androgens
08.03.04  Hormone antagonists
08.03.04.01  Breast cancer
Anastrozole (Arimidex®)
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Restricted Drug Restricted Tablets 1mg 
   
Exemestane (Aromasin®)
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Restricted Drug Restricted Tablets 25mg 
   
Goserelin (Zoladex®)
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Restricted Drug Restricted Implant 3.6mg 
   
Letrozole (Femara®)
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Formulary Tablets 2.5mg 
   
Tamoxifen
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Restricted Drug Restricted Tablets 10mg, 20mg 
   
Fulvestrant (Faslodex®)
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Restricted Drug Restricted
Red
High Cost Medicine
Injection 50mg/ml 
Link  NICE TA239: Fulvestrant for the treatment of locally advanced or metastatic breast cancer
   
08.03.04.02  Prostate cancer and gonadorelin analogues to top
08.03.04.02  Gonadorelin analogues
Degarelix (Firmagon®)
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Restricted Drug Restricted
Red
Approved by the Area Prescribing Committee, December 2014 
   
Cytotoxic Drug Enzalutamide (Xtandi®)
(40mg capsules)
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Restricted Drug Restricted
Red
Cancer Drugs Fund
 
   
08.03.04.02  Anti-androgens
Cytotoxic Drug Abiraterone (Zytiga®)
(250mg tablets)
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Restricted Drug Restricted
Red
Cancer Drugs Fund
 
Link  NICE TA259: Abiraterone for treating metastatic castration-resistant prostate cancer previously treated with a docetaxel-containing regimen
   
Bicalutamide (Casodex®)
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Restricted Drug Restricted  
   
Cyproterone Acetate
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Restricted Drug Restricted Tablets 100mg 
   
Flutamide
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Restricted Drug Restricted  
   
Goserelin (Zoladex®)
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Restricted Drug Restricted  
   
Triptorelin (Gonapeptyl Depot®)
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Restricted Drug Restricted Injection 3.75mg

Paediatric use only for precocious puberty 
   
08.03.04.02  Gonadotrophin-releasing hormone antagonists
08.03.04.03  Somatostatin analogues
Octreotide (Sandosatin®)
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Restricted Drug Restricted Injection 50micrograms/ml, 100micrograms/ml

Initiation on teh advice of a specialist 
   
Octreotide (Sandosatin Lar®)
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Restricted Drug Restricted Injection 10mg

Initiation on the advice of a specialist 
   
 ....
 Non Formulary Items
Aldesleukin  (Proleukin®)

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Non Formulary
 
Amifostine  (Ethyol®)

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Non Formulary
 
Cytotoxic Drug  Amsacrine  (Amsidine®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Cytotoxic Drug  Arsenic Trioxide  (Trisenox®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Bacillus Calmette-Guerin  (ImmuCyst®)

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Non Formulary
 
Bacillus Calmette-Guerin  (OncoTICE®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Basiliximab  (Simulect®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Bexarotene  (Targretin®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Bortezomib  (Velcade®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Buserelin  (Suprefact®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Busulfan  (Busilvex®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Calcium Leofolinate  (Isovorin®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Cytotoxic Drug  Carboplatin

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Non Formulary
 
Cytotoxic Drug  Carmustine  (Gliadel®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Ciclosporin  (Sandimmun®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Clofarabine  (Evoltra®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Crisantaspase  (Erwinase®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Cytotoxic Drug  Dacarbazine

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Daclizumab  (Zenapax®)

View adult BNF View SPC online View childrens BNF
Non Formulary
Link  Drug Safety Update - Daclizumab - Risk of Severe Liver Injury - January 2018
Link  Drug Safety Update - Daclizumab - suspension and recall for safety reasons; review patients as soon as possible and start alternative therapy
Link  Drug Safety Update Daclizumab - Risk of Severe Liver Injury - July 2017
 
Cytotoxic Drug  Dactinomycin  (Cosmegen Lyovac®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Dexrazoxane  (Savene®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Disodium Folinate  (Sodiofolin®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Disodium Levofolinate  (Levofolinic Acid )

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Cytotoxic Drug  Docetaxel  (Taxotere®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Erlotinib  (Tarceva® )

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Estramustine Phosphate  (Estracyt®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Ethinylestradol

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Everolimus  (Afinitor®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Glatiramer Acetate  (Copaxone®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Goserelin  (Zoladex® LA)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Histrelin  (Vantas®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Cytotoxic Drug  Idarubicin Hydrochloride  (Zavedos®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Cytotoxic Drug  Imatinib  (Gilvec®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Interferon Alfa  (IntronA)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Interferon Alfa  (Roferon-A®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Interferon Alfa  (Viraferon®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Interferon Beta  (Avonex®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Interferon Beta  (Betaferon®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Interferon beta  (Extavia®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Interferon Beta  (Proleukin®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Interferon Beta  (Rebif®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Cytotoxic Drug  Irinotecan Hydrochloride  (Campto®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Lanreotide  (Somatuline Autogel®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Lanreotide  (Somatuline® LA)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Lapatinib  (Tyverb®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Leuprorelin Acetate  (Prostap® 3)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Leuprorelin Acetate  (Prostap® SR)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Mitotane  (Lysodren®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Natalizumab  (Tysabri®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Palifermin  (Kepivance®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Peginterferon Alfa  (Pegasys®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Peginterferon Alfa  (PegIntron®)

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Non Formulary
 
Peginterferon Alfa  (ViraferonPeg®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Cytotoxic Drug  Pentostatin  (Nipent®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Porfimer Sodium

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Cytotoxic Drug  Procarbazine

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Raltitrexed  (Tomudex®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Sorafenib  (Nexavar®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Sunitinib  (Sutent®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Tacrolimus  (Modigraf®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Cytotoxic Drug  Tegafur with Uracil  (Uftoral®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Temoporfin  (Foscan®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Cytotoxic Drug  Temozolomide  (Temodal®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Cytotoxic Drug  Temsirolimus  (Torisel®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Thiotepa

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Non Formulary
 
Tioguanine  (Lanvis®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Cytotoxic Drug  Topotecan  (Hycamtin®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Cytotoxic Drug  Trabectedin  (Yondelis®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Treosulfan

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Triptoelin  (Decapeptyl® SR)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Vindesine Sulphate  (Eldisine®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Vinflunine  (Javlor®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
  
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 children's 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

Amber

Medicines which are suitable to be prescribed in primary care only after specialist recommendation. Ongoing prescribing by primary care includes titration of dose and assessment of efficacy. There is no need for ongoing monitoring other than for general adverse effects as listed in the BNF & SPC.  

Amber Shared Care

Medicines which are suitable to be prescribed in primary care only after specialist recommendation only under a shared care protocol once the patient has been stabilised. Prior agreement must be obtained by the specialist from the primary care provider before prescribing responsibility is transferred. The shared care protocol must be approved by the Harrogate & Rurual District Area Prescribing Committee (HaRD APC).   

Black

Medicines which the Harrogate & Rural District Area Prescribing Committee (HaRD APC) has reviewed and does not recommend for use at present based on a review of clinical and/or cost effectiveness data.   

Green

Medicines suitable for routine use and can be prescribed within primary care within their licensed indication in accordance with nationally recognised formularies e.g. BNF, BNF for Children, Palliative Care Formulary. Primary care prescribers take full responsibility for prescribing.  

Grey

Medicines which the Harrogate & Rural District Area Prescribing Committee (HaRD APC) have not yet reviewed.   

Red

Medicines for hospital use only. The responsibility for initiation and monitoring treatment should rest with an appropriate hospital clinician. The drug should be supplied by the hospital for the duration of the treatment course. Primary care prescriber initiation or continuation of treatemnt is not recommended.  

netFormulary