Working Formulary January 2013 Oncology Chemotherapy Regimens

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Working Formulary January 2013 Oncology Chemotherapy Regimens In the currently changing commissioning landscape, this document is intended to represent the up to date list of non clinical trial

1 Working Formulary January 2013 Oncology Chemotherapy Regimens In the currently changing commissioning landscape, this document is intended to represent the up to date list of non clinical trial chemotherapy regimens used across the Arden Cancer Network as of November At this time, this document includes the following: Those regimens which are approved by NICE and routinely funded by the responsible commissioner Those regimens which are approved and routinely funded by the West Midlands Cancer Drugs Fund (WM CDF); please note that for some regimens approved by the WM CDF, part of the regimen may be funded by the CDF and part by the responsible commissioner. Those regimens which have historically been used within the Network, where formal approval has not been sought and use is not covered by NICE; these have traditionally been funded by the responsible commissioner however, further information is to confirm on-going funding from April 2013 Those regimens which have historically been used within the Network, where formal approval has not been sought and where confirmation of funding should be sought from the relevant responsible commissioner, via the Individual Funding Request (IFR) route This working formulary is intended as a legacy to inform future Formulary Review as by NHS Commissioning Bodies. Version Number One Publication Date: January 2013 Author: Sue Robinson Lead Pharmacist Cancer Services Arden Cancer Network and UHCW Ratified on: 7 th March 2013 Contribution List: Arden Network Chemotherapy Group Oncology Consultants Haematology Consultants Ratified by: Chair of the Arden Network Executive Committee Date for Review: January 2014 Version Number 1 January

2 Version history Version Date Brief summary of change 1 January 2013 Updated from 2011 Edition Details of any NICE TAG s or CG s added Funding for regimens identified Version Number 1 January

3 CONTENTS PAGE Section Description Page 1 Contents 3 2 Circulation List 4 3 Index of Regimens - Oncology Breast 5 Lung 7 Mesothelioma 8 Colorectal 8 Anal 9 Gastro-Intestinal 10 Pancreas 10 Head and Neck 11 Ovarian 11 Cervix 12 Endometrial 12 Vulval 12 Teratoma 12 Bladder 13 Prostate 13 Renal 14 Melanoma 14 Brain 14 Sarcoma 14 Kaposi Sarcoma 15 Thyroid 15 GIST 15 Adrenal Cortical Cancer 15 Hepatocellular 15 Neuroendocrine 15 Small Cell outside of Lungs 16 Version Number 1 January

4 1 Circulation List Arden Cancer Network Network Office Lead Pharmacist Research Network Office Palliative Care Office UHCW Trust Intranet Professor I Brown Consultant Oncologist Dr A Chan Consultant Oncologist Dr P Correa Consultant Oncologist Dr C J Irwin Consultant Oncologist Dr J Hamilton Consultant Oncologist Dr ML Hocking Consultant Oncologist Dr C Humber Consultant Oncologist Professor C Poole Consultant Oncologist Dr M Scott-Brown - Consultant Oncologist Dr AD Stockdale Consultant Oncologist Dr S Sothi Consultant Oncologist Dr J Worlding Consultant Oncologist Dr N Walji - Consultant Oncologist Dr A Franks Consultant Oncologist Dr W Bokhari Consultant Haematologist Dr O Chapman Consultant Haematologist Dr N Jackson Consultant Haematologist Dr S Jobanputra Consultant Haematologist Dr B Harrison - Consultant Haematologist Dr A Lokare - Consultant Haematologist Lead Pharmacist Cancer Services Pharmacy Aseptic Lab Pharmacy Inpatient Dispensary Arden Cancer Centre Infusion Suite Arden Cancer Centre Bolus Area Ward 35 Oncology Ward 34 Haematology Haematology Day Unit Palliative Care Team Warwick Hospital, Warwick Cancer Services Pharmacist Consultant Nurse Cancer Services Pharmacy Dispensary Dr P Rose Consultant Haematologist Dr A Borg Consultant Haematologist Dr C Arbuthnot Consultant Haematologist George Eliot Hospital, Nuneaton Cancer Services Pharmacist Pharmacy Aseptic Lab Pharmacy Dispensary GE Dorothea Ward Lead Cancer Nurse Dr J Gandla Consultant Haematologist Dr M Narayanan Consultant Haematologist Dr J Muddana - Consultant Haematologist Alexandra Hospital, Redditch Cancer Services Pharmacist Pharmacy Aseptic Lab Pharmacy Dispensary Alexandra Garden Suite Lead Cancer Nurse St Cross Hospital, Rugby Pharmacy Dispensary Oncology Clinic All s Acute Trusts Cancer Leads Version Number 1 January

5 Index of Regimens - Oncology BREAST CANCER Comments NEO-ADJUVANT FEC FEC (75) + T (75) FEC (100) + T (100) TC (docetaxel + carboplatin) (for pts not suitable for anthracyclines) TCH (for pts not suitable for anthracyclines Max 18 cycles trastuzumab) DOCETAXEL + CYCLOPHOSPHAMIDE +/- TRASTUZUMAB (for pts not suitable for anthracyclines Max 18 cycles trastuzumab) EC (for patients not suitable for 5FU) ADJUVANT TA CG80 TA CG Neoadjuvant use not covered by NICE. Locally approved Neoadjuvant use not covered by NICE. Locally approved Patient group not covered by NICE TA s. In line with NICE advice to use anthracycline based regimen FEC FEC FEC (75) + T (75) FEC (100) + T (100) EC 90 (for patients not suitable for 5FU) Single Agent TRASTUZUMAB Adjuvant Max 18 cycles Weekly PACLITAXEL (Following anthracycline based regimen for patients not suitable for three weekly docetaxel) DOCETAXEL + CYCLOPHOSPHAMIDE +/- TRASTUZUMAB (for pts not suitable for anthracyclines Max 18 cycles trastuzumab) TA CG80 TA CG TA In line with NICE advice to use anthracycline based regimen Patient group not covered by NICE TA s. Version Number 1 January

6 ADJUVANT continued TC (docetaxel + carboplatin) (for pts not suitable for anthracyclines) TCH (for pts not suitable for anthracyclines Max 18 cycles trastuzumab) METASTATIC / ADVANCED Comments Patient group not covered by NICE TA s. Patient group not covered by NICE TA s. FEC CG EC 90 Probably for patients not suitable for 5FU? CG Single Agent DOCETAXEL TA CG In line with NICE advice to use anthracycline based regimen DOCETAXEL + TRASTUZUMAB CG GEMCITABINE+ PACLITAXEL TA CG DOCETAXEL + CAPECITABINE TA Weekly PACLITAXEL (patients not suitable for three weekly docetaxel) PACLITAXEL + TRASTUZUMAB (patients not suitable for three weekly docetaxel) Weekly PACLITAXEL + TRASTUZUMAB (patients not suitable for three weekly docetaxel) Single Agent TRASTUZUMAB Metastatic TA Single Agent VINORELBINE Single Agent Oral VINORELBINE TA CG TA CG VINORELBINE + TRASTUZUMAB WM/CDF/52 Single Agent CAPECITABINE CG LAPATINIB + CAPECITABINE (CDF only) WM/CDF/5 ABRAXANE (CDF only) WM/CDF/21 BEVACIZUMAB (CDF only) WM/CDF/8 ERIBULIN (CDF only) WM/CDF/31 FULVESTRANT WM/CDF/14 EVEROLIMUS + EXEMESTANE (CDF only) WM/CDF/54 Version Number 1 January

7 Comments Palliative Symptom Control C.M.F M.M.M Low Dose EPIRUBICIN Single Agent MITOZANTRONE IV CMF Rarely Used Regimens CARBOPLATIN + PACLITAXEL WEEKLY (to agree criteria for use) GEMCITABINE + CARBOPLATIN (to agree criteria for use) 1.037? 1.056? Small numbers may need to be considered as IFR s Small numbers may need to be considered as IFR s LUNG CANCER NON SMALL CELL (NSCLC) GEMCITABINE + CARBOPLATIN CG Single Agent GEMCITABINE CG Single Agent VINORELBINE CG VINORELBINE + CARBOPLATIN CG GEFITINIB 1 st line TA Single Agent ERLOTINIB 1 st line TA258 Single Agent DOCETAXEL CG Single Agent ERLOTINIB 2 nd line TA162 PEMETREXED + CISPLATIN TA PEMETREXED + CARBOPLATIN (for patients not suitable for cisplatin) TA PEMETREXED monotherapy maintenance TA Not covered by NICE TA but locally approved Single agent PACLITAXEL CG PACLITAXEL + CARBOPLATIN CG MVP Adjuvant CISPLATIN + VINORELBINE CG PEMETREXED Maintenance (CDF only) WM/CDF/39 Version Number 1 January

8 LUNG CANCER SMALL CELL (SCLC) Oral TOPOTECAN TA VAC CG ETOPOSIDE + CISPLATIN CG GEMCITABINE + CARBOPLATIN CG CARBOPLATIN + ETOPOSIDE CG MESOTHELIOMA PEMETREXED + CISPLATIN TA135 PEMETREXED + CARBOPLATIN (for patients not suitable for cisplatin) TA135 Not covered by NICE TA but locally approved COLO-RECTAL Adjuvant OXALIPLATIN + CAPECITABINE CG Single Agent CAPECITABINE TA CG Modified de Gramont TA CG131 OXALIPLATIN + Modified de Gramont TA CG131 5FU + Folinic Acid (WEEKLY) Advanced/Metastatic OXALIPLATIN + Modified de Gramont CG OXALIPLATIN + CAPECITABINE CG CETUXIMAB + OXALIPLATIN + Modified de Gramont CETUXIMAB + IRINOTECAN + Modified de Gramont TA TA Single Agent IRINOTECAN CG IRINOTECAN + Modified de Gramont CG Single Agent CAPECITABINE TA BEVACIZUMAB (CDF) WM/CDF/4 Version Number 1 January

9 COLO-RECTAL Advanced/Metastatic continued 5FU + Folinic Acid (WEEKLY) FU + Folinic Acid (5 DAY) Single Agent OXALIPLATIN Single Agent MITOMYCIN DAILY FLUOROURACIL (Bosset) CETUXIMAB Monotherapy (CDF only) WM/CDF/6 PANITUMUMAB (CDF only) WM/CDF/6 Rectal CAPECITABINE + XRT CG FLUOROURACIL + XRT (Bosset) CG Rarely Used Regimens OXALIPLATIN + CAPECITABINE + XRT (SR to clarify indication within rectal) Raltitrexed CG CG Funded in Worcs CG supports chemoradiot herapy. Regimen not specified CG supports chemoradiot herapy. Regimen not specified CG supports chemoradiot herapy. Regimen not specified Small numbers need to agree for Arden ANAL 5FU +MITOMYCIN + XRT FU +/- CISPLATIN FU +/- CARBOPLATIN (for patients not suitable for cisplatin) Version Number 1 January

10 GASTRO-OESOPHAGEAL CARBOPLATIN + CAPECITABINE (Stomach) TA ECX TA ECF (for patients not tolerating capecitabine) EOX TA CISPLATIN + CAPECITABINE TA TRASTUZUMAB + CISPLATIN + CAPECITABINE (CDF or NICE) TA WM/CDF/33 TRASTUZUMAB + CISPLATIN + 5FU TA WM/CDF/33 CISPLATIN + FLUOROURACIL CISPLATIN + FLUOROURACIL + XRT CX + XRT (for patients not suitable for 5FU) PANCREAS Funded Single Agent GEMCITABINE TA GEMCITABINE (adjuvant) FOLFOX (CDF only) WM/CDF/17 SUNITINIB pancreatic neuroendocrine (CDF only) EVEROLIMUS pancreatic neuroendocrine (CDF only) EVEROLIMUS neuroendocrine with secretory symptoms (CDF only) WM/CDF/ WM/CDF/ WM/CDF/51 FOLFIRINOX (CDF only) WM/CDF/48 GEMCAP (IFR only) CAPOX 2 nd line (CDF only) WM/CDF/17 Rarely Used Regimens GEMCITABINE + CISPLATIN (Cholangio) Not routinely funded in Worcs SR to check original discussions Version Number 1 January

11 HEAD + NECK CISPLATIN + FLUOROURACIL Walkmed CISPLATIN + FLUOROURACIL Bags CISPLATIN (80) + XRT CISPLATIN (100) + XRT CETUXIMAB + XRT TA145 CETUXIMAB advanced squamous cell (CDF only) Rarely Used Regimens WM/CDF/18 TPF Walkmed TPF Bags OVARIAN CANCER Single Agent CARBOPLATIN PACLITAXEL + CARBOPLATIN (AUC 5) TA PACLITAXEL + CARBOPLATIN (AUC 6) TA Weekly PACLITAXEL + CARBOPLATIN (for patients not suitable for 3 weekly paclitaxel) TA Liposomal DOXORUBICIN TA Single Agent PACLITAXEL TA TA Weekly PACLITAXEL (for patients not suitable for 3 weekly paclitaxel) TA Single Agent TOPOTECAN TA Weekly TOPOTECAN (for patients not suitable for 3 weekly topotecan) TA BEVACIZUMAB (CDF only) WM/CDF/46 Palliative/Rarely Used Oral TREOSULPHAN Oral ETOPOSIDE Single Agent CISPLATIN CISPLATIN + Oral ETOPOSIDE GEMCITABINE + CARBOPLATIN (day 1 only) CARBOPLATIN 2.25AUC + GEMCITABINE (day 1+8) (for patients not tolerating 3 weekly carboplatin) Version Number 1 January

12 CERVICAL CANCER Weekly CISPLATIN + XRT Single Agent CISPLATIN Weekly CARBOPLATIN + XRT (for patients not suitable for cisplatin) DOCETAXEL + GEMCITABINE CISPLATIN + TOPOTECAN TA ENDOMETRIAL CANCER CAP Single Agent CARBOPLATIN DOXORUBICIN + CISPLATIN PACLITAXEL + CARBOPLATIN Ovarian, endometrial and peritoneal tumours grouped together as often difficult to distinguish VULVAL CANCER MITOMYCIN + FLUOROURACIL TERATOMA + SEMINOMA Adjuvant BEP (Low Dose Etoposide) day BEP Intermediate / Poor Prognosis day BEP Good Prognosis ETOPOSIDE + CISPLATIN Single Dose CARBOPLATIN Palliative/Rarely Used Modified TIP 7.009? Small numbers may need to be considered as IFR s Version Number 1 January

13 BLADDER GEMCITABINE + CISPLATIN (28 day regimen) GEMCITABINE + CISPLATIN (21 day regimen) GEMCITABINE + fractionated CISPLATIN (for patients not tolerating 3/4 weekly cisplatin) Worcs Worcs Worcs Low cost/small numbers/ reflects standard UK practice need to agree for Arden Low cost/small numbers/ reflects standard UK practice need to agree for Arden Low cost/small numbers/ reflects standard UK practice need to agree for Arden MITOMYCIN + FLUOROURACIL + XRT MITOMYCIN + FLUOROURACIL (walkmed) + XRT GEMCITABINE + CARBOPLATIN (AUC 5) Low cost/small numbers/ reflects standard UK practice need to agree for Arden PROSTATE DOCETAXEL+ PREDNISOLONE TA DOCETAXEL+ PREDNISOLONE Weekly (for patients not tolerating 3 weekly docetaxel) TA ABIRATERONE TA CABAZITAXEL (CDF only) WM/CDF/29 ABIRATERONE sequential (CDF only) WM/CDF/53 CABAZITAXEL sequential (CDF only) WM/CDF/53 MITOZANTRONE + PREDNISOLONE Oral CYCLOPHOSPHAMIDE Oral ESTRAMUSTINE ENZALUTAMIDE PAS currently Version Number 1 January

14 RENAL INTERFERON SUNITINIB TA PAZOPANIB (NICE) TA EVEROLIMUS (CDF only) WM/CDF/2 TEMSIROLIMUS (CDF only) WM/CDF/22 MALIGNANT MELANOMA VINDESINE Single Agent DACARBAZINE IMATINIB mucosal melanoma (CDF only) WM/CDF/9 IPILIMUMAB TA WM/CDF/30 VEMURAFENIB TA WM/CDF/40 CDF until April 2012 CDF until April 2012 BRAIN Adjuvant TEMOZOLAMIDE + XRT TA Carmustine Wafers adjuvant TA PCV Single Agent Oral TEMOZOLAMIDE TA Oral LOMUSTINE Carmustine Wafers (relapsed GBM) SARCOMAS IFOSFAMIDE + DOXORUBICIN (1 day) Single Agent DOXORUBICIN CARBOPLATIN + IFOSFAMIDE IFOSFAMIDE + DOXORUBICIN (3 day) TRABECTEDIN (soft tissue) TA MIFAMURTIDE (osteosarcoma) TA IMATINIB (CDF only - Chordoma) WM/CDF43 Version Number 1 January

15 KAPOSI SARCOMAS VINCRISTINE + BLEOMYCIN Single Agent EPIRUBICIN THYROID Single Agent DOXORUBICIN SORAFENIB GASTRO INTESTINAL STROMAL TUMOUR (GIST) Single Agent IMATINIB (NICE) TA Single Agent SUNITINIB (NICE) TA IMATINIB adjuvant (CDF only) WM/CDF/18 ADRENAL CORTICAL CANCER Oral MITOTANE ??Worcs Small numbers may need to be considered as IFR s HEPATOCELLULAR CANCER SORAFENIB (CDF only) WM/CDF/1 NEUROENDOCRINE STREPTOZOTOCIN + CAPECITABINE Version Number 1 January

16 SMALL CELL CANCERS OUTSIDE LUNG CARBOPLATIN + ETOPOSIDE 1 st line VAC (CAV) 2 nd line Version Number 1 January

Protocol Number Tumour Group Protocol Name on NCCP website 22/02/ Lung Afatinib Monotherapy 244 Gastrointestinal Regorafenib Monotherapy

Last Updated 22-Feb-18 Date of last update Protocol Number Tumour Group Protocol Name on NCCP website 22/02/2018 221 Afatinib Monotherapy 244 Gastrointestinal Regorafenib Monotherapy 249 Gynaecology Intrathecal