Lancet 2008; 372 : CDF. N Engl J Med Aug 28;349(9): J Clin Oncol May 15;19(10): Cancer Nov 1;113(9):2471-7

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1 Tumour Group: UROLOGY Renal Palliative Sunitinib 1 st line therapy Lancet Jan 2;353(9146):14-7. Pazopanib 1 st line therapy J Clin Oncol (06): Everolimus 2 nd or 3 rd line in adv./metas.rcc refractory to Sunitinib or Pazopanib Interferon alpha Alternative 1 st line N Engl J Med Jan 11;356(2): Lancet 2008; 372 : CDF Bladder Neoadjuvant Chemotherapy Gem/Cis x 3-6 first-line regimen Cancer Nov 1;113(9): M-VAC x 3-6 Alternative first-line therapy N Engl J Med Aug 28;349(9):859- Accelerated MVAC x 3-6 with GCSF Gem/Carboplatin* x 3-6 Alternative first-line therapy Alternative to gemcitabine / cisplatin in patients unsuitable for cisplatin. 66 J Clin Oncol May 15;19(10): Cancer Nov 1;113(9): Adjuvant Chemotherapy Gemcitabine + Cisplatin x 4-6 Gemcitabine + Carboplatin x 4-6 Accelerated MVAC x 3-6 with GCSF First line Alternative to gemcitabine / cisplatin in patients unsuitable for cisplatin. Alternative first-line therapy Cancer Nov 1;113(9): See network guidelines J Clin Oncol May 15;19(10): Network protocols and regimens\agreed_ Regimens_Urology_Oct-12.doc *Regimen added 2012, 1

2 Palliative Chemotherapy Gemcitabine + Cisplatin First line J Clin Oncol 2000 x 6 Sep;18(17): (can be given as split Acta Oncol. dose version) 2008;47(1):110-9 (3 weekly) Gemcitabine + Alternative to Cancer J an Carboplatin x 6 gemcitabine / 15;106(2): cisplatin in patients unsuitable for cisplatin. Cisplatin Paclitaxel* x6 Second line to Int J Urol 2011; 18(5): gem/cis Carboplatin-Paclitaxel* Alternative to x 6 Cisplatin-Paclitaxel Paclitaxel weekly* Alternative to Clin Genitourin Canc er Cis/ Carbo- Pacli combinations 2009; 7(2): E28-33 MVAC Alternative to J Clin Oncol 2000 gem/cis Sep;18(17): Accelerated MVAC + GCSF Alternative to J Clin Oncol gem/cis May 15;19(10): Prostate Palliative Chemotherapy Docetaxel x 10 Current standard N Engl J Med practice in patients Oct 7;351(15):1502- with hormonerefractory 12 prostate cancer of good performance status. Cabazitaxel x 10 Post Docetaxel Lancet : Abiraterone PO Post Docetaxel N Engl J Med (364) Enzalutamide PO (Named patient basis) Mitoxantrone + Prednisolone x 6. CDF Post Docetaxel N Engl J Med EAP Alternative standard regimen in patients with hormone-refractory prostate cancer of less good performance status physician s Alternative second line regimen. J Clin Oncol Jun;14(6):

3 Cylophosphamide until progression ECF Ketoconazole Alternative to docetaxel in patients with hormone-refractory prostate cancer if slowly progressive disease or less good performance status. Alternative second line regimen Alternative second line post docetaxel Potential 3 rd line hormonal therapy J Urol Jun;177(6): ; discussion Eur J Cancer Jul;33(8): J Clin Oncol Mar 15;22(6): Germ cell Pathological sub-type: Seminoma Adjuvant Carboplatin AUC7 x 1 (EDTA calculated) Current standard practice for stage 1 disease. Lancet Jul 23-29;366(9482): Metastatic Disease or Disease Relapse 3 or 5-day BEP x 3-4 Current standard practice for metastatic disease or first relapse in patients previously untreated with BEP / EP. Duration prognostic group and physician EP x 4 Alternative regimen where physician chooses to avoid Carbo AUC 10 x 4-6 (EDTA calculated) VIP using bleomycin Alternative first line tx of metastatic seminoma Standard for with BEP / BOP. Feb;16(2):702-6 (5 J Clin Oncol 2001 Mar 15;19(6): (3 Dec 20;23(36): Accepted regimen from Anglian Germ Cell Group, Publication in process. Apr;16(4):

4 TIP Gemcitabine (needs funding) Alternate for with BEP. Post high dose chemotherapy Sep 20;23(27): J Clin Oncol Feb;17(2):512-6 To be applied Pathological sub-type: Non-seminomatous germ cell tumour Adjuvant Place in therapy Reference 3 or 5-day BEP x 1-2 Current standard practice. EP x 2-3 Alternate standard practice for stage 1 disease according to physician J Clin Oncol 1996 Apr;14(4): (3 J Urol 1999 Apr;161(4): (5 J Clin Oncol Jul;14(7): Metastatic Disease or Disease Relapse 3 or 5-day BEP x 3-4 EP x 4 VIP TIP Gemcitabine (needs funding) Current standard practice for metastatic disease or first relapse in patients previously untreated with BEP / EP. Duration prognostic group and physician Alternative regimen where physician chooses to avoid using bleomycin Standard for with BEP / BOP. Alternate for with BEP / BOP. Post high dose chemotherapy Feb;16(2):702-6 (5 J Clin Oncol 2001 Mar 15;19(6): (3 Dec 20;23(36): Apr;16 (4): Sep 20;23(27): J Clin Oncol Feb;17(2):512-6 To applied be 4

5 Pathological sub-type: Choriocarcinoma Palliative Place in therapy Reference Germ cell regimens as above for NSGCT Choice according to disease status and line of treatment physician s Pathological sub-type: Small Cell C arcinoma from urological primary ( e.g. bladder, prostate). Adjuvant Carbo/Etoposide x4-6 cycles Current standard practice. Acta Oncol 2002;41(7-8): Cancer 1987 May 15;59(10): (Pathological paper that demonstrates biology and hence need for adjuvant tx) Palliative Carbo/Etoposide x 6 Current standard Acta Oncol practice. 2002;41(7-8): CAV 2 nd line Urol Int 2001;67(3): Chemotherapy & Immunotherapy Regimens Tumour Group: Chemotherapy regimens agreed by: Simon Chowdhury Oct 2012 Sarah Rudman Oct 2012 Simon Hughes Dr Ana Montes Chair of Drugs Expenditure Executive, October

6 Dr Janine Mansi Chair Drugs and Therapeutics Advisory Committee, 29 th October