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 2012. 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 2013 1
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 2013 2
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 2013 3
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 2013 4
Index of Regimens - Oncology BREAST CANCER Comments NEO-ADJUVANT FEC 1.008 FEC (75) + T (75) 1.026 FEC (100) + T (100) 1.027 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 TA109 2006 CG80 TA109 2006 CG80 1.033 1.034 1.035 1.031 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 75 1.008 FEC 100 1.008 FEC (75) + T (75) 1.026 FEC (100) + T (100) 1.027 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) TA109 2006 CG80 TA109 2006 CG80 1.031 1.051 TA107 2006 1.032 1.035 In line with NICE advice to use anthracycline based regimen Patient group not covered by NICE TA s. Version Number 1 January 2013 5
ADJUVANT continued TC (docetaxel + carboplatin) (for pts not suitable for anthracyclines) TCH (for pts not suitable for anthracyclines Max 18 cycles trastuzumab) METASTATIC / ADVANCED 1.033 1.034 Comments Patient group not covered by NICE TA s. Patient group not covered by NICE TA s. FEC 1.008 CG81 2009 EC 90 Probably for patients not suitable for 5FU? 1.031 CG81 2009 Single Agent DOCETAXEL 1.018 TA116 2007 CG81 2009 In line with NICE advice to use anthracycline based regimen DOCETAXEL + TRASTUZUMAB 1.057 CG81 2009 GEMCITABINE+ PACLITAXEL 1.019 TA116 2007 CG81 2009 DOCETAXEL + CAPECITABINE 1.024 TA116 2007 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) 1.032 1.025 1.036 Single Agent TRASTUZUMAB Metastatic 1.050 TA34 2002 Single Agent VINORELBINE 1.016 Single Agent Oral VINORELBINE 1.052 TA54 2002 CG81 2009 TA54 2002 CG81 2009 VINORELBINE + TRASTUZUMAB 1.017 WM/CDF/52 Single Agent CAPECITABINE 1.023 CG81 2009 LAPATINIB + CAPECITABINE (CDF only) 1.052 WM/CDF/5 ABRAXANE (CDF only) 1.053 WM/CDF/21 BEVACIZUMAB (CDF only) 1.054 WM/CDF/8 ERIBULIN (CDF only) 1.055 WM/CDF/31 FULVESTRANT 1.058 WM/CDF/14 EVEROLIMUS + EXEMESTANE (CDF only) 1.059 WM/CDF/54 Version Number 1 January 2013 6
Comments Palliative Symptom Control C.M.F. 1.002 M.M.M 1.003 Low Dose EPIRUBICIN 1.004 Single Agent MITOZANTRONE 1.013 IV CMF 1.007 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 6.009 CG121 2011 Single Agent GEMCITABINE 6.013 CG121 2011 Single Agent VINORELBINE 6.015 CG121 2011 VINORELBINE + CARBOPLATIN 6.016 CG121 2011 GEFITINIB 1 st line 6.024 TA192 2010 Single Agent ERLOTINIB 1 st line 6.020 TA258 Single Agent DOCETAXEL 6.018 CG121 2011 Single Agent ERLOTINIB 2 nd line 6.020 TA162 PEMETREXED + CISPLATIN 06.022 TA181 2009 PEMETREXED + CARBOPLATIN (for patients not suitable for cisplatin) 06.021 TA181 2009 PEMETREXED monotherapy maintenance 6.025 TA190 2010 Not covered by NICE TA but locally approved Single agent PACLITAXEL 6.025 CG121 2011 PACLITAXEL + CARBOPLATIN 6.026 CG121 2011 MVP 6.012 Adjuvant CISPLATIN + VINORELBINE 6.019 CG121 2011 PEMETREXED Maintenance (CDF only) 6.027 WM/CDF/39 Version Number 1 January 2013 7
LUNG CANCER SMALL CELL (SCLC) Oral TOPOTECAN 06.023 TA184 2009 VAC 6.005 CG121 2011 ETOPOSIDE + CISPLATIN 6.010 CG121 2011 GEMCITABINE + CARBOPLATIN 6.014 CG121 2011 CARBOPLATIN + ETOPOSIDE 6.017 CG121 2011 MESOTHELIOMA PEMETREXED + CISPLATIN 22.004 TA135 PEMETREXED + CARBOPLATIN (for patients not suitable for cisplatin) 22.003 TA135 Not covered by NICE TA but locally approved COLO-RECTAL Adjuvant OXALIPLATIN + CAPECITABINE 11.011 CG131 2011 Single Agent CAPECITABINE 11.017 TA61 2003 CG131 2011 Modified de Gramont 11.020 TA100 2006 CG131 OXALIPLATIN + Modified de Gramont 11.020 TA100 2006 CG131 5FU + Folinic Acid (WEEKLY) 11.007 Advanced/Metastatic OXALIPLATIN + Modified de Gramont 11.020 CG131 2011 OXALIPLATIN + CAPECITABINE 11.011 CG131 2011 CETUXIMAB + OXALIPLATIN + Modified de Gramont CETUXIMAB + IRINOTECAN + Modified de Gramont 11.022 TA176 2009 11.023 TA176 2009 Single Agent IRINOTECAN 11.013 CG131 2011 IRINOTECAN + Modified de Gramont 11.021 CG131 2011 Single Agent CAPECITABINE 11.017 TA61 2003 BEVACIZUMAB (CDF) 11.026 WM/CDF/4 Version Number 1 January 2013 8
COLO-RECTAL Advanced/Metastatic continued 5FU + Folinic Acid (WEEKLY) 11.007 5FU + Folinic Acid (5 DAY) 11.006 Single Agent OXALIPLATIN 11.018 Single Agent MITOMYCIN 11.019 DAILY FLUOROURACIL (Bosset) 11.024 CETUXIMAB Monotherapy (CDF only) 11.027 WM/CDF/6 PANITUMUMAB (CDF only) 11.028 WM/CDF/6 Rectal CAPECITABINE + XRT 11.009 CG131 2011 FLUOROURACIL + XRT (Bosset) 11.024 CG131 2011 Rarely Used Regimens OXALIPLATIN + CAPECITABINE + XRT (SR to clarify indication within rectal) Raltitrexed 11.029 11.025 CG131 2011 CG131 2011 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 12.001 5FU +/- CISPLATIN 12.003 5FU +/- CARBOPLATIN (for patients not suitable for cisplatin) 12.005 Version Number 1 January 2013 9
GASTRO-OESOPHAGEAL CARBOPLATIN + CAPECITABINE (Stomach) 13.012 TA191 2010 ECX 13.008 TA191 2010 ECF (for patients not tolerating capecitabine) EOX TA191 2010 CISPLATIN + CAPECITABINE TA191 2010 TRASTUZUMAB + CISPLATIN + CAPECITABINE (CDF or NICE) 13.013 TA208 2010 WM/CDF/33 TRASTUZUMAB + CISPLATIN + 5FU 13.014 TA208 2010 WM/CDF/33 CISPLATIN + FLUOROURACIL 19.001 CISPLATIN + FLUOROURACIL + XRT 19.001 CX + XRT (for patients not suitable for 5FU) 19.004 PANCREAS Funded Single Agent GEMCITABINE 13.007 TA25 2001 GEMCITABINE (adjuvant) 13.009 FOLFOX (CDF only) 13.016 WM/CDF/17 SUNITINIB pancreatic neuroendocrine (CDF only) EVEROLIMUS pancreatic neuroendocrine (CDF only) EVEROLIMUS neuroendocrine with secretory symptoms (CDF only) 13.014 WM/CDF/24 13.015 WM/CDF/24 13.015 WM/CDF/51 FOLFIRINOX (CDF only) 13.012 WM/CDF/48 GEMCAP (IFR only) 13.013 CAPOX 2 nd line (CDF only) 13.017 WM/CDF/17 Rarely Used Regimens GEMCITABINE + CISPLATIN (Cholangio) 13.011 Not routinely funded in Worcs SR to check original discussions Version Number 1 January 2013 10
HEAD + NECK CISPLATIN + FLUOROURACIL Walkmed 14.002 CISPLATIN + FLUOROURACIL Bags 14.002 CISPLATIN (80) + XRT 14.005 CISPLATIN (100) + XRT 14.006 CETUXIMAB + XRT 14.007 TA145 CETUXIMAB advanced squamous cell (CDF only) Rarely Used Regimens 14.009 WM/CDF/18 TPF Walkmed 14.008 TPF Bags 14.008 OVARIAN CANCER Single Agent CARBOPLATIN 3.002 PACLITAXEL + CARBOPLATIN (AUC 5) 3.008 TA55 2003 PACLITAXEL + CARBOPLATIN (AUC 6) 3.008 TA55 2003 Weekly PACLITAXEL + CARBOPLATIN (for patients not suitable for 3 weekly paclitaxel) 3.016 TA55 2003 Liposomal DOXORUBICIN 3.011 TA91 2005 Single Agent PACLITAXEL 3.007 TA55 2003 TA91 2005 Weekly PACLITAXEL (for patients not suitable for 3 weekly paclitaxel) 3.015 TA55 2003 Single Agent TOPOTECAN 3.012 TA91 2005 Weekly TOPOTECAN (for patients not suitable for 3 weekly topotecan) 3.017 TA91 2005 BEVACIZUMAB (CDF only) 3.019 WM/CDF/46 Palliative/Rarely Used Oral TREOSULPHAN 3.004 Oral ETOPOSIDE 3.010 Single Agent CISPLATIN 3.001 CISPLATIN + Oral ETOPOSIDE 3.013 GEMCITABINE + CARBOPLATIN (day 1 only) CARBOPLATIN 2.25AUC + GEMCITABINE (day 1+8) (for patients not tolerating 3 weekly carboplatin) 3.014 3.018 Version Number 1 January 2013 11
CERVICAL CANCER Weekly CISPLATIN + XRT 4.001 Single Agent CISPLATIN 4.004 Weekly CARBOPLATIN + XRT (for patients not suitable for cisplatin) 4.005 DOCETAXEL + GEMCITABINE 4.006 CISPLATIN + TOPOTECAN 4.007 TA183 2009 ENDOMETRIAL CANCER CAP 5.001 Single Agent CARBOPLATIN 5.002 DOXORUBICIN + CISPLATIN 5.003 PACLITAXEL + CARBOPLATIN 5.004 Ovarian, endometrial and peritoneal tumours grouped together as often difficult to distinguish VULVAL CANCER MITOMYCIN + FLUOROURACIL 20.001 TERATOMA + SEMINOMA Adjuvant BEP (Low Dose Etoposide) 7.006 5 day BEP Intermediate / Poor Prognosis 7.007 3 day BEP Good Prognosis 7.008 ETOPOSIDE + CISPLATIN 7.012 Single Dose CARBOPLATIN 7.013 Palliative/Rarely Used Modified TIP 7.009? Small numbers may need to be considered as IFR s Version Number 1 January 2013 12
BLADDER GEMCITABINE + CISPLATIN (28 day regimen) GEMCITABINE + CISPLATIN (21 day regimen) GEMCITABINE + fractionated CISPLATIN (for patients not tolerating 3/4 weekly cisplatin) 9.004 Worcs 9.007 Worcs 9.008 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 9.010 MITOMYCIN + FLUOROURACIL (walkmed) + XRT GEMCITABINE + CARBOPLATIN (AUC 5) 9.011 9.010 Low cost/small numbers/ reflects standard UK practice need to agree for Arden PROSTATE DOCETAXEL+ PREDNISOLONE 18.004 TA101 2006 DOCETAXEL+ PREDNISOLONE Weekly (for patients not tolerating 3 weekly docetaxel) 18.004 TA101 2006 ABIRATERONE 18.006 TA259 2012 CABAZITAXEL (CDF only) 18.005 WM/CDF/29 ABIRATERONE sequential (CDF only) 18.007 WM/CDF/53 CABAZITAXEL sequential (CDF only) 18.008 WM/CDF/53 MITOZANTRONE + PREDNISOLONE 18.001 Oral CYCLOPHOSPHAMIDE 18.002 Oral ESTRAMUSTINE 18.003 ENZALUTAMIDE 18.009 PAS currently Version Number 1 January 2013 13
RENAL INTERFERON 21.001 SUNITINIB 21.002 TA169 2009 PAZOPANIB (NICE) 21.004 TA215 2011 EVEROLIMUS (CDF only) 21.005 WM/CDF/2 TEMSIROLIMUS (CDF only) 21.007 WM/CDF/22 MALIGNANT MELANOMA VINDESINE 8.001 Single Agent DACARBAZINE 8.004 IMATINIB mucosal melanoma (CDF only) 8.007 WM/CDF/9 IPILIMUMAB 8.008 TA268 2012 WM/CDF/30 VEMURAFENIB 8.009 TA269 2012 WM/CDF/40 CDF until April 2012 CDF until April 2012 BRAIN Adjuvant TEMOZOLAMIDE + XRT 10.005 TA121 2007 Carmustine Wafers adjuvant 10.006 TA121 2007 PCV 10.001 Single Agent Oral TEMOZOLAMIDE 10.004 TA23 2001 Oral LOMUSTINE 10.002 Carmustine Wafers (relapsed GBM) 10.006 SARCOMAS IFOSFAMIDE + DOXORUBICIN (1 day) 15.003 Single Agent DOXORUBICIN 15.005 CARBOPLATIN + IFOSFAMIDE 15.006 IFOSFAMIDE + DOXORUBICIN (3 day) 15.007 TRABECTEDIN (soft tissue) 15.008 TA185 2010 MIFAMURTIDE (osteosarcoma) 15.009 TA228 2011 IMATINIB (CDF only - Chordoma) 15.010 WM/CDF43 Version Number 1 January 2013 14
KAPOSI SARCOMAS VINCRISTINE + BLEOMYCIN 16.001 Single Agent EPIRUBICIN 16.002 THYROID Single Agent DOXORUBICIN 23.001 SORAFENIB 23.002 GASTRO INTESTINAL STROMAL TUMOUR (GIST) Single Agent IMATINIB (NICE) 24.001 TA86 2004 Single Agent SUNITINIB (NICE) 24.002 TA179 2009 IMATINIB adjuvant (CDF only) 24.003 WM/CDF/18 ADRENAL CORTICAL CANCER Oral MITOTANE 25.001??Worcs Small numbers may need to be considered as IFR s HEPATOCELLULAR CANCER SORAFENIB (CDF only) 26.001 WM/CDF/1 NEUROENDOCRINE STREPTOZOTOCIN + CAPECITABINE 27.001 Version Number 1 January 2013 15
SMALL CELL CANCERS OUTSIDE LUNG CARBOPLATIN + ETOPOSIDE 1 st line 28.001 VAC (CAV) 2 nd line 28.002 Version Number 1 January 2013 16