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 Formulary Chapter 8: Malignant disease and immunosuppression - Full Chapter
Notes:

The formulary for systemic anti-cancer treatments should be viewed alongside the 'National Cancer Drugs Fund list'

https://www.england.nhs.uk/publication/national-cancer-drugs-fund-list/

 Details...
08.02.03  Expand sub section  Anti-lymphocyte monoclonal antibodies
Alemtuzumab (Lemtrada®)
(Multiple sclerosis)
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Restricted Drug Restricted
GP - Red
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Provider notes

  • NMUH:
    • This medicine has a positive NICE Technology Appraisal but is not listed in the Trust Medicines Formulary as the service is not offered at NMUH.
  • RFL:
    • As per NICE TA
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • Non-formulary
 
Link  NICE TA312: Alemtuzumab for relapsing‑remitting multiple sclerosis
Obinutuzumab
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Restricted Drug Restricted
GP - Red
High Cost Medicine
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See NICE TA for eligibility criteria

Provider notes

  • NMUH:
    • This medicine has a positive NICE Technology Appraisal and is listed in the Trust Medicines Formulary when used in line with NICE recommendations and/or Local Trust Guidelines.
    • To be prescribed by the Haematology Team ONLY.
    • As per NICE TA343, TA472 and TA513.
  • RFL:
    • As per NICE TA343, TA472 and TA513.
    • This drug for the treatment of malignant disease must be prescribed on chemocare (RFL electronic chemotherapy prescribing system)
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • As per NICE TA343, TA472 and TA513.
 
Link  NICE TA343: Obinutuzumab with chlorambucil for CLL
Link  NICE TA472: Obinutuzumab with bendamustine for treating follicular lymphoma refractory to rituximab
Link  NICE TA513: Obinutuzumab for untreated advanced follicular lymphoma
Link  NICE TA629: Obinutuzumab with bendamustine for treating follicular lymphoma after rituximab
Ofatumumab
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Restricted Drug Restricted
High Cost Medicine
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See NICE TA for eligibility criteria

Provider notes

  • NMUH:
    • This medicine has a positive NICE Technology Appraisal and is listed in the Trust Medicines Formulary when used in line with NICE recommendations and/or Local Trust Guidelines.
    • To be prescribed by the Haematology Team ONLY.
    • Check MHRA Drug Safety Updates
    • See links below
  • RFL:
    • As per NICE guidance
    • This drug for the treatment of malignant disease must be prescribed on chemocare (RFL electronic chemotherapy prescribing system)
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • See links below
 
Link  NICE TA202 (not recommended): Ofatumumab for the treatment of chronic lymphocytic leukaemia refractory to fludarabine and alemtuzumab
Link  NICE TA344: Ofatumumab in combination with chlorambucil or bendamustine for untreated chronic lymphocytic leukaemia
Link  NICE TA469 (not recommended): Idelalisib with ofatumumab for treating chronic lymphocytic leukaemia (terminated appraisal)
Link  NICE TA470 (not recommended): Ofatumumab with chemotherapy for treating chronic lymphocytic leukaemia (terminated appraisal)
Rituximab
(Haematology)
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Restricted Drug Restricted
GP - Red
High Cost Medicine
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NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

Truxima brand is first choice (JFC March 2017).

JFC approved for:

  • Autoimmune haemolytic anaemia; second-line (after prednisolone) in warm and mixed-type AIHA and 1st line in cold-type AIHA (July 2016)
  • Idiopathic thrombocytopenic purpura (ITP); for refractory or relapsed disease only (November 2012)
  • See NICE TAs for eligibility criteria for other conditions

Provider notes

  • NMUH:
    • This medicine has a positive NICE Technology Appraisal and is listed in the Trust Medicines Formulary when used in line with NICE recommendations and/or Local Trust Guidelines.
    • See links below
    • Approved for ITP ad AIHA (see above)
      • This is an unlicensed use of rituximab and funding needs to be approved prior to use. This should only be prescribed by Haematology Consultants.
  • RFL:
    • Approved for the treatment of DBCL, FL, MCL, CLL, MALT, MZL, WM and LPL
    • Also approved for AIHA and ITP, Castleman's disease (1st line), acquired and congenital coagulation inhibitor disorders
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Check with haematology
 
Link  NHSE F02/P/a: The use of Rituximab as a second line agent for the eradication of inhibitors in patients with Acquired Haemophilia
Link  NICE TA137: Rituximab for the treatment of relapsed or refractory stage III or IV follicular non-Hodgkin’s lymphoma
Link  NICE TA174: Rituximab for the first-line treatment of chronic lymphocytic leukaemia
Link  NICE TA193: Rituximab for the treatment of relapsed or refractory chronic lymphocytic leukaemia
Link  NICE TA226: Rituximab for the first-line maintenance treatment of follicular non-Hodgkin’s lymphoma
Link  NICE TA243: Rituximab for the first-line treatment of stage III-IV follicular lymphoma
 ....
 Non Formulary Items
Blinatumomab

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Non Formulary
GP - Red

Provider notes

  • NMUH:
    • Non-formulary
    • This medicine has a positive NICE Technology Appraisal but is not listed in the Trust Medicines Formulary as the service is not offered at NMUH.
  • RFL:
    • Non-formulary
  • RNOH:
    • Non-formulary
  • UCLH:
    • Non-formulary
  • WH:
    • Non-formulary
Link  NICE TA450: Blinatumomab for previously treated Philadelphia-chromosome-negative acute lymphoblastic leukaemia
Link  NICE TA589: Blinatumomab for treating acute lymphoblastic leukaemia in remission with minimal residual disease activity
Gemtuzumab ozogamicin injection

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Non Formulary

See NICE TA for eligibility criteria

Provider notes

  • NMUH:
    • This medicine has a positive NICE Technology Appraisal but is not listed in the Trust Medicines Formulary as the service is not offered at NMUH.
  • RFL:
    • Non-formulary
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
Link  NICE TA545: Gemtuzumab ozogamicin for untreated acute myeloid leukaemia
  
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
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Link to adult BNF
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Link to children's BNF
click to search medicines.org.uk
Link to SPCs
Homecare
Homecare

Traffic Light Status Information

Status Description

GP - 1st

Medicines suitable for first-line use within primary care.

Can be initiated within primary care within their licensed indication, in accordance with nationally recognised formularies, for example the BNF, BNF for Children, Medicines for Children or Palliative Care Formulary. Primary care prescribers take full responsibility for prescribing. 

  

GP - 2nd

Medicines suitable for second-line use within primary care.

Can be initiated within primary care within their licensed indication, in accordance with nationally recognised formularies, for example the BNF, BNF for Children, Medicines for Children or Palliative Care Formulary. Primary care prescribers take full responsibility for prescribing. 

  

GP - Amber

Medicines that should be initiated by a specialist. Prescribing can be transferred to primary care once the patient has been stabilised.  

Shared care: For drugs with regular, ongoing need for monitoring and/or assessment of efficacy or toxicity. Prior agreement must be obtained by the specialist from the primary care provider before prescribing responsibility is transferred. The shared care protocol must have been agreed by the relevant secondary care trust Drugs and Therapeutics Committee(s) (DTC) and approved by the North Central London JFC.

Fact sheet: For drugs with some concerns surrounding safety or efficacy but do not require regular monitoring and/or monitoring of effectiveness/toxicity.

  

GP - Red

Medicines which should normally be prescribed by specialists only (hospital only).

For patients already receiving prescriptions in primary care - continue. No new patients to receive prescriptions in primary care.

See link for the complete NCL Red List https://www.ncl-mon.nhs.uk/wp-content/uploads/2017/08/ncl_red_list.pdf

  

GP - Grey

Medicines on hospital formularies which have not been reviewed for suitability in primary care.  

Black

Medicines not recommended for routine use in primary or secondary care.

Medicines, which the North Central London JFC has actively reviewed and does not recommend for use at present due to limited clinical and/or cost effective data.

  

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