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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...
08.02.04  Expand sub section  Other immunomodulating drugs
Alemtuzumab (Lemtrada®)
(Multiple sclerosis)
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Restricted Drug Restricted
GP - Red

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
   
Canakinumab
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
High Cost Medicine

Provider notes

  • RFL:
    • Approved for use by Professor Hawkins
 
Link  NICE TA281 (not recommended): Canakinumab for treating gouty arthritis attacks and reducing the frequency of subsequent attacks (terminated appraisal)
Link  NICE TA302 (not recommended): Canakinumab for treating systemic juvenile idiopathic arthritis (terminated appraisal)
   
Cladribine tablets (Mavenclad®)
(Multiple sclerosis)
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Restricted Drug Restricted
GP - Red

Provider notes

  • RFL:
    • As per NICE TA
 
Link  NICE TA493: Cladribine tablets for treating relapsing–remitting multiple sclerosis
   
Cobimetinib
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Formulary

Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Non-formulary
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
 
Link  NICE TA414 (not recommended): Cobimetinib in combination with vemurafenib for treating unresectable or metastatic BRAF V600 mutation-positive melanoma
   
Daclizumab
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Restricted Drug Restricted
GP - Red

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 TA441 : Daclizumab for treating relapsing–remitting multiple sclerosis
   
Daratumumab injection
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
Cancer Drugs Fund

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. 
    • See links below
  • RFL:
    • As per NICE TA
    • 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 TA
 
Link  NICE TA454 (not recommended): Daratumumab with lenalidomide and dexamethasone for treating relapsed or refractory multiple myeloma (terminated appraisal)
Link  NICE TA510: Daratumumab monotherapy for treating relapsed and refractory multiple myeloma
Link  NICE TA573: Daratumumab with bortezomib and dexamethasone for previously treated multiple myeloma
   
Dimethyl fumarate (Tecfidera®)
(Multiple sclerosis)
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Restricted Drug Restricted
High Cost Medicine

DO NOT CONFUSE Tecfidera® AND Skilarence® AS THEY ARE LICENSED FOR DIFFERENT INDICATIONS

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.
    • Check MHRA Drugs Safety Updates
  • RFL:
    • As per NICE TA
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
 
Link  NICE TA320: Dimethyl fumarate for multiple sclerosis
   
Fingolimod
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Formulary
GP - Red
High Cost Medicine

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.
    • Check MHRA Drug Safety Updates
  • RFL:
    • As per NICE TA
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
 
Link  NICE TA254: Fingolimod for highly active relapsing remitting multiple sclerosis
   
Lenalidomide
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Restricted Drug Restricted
GP - Red
High Cost Medicine
Cancer Drugs Fund

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. 
    • All prescriptions must be accompanied by a prescription authorisation form
    • See links below
    • Check MHRA Drug Safety Update
  • RFL:
    • As per NICE TAs
    • This drug for the treatment of malignant disease must be prescribed on chemocare (RFL electronic chemotherapy prescribing system). Additionally for in-patients this drug must be prescribed on an in-patients prescription chart (paper or electronic)
    • Patient, prescriber and supplying pharmacy must comply with a pregnancy prevention programme
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • No restriction stated
 
Link  NICE TA171: Lenalidomide for the treatment of multiple myeloma in people who have received at least one prior therapy
Link  NICE TA322: Lenalidomide for treating myelodysplastic syndromes associated with an isolated deletion 5q cytogenetic abnormality
Link  NICE TA505: Ixazomib with lenalidomide and dexamethasone for treating relapsed or refractory multiple myeloma
Link  NICE TA586: Lenalidomide plus dexamethasone for multiple myeloma after 1 treatment with bortezomib
Link  NICE TA587: Lenalidomide plus dexamethasone for previously untreated multiple myeloma
Link  NICE TA603 (terminated appraisal): Lenalidomide with bortezomib and dexamethasone for untreated multiple myeloma
   
Nintedanib  (Vargatef®)
(Oncology)
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Restricted Drug Restricted

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 Oncology Consultants ONLY.
    • 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).  Additionally for in-patients this drug must be prescribed on an in-patients prescription chart (paper or electronic)
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • No restriction stated
 
Link  NICE TA347: Nintedanib for previously treated locally advanced, metastatic, or locally recurrent non‑small‑cell lung cancer
   
Nivolumab injection
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Restricted Drug Restricted
High Cost Medicine
Cancer Drugs Fund

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.
    • See links below
    • TA400, TA417, TA530, TA558 and TA581 do not apply at NMUH as service is not offered
  • RFL:
    • As per NICE TA
    • 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 TA384: Nivolumab for treating advanced (unresectable or metastatic) melanoma
Link  NICE TA400: Nivolumab in combination with ipilimumab for treating advanced melanoma
Link  NICE TA417: Nivolumab for previously treated advanced renal cell carcinoma
Link  NICE TA462: Nivolumab for treating relapsed or refractory classical Hodgkin lymphoma
Link  NICE TA483: Nivolumab for previously treated squamous non-small-cell lung cancer
Link  NICE TA484: Nivolumab for previously treated non-squamous non-small-cell lung cancer
Link  NICE TA490: Nivolumab for treating squamous cell carcinoma of the head and neck after platinum-based chemotherapy
Link  NICE TA530 (not recommended): Nivolumab for treating locally advanced unresectable or metastatic urothelial cancer after platinum-containing chemotherapy
Link  NICE TA558: Nivolumab for adjuvant treatment of completely resected melanoma with lymph node involvement or metastatic disease
Link  NICE TA581: Nivolumab with ipilimumab for untreated advanced renal cell carcinoma
   
Ocrelizumab injection
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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:
    • As per NICE TA
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
 
Link  NICE TA533: Ocrelizumab for treating relapsing–remitting multiple sclerosis
Link  NICE TA585: Ocrelizumab for treating primary progressive multiple sclerosis
   
Olaparib
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
High Cost Medicine

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 TA381: Olaparib for maintenance treatment of relapsed, platinum-sensitive, BRCA mutation-positive ovarian, fallopian tube and peritoneal cancer after response to second-line or subsequent platinum-based chemotherapy
Link  NICE TA598: Olaparib for maintenance treatment of BRCA mutation-positive advanced ovarian, fallopian tube or peritoneal cancer after response to first-line platinum-based chemotherapy
   
Osimertinib
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Formulary
Cancer Drugs Fund

Provider notes

  • NMUH:
    • Positive NICE TA 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
  • RFL:
    • As per NICE guidance
    • This drug for the treatment of malignant disease must be prescribed on chemocare (RFL electronic chemotherapy prescribing system).  Additionally for in-patients this drug must be prescribed on an in-patients prescription chart (paper or electronic)
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • No restriction stated
 
Link  NICE TA416: Osimertinib for treating locally advanced or metastatic EGFR T790M mutation-positive non-small-cell lung cancer
   
Pomalidomide
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
High Cost Medicine
Cancer Drugs Fund

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
    • Check MHRA Drugs Safety Updates
  • RFL:
    • As per NICE TAs
    • This drug for the treatment of malignant disease must be prescribed on chemocare (RFL electronic chemotherapy prescribing system).
    • Additionally for in-patients this drug must be prescribed on an in-patients prescription chart (paper or electronic)
      Patient, prescriber and supplying pharmacy must comply with a pregnancy prevention programme
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • See links below
 
Link  NICE TA427: Pomalidomide for multiple myeloma previously treated with lenalidomide and bortezomib
Link  NICE TA602 (terminated appraisal): Pomalidomide with bortezomib and dexamethasone for treating relapsed or refractory multiple myeloma
   
Teriflunomide
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Restricted Drug Restricted
High Cost Medicine

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:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
 
Link  NICE TA303: Teriflunomide for relapsing remitting MS
Link  NICE TA405:Trifluridine–tipiracil for previously treated metastatic colorectal cancer
   
Thalidomide
(Haematology)
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Restricted Drug Restricted
GP - Red
High Cost Medicine

NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

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.
    • Check MHRA Drug Safety Alerts
  • RFL:
    • As per NICE TA
    • This drug for the treatment of malignant disease must be prescribed on chemocare (RFL electronic chemotherapy prescribing system).  Additionally for in-patients this drug must be prescribed on an in-patients prescription chart (paper or electronic)
    • Patient, prescriber and supplying pharmacy must comply with a pregnancy prevention programme
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • The use of thalidomide is restricted to Consultant Haematologists for the treatment of end-stage myeloma.
 
Link  NICE TA228: Bortezomib and thalidomide for the first‑line treatment of multiple myeloma
   
08.02.04  Expand sub section  Interferon Alfa
Interferon Alfa (IntronA®)
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
GP - Red
High Cost Medicine

Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • No restriction stated
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Restricted to Consultant Haematologists and Gastroenterologists only
 
Link  NICE TA75: Interferon Alfa - Chronic Hepatitis C
   
Interferon Alfa (Roferon-A®)
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
GP - Red
High Cost Medicine

Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Preferred brand for haematology
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • No restriction stated
 
   
Peginterferon Alfa (Pegasys®)
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
GP - Red
High Cost Medicine

NOTE: There is more than one monograph for PegInterferon Alfa, click here to search for formulary status and its use for other indications. 

Provider notes

  • NMUH:
    • Pegasys or ViraferonPeg
  • RFL:
    • Pegasys restricted to hepatology only for the treatment of Hepatitis B.
    • Pegasys (treatment duration over 48 weeks) approved for Hepatitis B and D co-infection (February 2017)
    • Formulary for myelofibrosis, essential thrombocythaemia and polycythaemia 
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Pegasys "Inj Pen 180 micrograms" or ViraferonPeg
 
Link  NICE TA106: Peginterferon alfa and ribavirin for the treatment of mild chronic hepatitis C
Link  NICE TA200: Peginterferon alfa and ribavirin for the treatment of chronic hepatitis C
Link  NICE TA300: Peginterferon alfa and ribavirin for treating chronic hepatitis C in children and young people
Link  NICE TA75: Interferon alfa (pegylated and non-pegylated) and ribavirin for the treatment of chronic hepatitis C
Link  NICE TA96: Adefovir dipivoxil and peginterferon alfa-2a for the treatment of chronic hepatitis B
   
Peginterferon Alfa (ViraferonPeg®)
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Formulary
GP - Red
High Cost Medicine

NOTE: There is more than one monograph for PegInterferon Alfa, click here to search for formulary status and its use for other indications. 

Provider notes

  • NMUH:
    • Pegasys or ViraferonPeg
  • RFL:
    • Non-formulary
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Pegasys "Inj Pen 180 micrograms" or ViraferonPeg
 
Link  NICE TA200: Peginterferon alfa and ribavirin for the treatment of chronic hepatitis C
Link  NICE TA300: Peginterferon alfa and ribavirin for treating chronic hepatitis C in children and young people
   
08.02.04  Expand sub section  Interferon beta
Interferon beta-1a (Rebif®)
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
GP - Red
High Cost Medicine

Provider notes

  • RFL:
    • Restricted to neurology for the treatment of MS in line with NHSE clinical commissioning policy
 
Link  NICE TA527: Beta interferons and glatiramer acetate for treating multiple sclerosis
   
Peginterferon Beta-1a (Plegridy®)
View adult BNF View SPC online View childrens BNF
Formulary
High Cost Medicine

Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Restricted to Neurology for the treatment of MS in line with NHSE clinical commissioning policy
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
 
   
08.02.04  Expand sub section  Interferon gamma
Interferon gamma-1b (Immukin®)
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted

Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Restricted to immunology use only
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
 
   
08.02.04  Expand sub section  Aldesleukin to top
BCG bladder instillation (ImmuCyst®)
View adult BNF View SPC online View childrens BNF
Formulary

Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • Non-formulary
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
 
   
BCG bladder instillation (OncoTICE®)
View adult BNF View SPC online View childrens BNF
Formulary

Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • No restriction stated
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
 
   
08.02.04  Expand sub section  BCG bladder instillation
08.02.04  Expand sub section  Canakinumab
08.02.04  Expand sub section  Dimethyl fumarate
08.02.04  Expand sub section  Fingolimod
08.02.04  Expand sub section  Glatiramer acetate to top
Glatiramer acetate
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
GP - Red
High Cost Medicine

Approve for relapsing-remitting multiple sclerosis inline with NHS England Commissioning (JFC Feb 2016).

Brabio® is the preferred brand.

Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • As per NHSE clinical commissioning policy
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • For relapsing-remitting multiple sclerosis, see above
 
Link  NICE TA527: Beta interferons and glatiramer acetate for treating multiple sclerosis
   
08.02.04  Expand sub section  Histamine
08.02.04  Expand sub section  Lenalidomide, pomalidomide, and thalidomide
08.02.04  Expand sub section  Mifamurtide
Mifamurtide
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted

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 to WH
 
Link  NICE TA235: Osteosarcoma - mifamurtide: guidance
   
08.02.04  Expand sub section  Natalizumab
Natalizumab
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
GP - Red
High Cost Medicine

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.
    • Check MHRA Drug Safety alerts
  • RFL:
    • As per NICE TA.
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • As per NICE TA
 
Link  NICE TA127: Multiple sclerosis - natalizumab
   
08.02.04  Expand sub section  Teriflunomide to top
 ....
 Non Formulary Items
Aldesleukin

View adult BNF View SPC online View childrens BNF
Non Formulary
GP - Red
High Cost Medicine

 Approved for

  • Idiopathic CD4 lymphocytopenia (November 2012)

Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Non-formulary
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
 
Cediranib  (Recentin®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Dinutuximab beta injection

View adult BNF View SPC online View childrens BNF
Non Formulary

See NICE TA for eligibility criteria

Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Non-formulary
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
Link  NICE TA538: Dinutuximab beta for treating neuroblastoma
 
Interferon Alfa  (Viraferon®)

View adult BNF View SPC online View childrens BNF
Non Formulary
GP - Red
High Cost Medicine
 
Interferon beta-1a  (Avonex®)

View adult BNF View SPC online View childrens BNF
Non Formulary
GP - Red
High Cost Medicine
Link  NICE TA527: Beta interferons and glatiramer acetate for treating multiple sclerosis
 
Interferon beta-1b  (Betaferon®)

View adult BNF View SPC online View childrens BNF
Non Formulary
GP - Red
High Cost Medicine
Link  NICE TA527 (not recommended): Beta interferons and glatiramer acetate for treating multiple sclerosis
 
Interferon beta-1b  (Extavia®)

View adult BNF View SPC online View childrens BNF
Non Formulary
GP - Red
High Cost Medicine
Link  NICE TA527: Beta interferons and glatiramer acetate for treating multiple sclerosis
 
Pemrolizumab  (Keytruda®)

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

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
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

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.

  

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.

  

netFormulary