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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...
08.03.04.01  Expand sub section  Breast cancer
Anastrozole
(Breast cancer)
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Restricted Drug Restricted
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Provider notes

  • NMUH:
    • Restricted to Oncology department use only.
  • RFL:
    • No restriction stated
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • No restriction stated
 
Link  NICE TA112: Hormonal therapies for the adjuvant treatment of early oestrogen-receptor-positive breast cancer
   
Exemestane
(Breast caner)
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Restricted Drug Restricted
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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
  • RFL:
    • No restriction stated
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • Exemestane is indicated for 3rd line treatment (after tamoxifen and anastrazole) in post-menopausal women with metastatic breast cancer
 
Link  NICE TA112: Hormonal therapies for the adjuvant treatment of early oestrogen-receptor-positive breast cancer
   
Fulvestrant
(Breast cancer)
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Restricted Drug Restricted
GP - Red
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Approved as Third-line therapy for locally advanced or metastatic HER2-, ER+ breast cancer in postmenopausal women without symptomatic visceral disease, that has recurred or progressed after a non-steroidal aromatase inhibitor and tamoxifen (JFC February 2016).

Provider notes

  • NMUH:
    • To be prescribed by Oncology Consultants ONLY
    • See indication above
  • RFL:
    • Approved as per above
    • Approved as per NICE TA593 in combination with ribociclib
    • Approved as per NICE TA597 in combination with abemaciclib
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • See indication above
 
Link  NICE TA239 (not recommended): Fulvestrant for the treatment of locally advanced or metastatic breast cancer
Link  NICE TA503 (not recommended): Fulvestrant for untreated locally advanced or metastatic oestrogen-receptor positive breast cancer
Link  NICE TA593: Ribociclib with fulvestrant for treating hormone receptor-positive, HER2-negative, advanced breast cancer
   
Letrozole
(Breast cancer)
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Formulary
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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. 

Provider notes

  • NMUH:
    • Restricted to Oncology department use only
  • RFL:
    • No restriction stated
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • No restriction stated
 
Link  NICE TA112: Hormonal therapies for the adjuvant treatment of early oestrogen-receptor-positive breast cancer
   
Tamoxifen
(Breast cancer/ mastocytosis)
View adult BNF View SPC online View childrens BNF
Formulary
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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. 

Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • No restriction stated
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • No restriction stated
 
Link  NICE TA112: Hormonal therapies for the adjuvant treatment of early oestrogen-receptor-positive breast cancer
   
 ....
 Non Formulary Items
Toremifene

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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.

  

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