Chapter 8: Malignant Disease & Immunosuppression

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North East Yorkshire &
Humber Clinical Alliance
Oncology Network Guidance

***Please note this chapter is being reviewed and awaiting ratification by the APC***

Review of draft chapter are available to view and comment on via Chapter 8 – version 1 or via

8.1 Cytotoxic drugs

8.1.1 Alkylating drugs

i. Cyclophosphamide Tablets, Injection. Hospital Initiated Only
ii. Busulfan Tablets. Hospital Only
iii. Carmustine Injection. Hospital Only
iv. Chlorambucil Tablets. Hospital Only
v. Chlormethine (Mustine) Injection. Hospital Only
vi. Estramustine Capsules. Hospital Only
vii. Ifosfamide Injection. Hospital Only
viii. Lomustine Capsules. Hospital Only
ix. Melphalan Tablets. Hospital Only
x. Thiotepa Injection. Hospital Only
xi. Treosulfan Capsules. Hospital Only
xii. Bendamustine. Hospital Only NICE TA216

8.1.2 Cytotoxic antibiotics

i. Bleomycin Injection. Hospital Only
ii. Dactinomycin (Actinomycin D) Injection. Hospital Only
iii. Daunorubicin Injection. Hospital Only
iv. Doxorubicin Injection, Liposomal Injection. Hospital Only
v. Epirubicin Injection. Hospital Only
vi. Idarubicin Capsules, Injection. Hospital Only
vii. Mitomycin Injection. Hospital Only
viii. Mitoxantrone Injection. Hospital Only
ix. Pixantrone Injection. Hospital Only NICE TA306

8.1.3 Anti-metabolites

i. Mercaptopurine Tablets. Hospital Initiated Only
ii. Methotrexate Injection, Tablets. Hospital Initiated Only
iii. Flurouracil Cream. Hospital Initiated Only
iv. Flurouracil Injection. Hospital Initiated Only
v. Efudix Cream. Hospital Initiated Only
vi. Calcium Folinate Injection. Hospital Only
vii. Calcium Folinate Tablets. Hospital Only
viii. Capecitabine Tablets. Hospital Only
ix. Fludarabine Tablets. Hospital Only
x. Cladribine Subcutaneous Injection. Hospital Only
xi Cladribine Tablets NICE TA493
xii. Cytarabine Injection. Hospital Only
xiii. Fludarabine Injection. Hospital Only
xiv. Gemcitabine Injection. Hospital Only
xv. Raltitrexed Injection. Hospital Only
xvi. Tioguanine (Thioguanine) Tablets. Hospital Only
xvii. Tegafur/Uracil Capsules. Hospital Only
xviii. Azacitidine. Hospital Only, NICE TA218
xix. Pemetrexed. Hospital Only, NICE TA181 & TA190

8.1.4 Vinca alkaloids and Etoposide

i. Vinblastine Injection. Hospital Only
ii. Vincristine Injection. Hospital Only
iii. Vindesine Injection. Hospital Only
iv. Vinorelbine Injection, Capsules. Hospital Only
v. Etoposide Capsules, Injection. Hospital Only
vi. Vinflunine Injection. Hospital Only, NICE TA272

8.1.5 Other Antineoplastic Drugs

i. Hydroxycarbamide (Hydroxyurea) Capsules
ii. Altretamine Capsules. Hospital Only
iii. Amsacrine Injection. Hospital Only
iv. Carboplatin Injection. Hospital Only
v. Cisplatin Injection. Hospital Only
vi. Crisantaspase Injection. Hospital Only
vii. Dacarbazine Injection. Hospital Only
viii. Docetaxel Injection. Hospital Only
ix. Erlotinib Tablets. Use as per HEYHCA Guidelines and NICE TA374
x. Gefitinib Tablets. Use as per HEYHCA Guidelines and NICE TA374
xi. Imatinib Tablets. Use as per HEYHCA Guidelines and NICE TA425 & NICE TA426
xii. Lapatinib Tablets. Use as per HEYHCA Guidelines
xiii. Nilotinib Capsules. Use as per HEYHCA Guidelines and NICE TA425 & NICE TA426
xiv. Trastuzumab. Use as per HEYHCA Guidelines
xv. Irinotecan Injection. Hospital Only
xvi. Oxaliplatin Injection. Hospital Only
xvii. Pazopanib Tablets. Use as per NICE Guidelines, Hospital Only
xviii. Paclitaxel Injection. Hospital Only. NICE TA389 & NICE TA476
xix. Pentostatin Injection. Hospital Only
xx. Procarbazine Capsules. Hospital Only
xxi. Temozolomide Capsules. Hospital Only
xxii. Tretinoin Capsules. Hospital Only
xxiii. Cabazitaxel. Hospital Only, NICE TA255
xxiv. Eribulin. Hospital Only, NICE TA250
xxv. Bevacizumab. Hospital Only, NICE TA242 & TA214
xxvi. Panitumumab. Hospital Only, NICE TA242
xxvii. Bortezomib. Hospital Only, NICE TA228 & TA311
xxviii. Trabectedin. Hospital Only, NICE TA389 & TA185
xxix. Topotecan (Oral). Hospital Only, NICE TA183 & TA184
xxx. Sunitinib. Hospital Only, NICE TA179
xxxi. Cetuximab. Hospital Only, NICE TA176
xxxii. Sorafenib. Hospital Only, NICE TA178 & TA474
xxxiii. Temsirolimus. Hospital Only, NICE TA178
xxxiv. Trastuzumab. Hospital Only, NICE TA34
xxxv. Ipilimumab. Hospital Only, NICE TA268 and TA319
xxxvi. Afatinib. Hospital Only, NICE TA310
xxxvii. Nintedanib Capsules. Hospital Only, NICE TA347 and NICE TA379
xxxviii. Idelalisib. Hospital Only, NICE TA359
xxxix. Panobinostat. Hospital Only, NICE TA380
xl. Olaparib Capsules. Hospital Only, NICE TA381
xli. Ruxolitinib Tablets. Hospital Only. NICE TA386
. Gemcitabine Infusion. Hospital Only. NICE TA389
. Trabectedin Infusion. Hospital Only. NICE TA389
xliv. Everolimus Tablets, NICE TA432
xlv Dasatinib NICE TA425 & NICE TA426
xlvi Carfilzomib Hospital Only Specialist Commissioner as per NICE TA457
xlvii Brentuximab – Red – Hospital Only as per NICE TA446  & TA478
xlviii Everolimus and Sunitinib – Red – Hospital Only as per NICE TA449  
xlix Venetoclax as per NICE TA487 
l Regorafenib as per NICE TA488 – Specialist Centre Only
li Ibrutinib as per NICE TA491
lii Trastuzumab as per NICE TA 458
liii Palbociclib as per NICE TA495
liv Ribociclib as per NICE TA496

Adalimumab, certolizumab pegol, etanercept, golimumab and infliximab have received the NICE Technology Appraisal TA383 and can be used as per TA383 in hospital settings only.

Adalimumab, etanercept, infliximab, certolizumab pegol, golimumab, tocilizumab and abatacept for rheumatoid arthritis not previously treated with DMARDs or after conventional DMARDs only have failed as per NICE TA 375

Ixazomib with lenalidomide and dexamethasone as per NICE TA505

Lenvatinib with everolimus as per NICE TA498

Ceritinib as per NICE TA500

Ibrutinib as per NICE TA502

Pertuzumab with trastuzumab and docetaxel as per NICE TA509
Tivozanib as per NICE TA512
Cabozantinib as per NICE TA516


8.1.6 Taxanes

i. Paclitaxel Injection 6mg/ml, 5ml vial, 16.7ml and 50ml vial. Hospital Only
ii. Docetaxel Injection 40mg/ml, 0.5ml vial, 2ml vial. Hospital Only

8.2 Drugs affecting the immune response

8.2.1 Antiproliferative Immunosuppressants

i. Azathioprine Tablets 25mg, 50mg. Hospital Initiated Only
ii. Mycophenolate Mofetil. Hospital Initiated Only
iii. Mycophenolic Acid. Hospital Initiated Only

8.2.2 Corticosteroids and other immunosuppressants

i. Ciclosporin Capsules 10mg, 25mg, 50mg, 100mg. Hospital Initiated Only
ii. Tacrolimus Capsules 500 micrograms. Hospital Initiated Only
iii. Ciclosporin Oral solution 100mg/ml, 50ml. Hospital Initiated Only
iv. Ciclosporin Concentrate for IV Infusion 50mg/ml. Hospital Only
v. Sirolimus Tablets, Oral solution. Hospital Initiated Only
vi. Basiliximab. Hospital Only, NICE TA99

8.2.3 Rituximab and Alemtuzumab

i. Alemtuzumab Injection. Hospital Only, NICE TA312
ii. Rituximab 100mg, 500mg vial & 1400mg SC Injection. Hospital Only
iii. Ofatumumab. Hospital Only, NICE TA202 and NICE TA344
iv. Obinutuzumab 25mg/ml, 40mg Vial. Hospital Only, NICE TA343
v. Nivolumab Injection. Hospital Only, NICE TA384 
vi Blinatumomab – Red – Hospital Only – as per NICE TA450
vii Ponatinib – Red – Hospital Only – as per NICE TA451
viii Obinutuzumab as per NICE TA 513

8.2.4 Other Immunomodulating Drugs

i. Interferon-Roferon A. Hospital Only
ii. Peginterferon, ViraferonPeg. Hospital Only
iii. Peginterferon-alfa 2a, Pegasys. Hospital Only
iv. Thalidomide Pharmion. Hospital Only
v. Lenalidomide Capsules. Hospital Only, NICE TA322
vi. Fingolimod. Hospital Only, NICE TA254
vii. Mifamurtide. Hospital Only, NICE TA235
viii. Natalizumab. Hospital Only, NICE TA127
ix. Teriflunomide. Hospital Only, NICE TA303
x. Pembrolizumab. Hospital Only, NICE TA357  and NICE TA447 and NICE TA 519
xi Nivolumab – for treating relapsed or refractory classical Hodgkin Lymphoma – Secondary Care Only – Red as per NICE TA484 , TA400 ,  TA462 , TA417TA490 ,  TA384TA483 &  NICE TA462  
xii Atezolizumab TA492 
xii Daratumumab. As per NICE TA510
xiii Avelumab as per NICE TA517


8.3 Sex hormones and hormone antagonists in malignant disease

8.3.1 Oestrogens

i. Diethylstilbestrol (Stilboestrol) Tablets 1mg, 5mg. Hospital Initiated Only
ii. Estradiol Valerate Tablets 1mg. Hospital Initiated Only
iii. Ethinylestradiol Tablets 10 mcg, 50 mcg, 1000mcg. Hospital Initiated Only
iv. Degarelix (NICE TA404) Hospital Only

8.3.2 Progestogens

i. Medroxyprogesterone Acetate Tablets 100mg, 250mg. Hospital Initiated Only
ii. Megestrol Acetate Tablets 40mg, 160mg. Hospital Initiated Only
iii. Medroxyprogesterone Acetate Injection 500mg vial. Hospital Initiated Only
iv. Norethisterone Tablets 5mg. Hospital Initiated Only

8.3.3 Androgens

i. Testosterone (mixed esters) Injection 100mg/ml, 250mg/ml. Hospital Initiated Only

8.3.4 Hormone antagonists

i. Radium-223 Dichloride Breast cancer

i. Anastrozole Tablets 1mg. Hospital Initiated Only
ii. Tamoxifen Tablets 10mg, 20mg. Hospital Initiated Only
iii. Letrozole Tablets. Hospital Initiated Only
iv. Exemestane Tablets 25mg. Hospital Initiated Only
v. Fulvestrant 250mg Injection. Use as per HEYHCA Guidelines Only
vi. Toremifene Tablets 60mg. Hospital Initiated Only Gonadorelin analogues and gonadotrophin-releasing hormone antagonists

i. Leuprorelin Injection 3.75mg, 11.25mg. Hospital Initiated Only
ii. Bicalutamide Tablets 50mg, 150mg. Hospital Initiated Only
iii. Goserelin Injection 3.6mg, 10.8mg. Hospital Initiated Only
iv. Cyproterone Tablets 50mg. Hospital Initiated Only
v. Flutamide Tablets 250mg. Hospital Initiated Only
vi. Buserelin Nasal Spray. Hospital Initiated Only
vii. Abiraterone Tablets 250mg. Hospital Initiated Only. As Per NICE TA387
viii. Enzalutamide 40mg Capsules. Hospital Only. As Per NICE TA316 and NICE TA377
ix Degarelix NICE TA404
x. Triptorelin Injection. Hospital Initiated Only Somatostatin analogues

i. Lanreotide Injection. Hospital Initiated Only
ii. Octreotide Injection 50 mcg/ml, 100 mcg/ml. Hospital Initiated Only
iii. Octreotide (Sandostatin LAR). Hospital Initiated Only

Please refer to the North East Yorkshire and Humber Clinical Alliance for full cancer guidelines and chemotherapy regimens.