8: Malignant disease & immunosupression
Approved: 4 Oct 2017. Last amended: 4 Oct 2017.
8.1 Cytotoxic drugs
Not currently included in Joint Formulary
8.2 Drugs affecting the immune response
Not currently included in Joint Formulary
8.3 Sex hormones and hormone antagonists in malignant disease
8.3.1 Oestrogens
Not currently included in Joint Formulary
8.3.2 Progestogens
Not currently included in Joint Formulary
8.3.3 Androgens
Not currently included in Joint Formulary
8.3.4 Hormone antagonists
8.3.4.1 Breast Cancer
Not currently included in Joint Formulary
8.3.4.2 Gonadorelin analogues
Recommended
Triptorelin (Decapeptyl® SR)
3mg, 11.25mg, 22.5mg (22.5mg IM 6 monthly injection preferred in Primary Care)
Alternative
Leuprorelin (Prostap®)
3.75mg, 11.25mg
Goserelin (Zoladex®)
3.6mg, 10.8mg
8.3.4.3 Anti-androgens
Recommended
Bicalutamide
Alternative
Cyproterone
Specific Indication
Abiraterone
- castration-resistant metastatic prostate cancer, as per NICE TA259
- metastatic hormone-relapsed prostate cancer before chemotherapy is indicated, as per NICE TA387
- newly diagnosed high-risk hormone-sensitive metastatic prostate cancer, as per NICE TA721
Enzalutamide
- metastatic hormone relapsed prostate cancer previously treated with a docetaxel containing regimen, as per NICE TA316
- metastatic hormone-relapsed prostate cancer before chemotherapy is indicated, as per NICE TA377
- hormone-sensitive metastatic prostate cancer, as per NICE TA712
8.3.4.4 Gonadotrophin-releasing hormone antagonists
Degarelix
Advanced hormone-dependent prostate cancer in people with spinal metastases, as per NICE TA404
8.3.4.5 Somatostatin analogues
Not currently included in Joint Formulary