Approved in line with NICE TA259 for use by an oncologist for castration resistant metastatic prostate cancer, previously treated with docetaxel. Commissioners have confirmed that abiraterone in the above indication is not routinely commissioned in England in patients who have received prior enzalutamide therapy. An exception will be where enzalutamide has had to be stopped within 3 months of its start solely as a consequence of dose-limiting toxicity and in the clear absence of disease progression.
Approved in line with NICE TA387 for treating metastatic hormone-relapsed prostate cancer before chemotherapy is indicated
At SFH, see link below.
Patients commenced on the drug prior to 1st May 2011 are eligible for free of charge stock via a compassionate use programme.
Approved in accordance with the National Cancer Drugs Fund with androgen deprivation therapy for treating non-metastatic hormone-resistant prostate cancer where the specified criteria are met.
Tablets (NB: Capsules discontinued Sept 2019)
Approved in line with NICE TA377 for treating metastatic, hormone-relapsed prostate cancer before chemotherapy is indicated.
Enzalutamide is routinely commissioned for metastatic hormone-relapsed prostate cancer previously treated with a docetaxel-containing regimen in accordance with NICE TA316.
NB: The use of enzalutamide for treating metastatic hormone-relapsed prostate cancer previously treated with abiraterone is not covered by this guidance.
Enzalutamide requires National Cancer Drugs Fund approval (until April 2016) for the treatment of chemotherapy naïve castrate-resistant Metastatic Prostate Cancer. Confirm funding is approved on BlueTeq for all new CDF starters.
NUH: For more about CDF approved indications, including criteria, see the DTC website; available here
SFH: For all new starters contact the oncology pharmacy team (3156) or the HCD Team (4660) to confirm whether CDF approval is required or not.
Triptorelin is GnRH analogue of choice for all indications except breast cancer. Leuprorelin is restricted to patients in whom IM injections should be avoided, eg those on anticoagulants (May 2014) as it may be given SC and therefore preferable to IM triptorelin.
Grey / Non-Formulary: Medicines, which the Nottinghamshire APC has actively reviewed and does not recommend for use at present due to limited clinical and/or cost effective data. Grey / Non-Formulary (undergoing assessment): Work is ongoing and will be reviewed at a future APC meeting. Grey / Non-Formulary (no formal assessment): APC has not formally reviewed this medicine or indication because it had never been requested for formulary inclusion. Often used for drugs new to market.
Medicines which should normally be prescribed by specialists only. eg hospital only.
For patients already receiving prescriptions in primary care - continue. No new patients to receive prescriptions in primary care.
Medicines that should be initiated by a specialist and prescribed by primary care prescribers only under a shared care protocol, once the patient has been stabilised.
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 Nottinghamshire APC.
Medicines suitable to be prescribed in primary care / general practice after specialist* recommendation or initiation.
A supporting prescribing guideline may be requested which must have been agreed by the relevant secondary care trust DTCs and approved by the Nottinghamshire APC.
*Specialist is defined by the APC as a clinician who has undertaken an appropriate formal qualification or recognised training programme within the described area of practice
Primary care/ non specialist may initiate as per APC guideline.
The supporting prescribing guideline must have been agreed by the relevant secondary care trust D&TC(s) and approved by the Nottinghamshire APC.
Medicines suitable for routine 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.