NHS Greater Glasgow & Clyde Area Drug and Therapeutics Committee
Greater Glasgow and Clyde Medicines
Medicines Update Oncology

Medicines Update Oncology March 2017

The following West of Scotland Cancer Network (WOSCAN) protocols have been prepared  or updated in response to national guidance and are now available on the WOSCAN intranet site (NHS network access required):

 

Idelalisib in combination with rituximab for the treatment of adult patients with chronic lymphocytic leukaemia (CLL) who have received at least one prior therapy, or as first line treatment in the presence of 17p deletion or TP53 mutation in patients unsuitable for chemo-immunotherapy. The advice also incorporates recent European Medicines Agency (EMA) guidance for initiation and monitoring of treatment

  • For protocol click here
  • The GGC formulary entry has been updated. Click here
  • For relevant SMC advice click here

 

Eribulin for the treatment of adult patients with locally advanced or metastatic breast cancer who have progressive disease after at least two prior chemotherapeutic regimens for advanced disease. Prior therapy should have included an anthracycline, taxane and capecitabine in either the adjuvant or metastatic setting unless patients were not suitable for these treatments.

  • For protocol click here
  • The GGC formulary entry has been updated. Click here
  • For relevant SMC advice click here

 

Dasatinib (Sprycel®) for the treatment of adult patients with:

- newly diagnosed Philadelphia chromosome positive (Ph+) chronic myelogenous leukaemia (CML) in the chronic phase

- chronic, accelerated or blast phase chronic myelogenous leukaemia (CML) with resistance or intolerance to prior therapy including imatinib mesilate.

  • For protocol click here
  • The GGC formulary entry has been updated. Click here
  • For relevant SMC advice click here

 

Lenvatinib for the treatment of adult patients with progressive, locally advanced or metastatic, differentiated (papillary/follicular/Hürthle cell) thyroid carcinoma (DTC), refractory to radioactive iodine (RAI).

  • For protocol click here
  • The GGC formulary entry has been updated. Click here
  • For relevant SMC advice click here

 

Erlotinib for the treatment of non-small cell lung cancer that has progressed after prior chemotherapy:

The erlotininb protocol has been amended (in line with HIS endorsed NICE MTA374)  to remove the use of erlotininb in the second line setting for patients who are EGFR negative.  There may be some patients in whom EGFR status is unobtainable due to inadequate/poor quality tissue sample, but the treating clinician considers that the tumour is very likely to be EGFR positive, these patients may still receive erlotinib.

  • For updated protocol click here
  • The GGC formulary entry has been updated. Click here
  • For NICE MTA click here

 

Nintedanib plus docetaxel for the treatment of locally advanced, metastatic or locally recurrent non small cell lung cancer (NSCLC) of adenocarcinoma tumour histology after first line therapy:

 The protocol has been amended to clarify when it is appropriate to continue with single agent nintedanib.  Patients may be considered for nintedanib monotherapy after completion of 4 cycles of nintedanib plus docetaxel.  Routine use of single agent nintedanib is not supported.

  • For updated protocol click here

 

Idelalisib as monotherapy for the treatment of adult patients with  follicular lymphoma (FL) that is refractory to two prior lines of treatment:

The protocol has been amended to include the recent European Medicines Agency (EMA) guidance for initation and monitoring of treatment.

  • For updated protocol click here
  • For EMA guidance click here

 

Guidelines for the use of GCSF in Adult Patients receiving SACT:

The guideline has been amended in response to the current procurement contract for GCSF.  A biosimilar preparation of short acting daily filgrastim is now the medicine of choice (except in the allogenic donor setting) and has been demonstrated to be non inferior to long acting filgrastim preparations and is significantly more cost effective.  Lenograstim has been removed from the guideline.

  • For updated guideline click here

 

Clinical Management Guidelines (CMG's)

The following CMG's have been updated and are available on the WOSCAN intranet site:

Haemato-oncology MCN - Acute Myeloid Leukaemia CMG and AML17 Risk Score Calculator

HBP MCN - Hepatocellular Carcinoma CMG

Lung MCN - NSCLC CMG

Upper GI MCN - Oesophageal Cancer CMG and Gastric Cancer CMG

Sarcoma MCN - Gastrointestinal Stromal Tumour (GIST) CMG

Urology MCN - Bladder Cancer CMG

 

The CMG for "Prostate Cancer which is not Castrate Resistant" has been amended as follows:

LHRH agonist of choice

  • Leuprorelin (Prostap DCS) is the recommended LHRH agonist
  • All new patients should be initiated on leuprorelin if an LHRH agonist is appropriate
  • Existing patients already receiving other LHRH analogues should not be switched to leuprorelin.

Degarelix

  • The urology team have removed the recommendation that degarelix be considered in patients who have experienced a prior major cardiovascular event as evidence suggests that it is not possible to conclude that degarelix would reduce the risk of cardiovascular events in patients with pre-existing cardiovascular disease compared with LHRH agonists.

Cancer Medicines Outcomes Programme (CMOP)

The Scottish Government has funded a 3 year programme of work, the Cancer Medicines Outcomes Programme (CMOP), which commenced in Autumn 2016 and is led by NHS Greater Glasgow and Clyde in collaboration with the University of Strathclyde.  The programme is focused on determining the clinical effectiveness of cancer medicines in the real-world setting and will explore two aspects:

- To test the connectivity and linkage of routinely captured electroic health data to determine clinical outcomes

- To explore the potential scope and use of PROMs (Patient Reported Outcome Measures) as applied to routine clinical practice.

Clinical topics for year one are Prostate Cancer (Clinician lead Prof Rob Jones, CE Pharmacist Kelly Baillie) and Melanoma (Clinician lead Dr Ashita Waterston, CE Pharmacist Julie Clarke).  Communication will be ongoing as the programme is rolled out.   The project team are keen to have input from local cancer care clinicians.  A showcase event relating to cancer PROMs and to help inform the project methodology is to be held at the University of Strathclyde on Friday 24th March.  Anyone who wishes to hear more about CMOP or would like to attend the showcase event should contact Jennifer Laskey, Lead Clinical Effectiveness Pharmacist CMOP, jennifer.laskey@ggc.scot.nhs.uk