8.1.3. Antimetabolites
Restrictions:
Use for the treatment of adult patients who are not eligible for haematopoietic stem cell transplantation (SCT) with intermediate-2 and high-risk myelodysplastic syndrome (MDS) or acute myeloid leukaemia (AML) is restricted to specialist use in accordance with regional protocol, which excludes the routine use in chronic myelomonocytic leukaemia (CMML).
Prescribing Notes:
The regional protocol for azacitadine for intermediate-2 and high-risk myelodysplastic syndrome (MDS) or acute myeloid leukaemia (AML) is available here
The treatment of adults aged 65 years or older who are not eligible for haematopoitec stem cell transplantation (HSCT) with acute myeloid leukaemia (AML) with >30% bone marrow blasts is not recommended for use in NHSScotland by the SMC and is non-Formulary.
Restrictions:
Restricted to specialist use in accordance with regional protocol for the indication outlined below.
Acute myeloid leukaemia
Maintenance therapy in adult patients with acute myeloid leukaemia who achieved complete remission or complete remission with incomplete blood count recovery following induction therapy with or without consolidation treatment and who are not candidates for, including those who choose not to proceed to, haematopoietic stem cell transplantation.
Restrictions:
Restricted to specialist use only. Restricted to use in accordance with regional protocols.
Restrictions:
Restricted to specialist use only.
Prescribing Notes:
Excludes liposomal formulations.
Restrictions:
Restricted to specialist use only. Restricted to use for treatment of CLL in accordance with regional protocol.
Restrictions:
Restricted to specialist use only. Restricted to use only for bladder, pancreatic or lung cancer in accordance with regional protocols.
Restrictions:
Use in oncology is restricted to specialist use only. Oral use in the unlicensed indications of inflammatory bowel disease (see section 1.5) and autoimmune hepatitis is restricted to specialist initiation only in patients who fail to tolerate azathioprine.
Prescribing Notes:
Near Patient Testing (NPT) arrangements for GPs may be in place for this medicine. See the relevant section in the Prescribing Resources page for current information.
Restrictions:
Restricted to specialist use only. Use in the treatment of cancer is restricted to specialist use only, other indications require specialist initiation, but may be suitable for continuation by the GP.
Restrictions:
Restricted to use only in patients in whom nelarabine is being used as a treatment to bridge to allogeneic stem cell transplant and restricted to use by specialists in haemato-oncology. It is not cost-effective when used for palliation.
Restrictions:
The following indications are formulary but use is restricted to specialists and according to regional protocols:
- Treatment of chemotherapy-naïve patients with stage III/IV unresectable malignant pleural mesothelioma. Use in the second line monotherapy of non-small cell lung cancer (NSCLC) is restricted to use according to regional protocol.
- Use as monotherapy for maintenance treatment of locally advanced or metastatic non-small cell lung cancer other than predominently squamous cell histology in patients whose disease has not progressed immediately following platinum-based chemotherapy. For regional protocol click here.
- In combination with cisplatin as adjuvant treatment for patients with completely resected stage IIA to IIIA nonsquamous non–small-cell lung cancer (off label indication as approved by NCMAG).
Restrictions:
Use in adults for the treatment of advanced gastric cancer in combination with cisplatin is restricted to specialist use in accordance with regional protocol.