NHS Greater Glasgow & Clyde Area Drug and Therapeutics Committee
Greater Glasgow and Clyde Prescribing
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8 Malignant disease and immunosuppression

8.3 Sex hormones and hormone antagonists in malignant disease

Total Formulary
RADIUM-223 DICHLORIDE (XOFIGO) (injection)

Restrictions: The treatment of adults with castration-resistant prostate cancer, symptomatic bone metastases and no known visceral metastases is restricted to specialist use in accordance with regional protocol (in development) when the service infrastructure is in place to support the safe delivery of this treatment.

8.3.1 Oestrogens

Total Formulary
DIETHYLSTILBESTROL

Restrictions: Restricted to specialist initiation.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/4797.htm

8.3.2 Progestogens

Total Formulary
MEDROXYPROGESTERONE

Restrictions: Restricted to specialist initiation.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/4808.htm

MEGESTROL

Restrictions: Restricted to specialist initiation.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/4812.htm

PROGESTERONE

Prescribing Notes:

Use for luteal support as part of an assisted reproductive technology (ART) treatment program for infertile women is restricted to specialist use only in line with national guidance.

8.3.3 Androgens

8.3.4 Hormone antagonists

8.3.4.1 Breast cancer

Total Formulary
LETROZOLE

Restrictions: Restricted to specialist initiation. Restricted to use on the advice of breast cancer specialists in accordance with regional protocols.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/56613.htm

TAMOXIFEN

Restrictions: Restricted to specialist initiation.

Prescribing Notes:

Excludes tamoxifen liquid.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/4836.htm

ANASTROZOLE

Restrictions: Restricted to specialist initiation. Restricted to use on the advice of breast cancer specialists in accordance with regional protocols.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/36794.htm

EXEMESTANE

Restrictions: Restricted to specialist initiation. Restricted to use on the advice of breast cancer specialists in accordance with regional protocols.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/86293.htm

FULVESTRANT (FASLODEX) (injection)

Restrictions: Restricted to specialist use in accordance with regional protocol (see Prescribing Notes below for link).

GOSERELIN

Prescribing Notes:

For the management of advanced breast cancer (in pre- and peri- menopausal women), goserelin (but not Zoladex LA®) is approved where other treatments have failed.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/4832.htm

8.3.4.2 Gonadorelin analogues and gonadotrophin-releasing hormone antagonists

Total Formulary
LEUPRORELIN (Prostap)

Restrictions: Restricted to specialist initiation.

Prescribing Notes:

  • Prostap® is the first line LHRH agonist for new patients with prostate cancer based on regional recommendations following the development of a national consensus statement.
  • Prostap® is available in two different presentations; Prostap® 3 DCS and Prostap® SR DCS, which have different frequencies of administration and as such, should be prescribed by brand name clearly specifying the preparation to avoid confusion.
  • Please note, although other brands of leuprorelin are available, the regional recommendation relates to Prostap® only

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/4834.htm

CYPROTERONE

Restrictions: Restricted to specialist initiation. Owing to the risk of hepatotoxicity, cyproterone should be used for long-term treatment only where other treatments are not tolerated.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/4826.htm

FLUTAMIDE

Restrictions: Restricted to specialist initiation.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/4828.htm

GOSERELIN

Restrictions: Restricted to specialist initiation.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/4832.htm

HISTRELIN ACETATE (VANTAS) (Subcutaneous implant)

Restrictions: Restricted to use for the palliative treatment of advanced prostate cancer in accordance with the relevant Clinical Management Guideline

Prescribing Notes:

For the relevant SMC advice click here

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/204174.htm

DEGARELIX (FIRMAGON)

Restrictions: The treatment of adult male patients with advanced hormone-dependent prostate cancer is restricted to specialist initiation in accordance with regional protocol.

Prescribing Notes:

For the relevant SMC advice click here

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/202685.htm

ABIRATERONE ACETATE (tablets)

Restrictions: Restricted to specialist use in accordance with regional protocol for the indications as outlined in the Prescribing Notes below.

Prescribing Notes:

Metastatic castration resistant prostate cancer (mCRPC):

  • Use in adult men in whom chemotherapy is not yet clinically indicated after failure of androgen deprivation therapy according to regional protocol 
  • Use in adult men who have received only one prior chemotherapy regimen (The Regional Protocol can be accessed here - NHS network access required)

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/PHP5787-abiraterone-acetate.htm

AMINOGLUTETHIMIDE

Restrictions: Restricted to specialist initiation.

BICALUTAMIDE

Restrictions: Restricted to specialist initiation.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/31759.htm

ENZALUTAMIDE (soft capsules)

Restrictions: Restricted to use in accordance with regional protocol for metastatic castration resistant prostate cancer (mCRPC).

Prescribing Notes:

The Regional Protocol for metastatic castration resistant prostate cancer (mCRPC) can be accessed here (NHS network access required).

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/PHP33817-enzalutamide.htm

TRIPTORELIN

Restrictions: Decapeptyl SR 11.25mg is restricted for treatment of advanced prostate cancer in patients for whom the use of triptorelin is appropriate and would benefit from reduced frequency of administration compared with Decapeptyl SR 3mg. Triptorelin 22.5mg injection (Decapeptyl SR) for the treatment of locally advanced, non-metastatic or metastatic prostate cancer should be in accordance with Regional Protocol. Gonapeptyl Depot has not been recommended by SMC for the treatment of advanced prostate cancer.

Prescribing Notes:

For other indications for triptorelin, see section 6.7.2

Note: This Formulary entry relates to triptorelin acetate and triptorelin pamoate.  Triptorelin embonate is not indicated for prostate cancer and is not included in the GGC Formulary.  Care should be taken to ensure the correct triptorelin preparation is prescribed and dispensed.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/30434.htm

8.3.4.3 Somatostatin analogues

Total Formulary
LANREOTIDE (AUTOGEL)

Restrictions: Restricted to specialist initiation. The use in the treatment of thyrotrophic adenomas is non-Formulary.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/72739.htm

OCTREOTIDE

Restrictions: Restricted to specialist initiation.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/4841.htm

PASIREOTIDE (SIGNIFOR) (injection)

Restrictions: Restricted to specialist use for the treatment of adults with acromegaly for whom surgery is not an option is has been curative and who are inadequately controlled on treatment with another somatostatin analogue.

BNF Link: https://www.medicinescomplete.com/mc/bnf/current/PHP18716-signifor.htm?q=pasireotide&t=search&ss=text&p=3#PHP18716-signifor