|Therapeutic Area||Formulary Choices||Cost for 28|
(unless otherwise stated)
|Rationale for decision / comments|
|BNF Chapter 8: Malignant disease and immunosupression|
|8.3 Sex hormones and hormone antagonists in malignant disease|
|Hormone antagonists||Anastrozole||1mg tablets: £1.19 (28)||Anastrazole is recommended as an adjuvant to early oestrogen-receptor-positive breast cancer and is supported by a Shared Care Protocol.
Letrozole is recommended as an adjuvant to early oestrogen-receptor-positive breast cancer and is supported by a Shared Care Protocol.
Use of an aromatase inhibitor is an indication for evaluation of BMD by DEXA
|Letrozole||2.5mg tablets: £1.32 (14)
|Pre- or Postmenopausal women at high risk of breast cancer||Tamoxifen||10mg tablets: £37.81 (30)|
20mg tablets: £2.73 (30)
40mg tablets: £33.47 (30)
|NICE CG164 Jun-13 (Updated Aug-15):
• for 5 years to premenopausal women at high risk of breast cancer unless they have a past history or may be at increased risk of thromboembolic disease or endometrial cancer
• for 5 years to postmenopausal women with or without a uterus and at high risk of breast cancer unless they have a past history or may be at increased risk of thromboembolic disease or endometrial cancer
Local agreement: Tamoxifen is approved for longterm use (>5 years)
|Raloxifene||60mg tablets: £3.77 (28)||Raloxifene (unlicensed use) for 5 years to postmenopausal women with a uterus and at high risk of breast cancer unless they have a past history or may be at increased risk of thromboembolic disease or endometrial cancer (NICE CG164 Jun-13 Updated Aug-15)|
|Prostate cancer & Gonadorelin analogues||Monthly injections of triptorelin and goserelin were approved at the March 2010 meeting of the Somerset Prescribing Forum for use within licensed indications re: Breast Cancer – endometriosis and uterine fibroids.|
|First-line:||Triptorelin as Decapeptyl SR®||3mg (4.2mg) vial: £69.00 (1)|
11.25mg (15mg) vial: £207.00 (1)
22.5mg (28mg) vial: £414.00 (1)
|Decapeptyl SR® is recommended as the first line GnRH anaologue within its licensed indications for prostate cancer.
Patients with a life expectancy of >12 months who do not require 3-monthly reviews should be considered for a switch from the 3-monthly (15mg) to the 6-monthly (28mg) preparation.
|3.75mg PFS: £75.24|
|Administered every 13 weeks rather that 12 making it more cost effective than goserelin|
|Third line:||Goserelin||3.6mg PFS: £65.00 (1)|
10.8mg PFS: £235.00 (1)
|Goserelin is considered as third line GnRH analogue for use within its licensed indications, where Decapeptyl and Triptorelin are not appropriate.
Goserelin is used in young women with breast cancer. It is used either to protect their ovaries during chemotherapy or to suppress their ovaries following treatment to reduce the chance of recurrence. The 10.8 mg 3 monthly implant is not licensed in breast cancer so the 3.6 mg injection is given on a monthly basis - usually for 18m to 2 years