• Approved for methotrexate-induced mucositis and myelosuppression. The following formulations are approved:
  
  • 15mg tablets.
  • 3mg, 15mg, 30mg, and 300mg injections
  • A calcium folinate 1mg per ml mouthwash can be prepared if needed.unlicensed
  
  

• For use in line with NECN extravasation.

• Approved formulations include 1gram in 10ml injection and 400mg tablets.

• Approved for the urgent treatment of methotrexate-induced renal
  dysfunction.

• Approved for the first line treatment of CLL (Binet stage B or C) in, patients for whom fludarabine combination chemotherapy is not appropriate in line with NICE. 
• NECDAG approved for use in combination with rituximab for patients with CLL not fit for FCR chemotherapy and not fit for alemtuzumab. 
• Approved for Low Grade Non-Hodgkins Lymphoma in line with NICE - not recommended for (low grade) non-Hodgkin's lymphoma that is refractory to rituximab or a rituximab-containing regimen NICE.

• Approved formulations include:
  
  • 2mg tablets;
  • 25mg capsules (unlicensed);
  • 60mg in 10ml injection.
  
  

• Approved formualtions include 100mg injection and 7.7mg implants.
• Approved for newly diagnosed glioblastoma multiforme (GBM) in line with NICE.

• 160micrograms/g gel 
• Approved for the treatment of mycosis fungoides-type cutaneous T-cell lymphoma in line with NICE

• Note: 10mg capsules are unlicensed.

• Approved in combination with fludarabine for malignant disease before allogeneic stem cell transplant in line with NICE and NHS England Commissioning Policy

• Also approved for use in intralesional sclerotherapy in the treatment of low-flow vascular lesions. unlicensed indication

• The following formualtions are approved:
  
  • 20mg injection;
  • 10mg, 15mg, 35mg;
  • 40mg prefilled syringes.
  
  

• Doxorubicin 50mg injection - includes use with DC Beads for use in transcatheter arterial chemoembolisation (TACE) therapy in patients with hepatocellular cancer. 
• Doxorubicin 20mg & 50mg pegylated liposomal injection - approved for second-line (or subsequent) treatment in advanced ovarian cancer in line with NICE. 
• Approved for the treatment of recurrent ovarian cancer in line with NICE.

• Note: epirubicin 100mg injection is unlicensed.

• Approved formulations include:
  
  • 5mg and 10mg capsules;
  • 10mg injection.
  
  

• Also approved for treatment in combination with 5-Fluorouracil for bladder cancer concurrent with radiotherapy.
• Mitomycin 0.04% preservative free eye drops  are also approved for use - unlicensed.

• Approved as a possible treatment for adults with multiply relapsed or refractory aggressive non-Hodgkin's B cell lymphoma if they have previously been treated with rituximab and they are having third- or fourth-line treatment in line with NICE. 

• Approved for myelodysplastic syndromes, CLL and AML - in line with NICE guidance.

• Only approved for use in accordance with NICE guidance.

• Approved in combination with gemcitabine following surgery for pancreatic cancer in line with NHS England Clinical Commissioning Policy

• 10mg in 10ml solution for preparing infusions; 2mg in 1ml subcutaneous injection 
• Approved for Hairy cell leukaemia only.

• 10mg tablets
• Approved for treating highly active multiple sclerosis in adults in line with NICE

• A cytarabine 50mg vial - intrathecal injection (cytarabine encapsulated in liposomes) is also approved for use. 

• Daunorubicin 44mg/cytarabine 100mg powder for solution for infusion


• Approved for untreated acute myeloid leukaemia in line with NICE

• Approved for the second line therapy of B-cell CLL in line with NICE.
• Note: fludarabine is not approved for monotherapy in the first line treatment of CLL - this is in line with NICE.

• A fluorouracil 10mg in 0.4ml subconjunctival injection (unlicensed) is also approved for use. 
• FOLFIRINOX is approved for the management of selected patients with inoperable pancreatic cancer in patients with performance status 0-1.

• Approved in combination with paclitaxel for metastatic breast cancer in line with NICE. 


• NECDAG approved for the second line treatment of women with partially platinum – sensitive, platinum resistant or platinum refractory advanced ovarian cancer (To be used when liposomal doxorubicin [Caelyx] is unavailable). 


• Approved for pancreatic cancer in line with NICE. 


• Approved for the treatment of recurrent ovarian cancer in line with NICE.


• Approved in combination with capecitabine following surgery for pancreatic cancer in line with NHS England Clinical Commissioning Policy

• A mercaptopurine 20mg in 1ml suspension (unlicensed) is also approved for use. 
• Note: when prescribed for inflammatory bowel disease. 

•  Approved formulations:
  • Methotrexate 2.5mg tablets
  • Methotrexate 10mg in 5ml oral solution. unlicensed
  • Methotrexate injections (various strengths) – including prefilled syringes.
  • Methotrexate 5mg in 2ml intrathecal injection.

• NOTE: when used in chronic inflammatory conditions, e.g. Crohn’s disease, rheumatoid arthritis.
• NOTE: Subcutaneous injection for chronic inflammatory conditions in Tees SICBL 

• Approved for:
  
  • Mesothelioma in line with NICE (funding has to be agreed on an individual patient basis if treatment is not in line with NICE).
  • Combination with cisplatin for the first line treatment of locally advanced or metastatic NSCLC (non-squamous cell histology) in line with NICE.
  • Maintenance treatment of locally advanced or metastatic NSCLC (non-squamous cell histology) in line with NICE.
  • Maintenance treatment of non-squamous non-small lung cancer after pemetrexed and cisplatin in line with NICE and NHS England Commissioning Policy.
  
  
• Note: pemetrexed is not approved for locally advanced or metastatic NSCLC as per NICE. 

• Approved for metastatic colorectal cancer in line with NICE.

• 50mg in 1ml suspension is also approved.unlicensed

• Approved for previously treated metastatic colorectal cancer in adults in line with NICE and NHS England Commissioning Policy (SSC1662). 

• The following formulations are approved for use:
  
  • 50mg capsules & 100mg capsules;
  • 100mg in 5ml injections;
  • 500mg in 25ml injections.
  
  

• The following formulations are approved for use:
  
  • 20mg & 30mg capsules;
  • 10mg in 1ml injections;
  • 50mg in 5ml injections.
  
  

• 100mg capsules
• Approved for treating chronic lymphocytic leukaemia in adults in line with NICE

• 150mg capsules
• Approved as an option for untreated anaplastic lymphoma kinase (ALK)-positive advanced non-small-cell lung cancer (NSCLC) in adults in line with NICE 

• 20mg and 40mg tablets
• Approved as an option for treating chronic-phase Philadelphia chromosome-positive chronic myeloid leukaemia without a T315I mutation after 2 or more tyrosine kinase inhibitors in adults, in line with NICE

• 840mg/14ml & 1200mg/20m concentrate for solution for infusion (IV)
• 1875mg/15ml solution for injection (S/C)
• Approved for treating locally advanced or metastatic non-small-cell lung cancer (NSCLC) in adults who have had chemotherapy (and targeted treatment if they have an EGFR- or ALK‑positive tumour).  
• Approved in combination with bevacizumab for treating advanced or unresectable hepatocellular carcinoma (HCC) in adults who have not had previous systemic treatment in line with NICE
• Approved for the treatment of advanced non-small-cell lung cancer in line with NICE
• Approved for untreated PD-L1-positive locally advanced or metastatic urothelial cancer in adults when cisplatin-containing chemotherapy is unsuitable in line with NICE
• Approved for for adjuvant treatment of resected non-small-cell lung cancer in adults in line with NICE
• Approved with carboplatin and etoposide is recommended as an option for untreated extensive-stage small-cell lung cancer in adults in line with NICE
• Approved with nab‑paclitaxel for triple-negative, unresectable, PD‑L1‑positive, locally advanced or metastatic breast cancer in adults who have not had chemotherapy for metastatic disease in line with NICE
• Approved for untreated PD-L1-positive locally advanced or metastatic urothelial cancer in adults when cisplatin-containing chemotherapy is unsuitable in line with NICE

• 0.4 – 2 × 10⁸ cells dispersion for infusion

• 0.4 – 2 × 10⁸ cells dispersion for infusion

• Approved for use in previously treated multiple myeloma in line with NICE and NHSE Commissioning Policy
• Approved in combination with dexamethasone and lenalidomide for previously treated multiple myeloma in line with NICE

• Approved for treating metastatic or locally advanced cutaneous squamous cell carcinoma in adults in line with NICE

160 micrograms/g gel

Approved for use in accordance with the following NICE TAs or if the indication is funded from the Cancer Drugs Fund:

• Overview | Chlormethine gel for treating mycosis fungoides-type cutaneous T-cell lymphoma | Guidance | NICE

Commissioner: NHS England

Only to be used in line with a current chemotherapy protocol from the North of England Cancer Alliance in line with the appropriate Network Site Specific Group’s clinical guidelines or chemotherapy algorithm.

• Approved as an option for untreated locally advanced or metastatic epidermal growth factor receptor (EGFR) mutation-positive non-small-cell lung cancer in adults in line with NICE

• Approved in combination with bortezomib, thalidomide and dexamethasone for untreated multiple myeloma when a stem cell transplant is suitable in line with NICE
• Approved as an option for treating relapsed and refractory multiple myeloma in adults who have had a proteasome inhibitor and an immunomodulator, and whose disease progressed on the last treatment in line with NICE
• Approved with lenalidomide and dexamethasone for untreated multiple myeloma when a stem cell transplant is unsuitable in line with NICE and NHSE Specialised Commissioning guidance
• Approved in combination for treating newly diagnosed systemic amyloid light-chain amyloidosis in line with NICE and NHSE Specialised Commissioning Guidance

• 20mg/4.5mL concentrate for solution for infusion 
• Approved for the treatment of high-risk neuroblastoma in people aged 12 months and over in line with NICE

• 500mg/10ml concentrate for solution for infusion
• Approved for previously treated advanced or recurrent endometrial cancer with high microsatellite instability or mismatch repair deficiency in adults who have had platinum-based chemotherapy in line with NICE
• Approved with platinum-based chemotherapy for treating advanced or recurrent endometrial cancer with high microsatellite instability or mismatch repair deficiency in adults in line with NICE

• Approved for locally advanced unresectable non-small-cell lung cancer after platinum-based chemoradiation in adults in line with NICE.
• Approved in combination with gemcitabine and cisplatin for treating unresectable or advanced biliary tract cancer in line with NICE and NHS England Specialised Commissioning Policy.

• Approved for ROS1-positive advanced non-small-cell lung cancer (NSCLC) in adults who have not had ROS1 inhibitors in line with NICE

• 4mg/0.8ml & 48mg/0.8ml solution for injection 
• Approved for treating relapsed or refractory diffuse large B-cell lymphoma in adults after 2 or more systemic treatments in line with NICE

• Approved for the treatment of locally advanced or metastatic breast cancer after 2 or more chemotherapy regimens  in accordance with NICE and NHS England Commissioning Policy

100mg and 150mg film-coated tablets

Approved for use in accordance with the following NICE TAs or if the indication is funded from the Cancer Drugs Fund:

• NICE TA835: Fostamatinib for treating refractory chronic immune thrombocytopenia

Commissioner: NHS England

Only to be used in line with a current chemotherapy protocol from the North of England Cancer Alliance in line with the appropriate Network Site Specific Group’s clinical guidelines or chemotherapy algorithm

•  Approved for untreated acute myeloid leukaemia in line with NICE

• Approved for relapsed or refractory FLT3-mutation-positive acute myeloid leukaemia in adults in line with NICE

• 2.5mg and 10mg concentrate for solution for infusion
• Approved for treating relapsed or refractory diffuse large B-cell lymphoma after 2 or more systemic treatments in line with NICE and NHSE Specialised Commissioning guidance

• Approved in combination with rituximab for the treatment of:
  
  • Untreated chronic lymphocytic leukaemia in adults with a 17p deletion or TP53 mutation; NICE or
  • Chronic lympocytic leukaemia in adults when the disease has been treated but has relapsed within 24 months NICE.

• 11mg powder for concentrate for solution for infusion
• Approved for desensitisation treatment before kidney transplant in people with chronic kidney disease in line with NICE and NHSE Commissioning Policy

• Approved for treating relapsed or refractory CD22-positive B-cell precursor acute lymphoblastic leukaemia in adults in line with NICE

20mg/mL concentrate for solution for infusion.

Approved for use in accordance with the following NICE TAs or if the indication is funded from the Cancer Drugs Fund:

• NICE TA658: Isatuximab with pomalidomide and dexamethasone for treating relapsed and refractory multiple myeloma

Not approved in accordance with the following NICE TAs:

• NICE TA727: Isatuximab with carfilzomib and dexamethasone for treating relapsed or refractory multiple myeloma (terminated appraisal)

Commissioner: NHS England

Only to be used in line with a current chemotherapy protocol from the North of England Cancer Alliance in line with the appropriate Network Site Specific Group’s clinical guidelines or chemotherapy algorithm.

• 250mg tablets
• Approved for treating locally advanced or metastatic cholangiocarcinoma with an IDH1 R132 mutation in adults after 1 or more systemic treatments in line with NICE and NHSE Specialised Commissioning Policy.
• Approved for untreated acute myeloid leukaemia with an IDH1 R132 mutation in line with NICE
  
  

• Capsules: 2.3mg, 3mg, 4mg

20 mg/mL oral solution

• 10mg powder for concentrate for solution for infusion
• Approved or treating relapsed or refractory diffuse large B-cell lymphoma and high-grade B-cell lymphoma in adults after 2 or more systemic treatments in line with NICE and NHSE Specialised Commissioning Policy

• Approved for previously treated ALK-positive advanced non-small-cell lung cancer in adults in line with NICE

• Lutetium (177Lu) oxodotreotide (Lutathera)
  • Approved for treating unresectable or metastatic neuroendocrine tumours in adults in line with NICE
• Lutetium-177 vipivotide tetraxetan (Pluvicto)
  • Approved for treating prostate-specific membrane antigen-positive hormone-relapsed metastatic prostate cancer after 2 or more treatments in adults in line with NICE 

• Approved for the treatment of advanced systemic mastocytosis in line with NICE

• Approved for previously treated mycosis fungoides and Sézary syndrome in line with NICE

• 100mg, 150mg and 200mg tablets
• Approved for treating myelofibrosis-related splenomegaly or symptoms in adults in line with NICE

• Approved for the treatment of early hormone receptor-positive HER2-positive breast cancer after adjuvant trastuzumab in line with NHS England Commissioning Policy and NICE

• Approved for treating relapsed, platinum-sensitive high-grade serous epithelial ovarian, fallopian tube or primary peritoneal cancer in adults in line with NICE

• For the treatment of locally advanced or metastatic squamous nonsmall cell lung cancer (NSCLC) after prior chemotherapy in adults.
• Approved for the treatment of advanced (unresectable or metastatic) melanoma in adults in line with NICE.
• Approved in combination with ipilimumab for treating advanced melanoma in line with NICE and NHS England Commissioning Policy (SSC1664)
• Approved for the treatment of advanced renal cell carcinoma in adults in line with NICE and NHS England Commissioning Policy
• Approved for the treatment of relapsed of refractory classical Hodgkin lymphoma in line with NICE and NHS England Commissioning Policy 
• Approved for the treatment of  locally advanced or metastatic squamous non-small-cell lung cancer (NSCLC) in adults after chemotherapy in line with NICE
• Approved for adjuvant treatment of completely resected melanoma with lymph node involvement or metastatic disease in adults
• Approved for use in patients with previously untreated unresectable advanced or recurrent oesophageal cancer in line with NICE
• Approved in combination ipilimumab for use in patients with previously treated metastatic colorectal cancer with high microsatellite instability or mismatch repair deficiency in line with NICE
• Approved for treating recurrent or metastatic squamous cell carcinoma of the head and neck after platinum-based chemotherapy in adults in line with NICE
• Approved adjuvant treatment of completely resected oesophageal or gastro‑oesophageal junction cancer in adults who have residual disease after previous neoadjuvant chemoradiotherapy in line with NICE
• Approved in combination with ipilimumab for untreated advanced renal cell carcinoma in line with NICE
• Approved for adjuvant treatment of invasive urothelial cancer at high risk of recurrence in line with NICE
• Approved with ipilimumab or untreated unresectable malignant pleural mesothelioma in adults in line with NICE
• Approved for treating locally advanced or metastatic non-squamous non-small-cell lung cancer (NSCLC) in adults after chemotherapy in line with NICE
• Approved (with fluoropyrimidine-based and platinum-based combination chemotherapy) for untreated unresectable advanced, recurrent, or metastatic oesophageal squamous cell carcinoma in adults whose tumours express PD‑L1 at a level of 1% or more.
• Approved as an option for the neoadjuvant treatment of resectable (tumours at least 4 cm or node positive) non-small-cell lung cancer (NSCLC) in adults - in line with NICE TA876.
• Approved with cabozantinib (Cabometyx) for untreated advanced renal cell carcinoma in adults

• 240mg/20ml (12mg/1ml) & 80mg/20ml (4mg/1ml) concentrate for solution for infusion
• Approved for untreated advanced (unresectable or metastatic) melanoma in people 12 years and over in line with NICE

• Approved for the maintenance treatment of BRCA 1 or 2 mutated, relapsed, platinum-sensitive ovarian, fallopian tube and peritoneal cancer in people whose relapsed disease has responded to platinum-based chemotherapy in line with NICE.
• Approved for maintenance treatment of relapsed platinum-sensitive ovarian, fallopian tube or primary peritoneal cancer in adults with a BRCA1 or BRCA2 mutation in line with NICE
• Approved for adjuvant treatment of BRCA mutation-positive HER2-negative high-risk early breast cancer after chemotherapy in adults in line with NICE
• Approved for previously treated BRCA mutation-positive hormone-relapsed metastatic prostate cancer in adults in line with NICE
• Approved as maintenance treatment of relapsed, platinum-sensitive ovarian, fallopian tube or peritoneal cancer after 2 or more courses of platinum-based chemotherapy in adults in line with NICE and NHSE Specialised Commissioning policy
• Approved with bevacizumab for maintenance treatment of advanced high-grade epithelial ovarian, fallopian tube or primary peritoneal cancer in adults in line with NICE and NHSE Specialised Commissioning policy
• Approved with abiraterone for untreated hormone-relapsed metastatic prostate cancer in adults in line with NICE
• Approved for maintenance treatment of BRCA muatation-positive advanced ovarian, fallopian tube or peritoneal cancer after response to first-line platinum-based chemotherapy

• Approved in combination with bortezomib and dexamethasone as an option for the treatment of multiple myeloma in line with NICE.

• Approved for the treatment of advanced melanoma after disease progression with ipilimumab in accordance with NICE.  
• Approved for the treatment of advanced melanoma not previously treated with ipilimumab in accordance with NICE. 
• Approved for treating PD-L1-positive non-small-cell lung cancer 
• Approved for treating PD-L1-positive metastatic non-small-cell lung cancer 
• Approved for untreated metastatic or unresectable recurrent head and neck squamous cell carcinoma (HNSCC) in adults whose tumours express PD L1 with a combined positive score (CPS) of 1 or more in line with NICE
• Approved with pemetrexed and platinum chemotherapy for untreated, metastatic, non-squamous non-small-cell lung cancer (NSCLC) in adults whose tumours have no epidermal growth factor receptor (EGFR)- or anaplastic lymphoma kinase (ALK)-positive mutations.
• Approved for treating locally advanced or metastatic urothelial carcinoma after platinum-containing chemotherapy in adults in line with NICE
• Approved for untreated metastatic colorectal cancer with high microsatellite instability or mismatch repair deficiency in line with NICE
• Approved with platinum- and fluoropyrimidine-based chemotherapy for untreated advanced oesophageal and gastro-oesophageal junction cancer in adults in line with NICE
• Approved for adjuvant treatment of completely resected stage 3 melanoma in line with NICE
• Approved in combination with carboplatin and paclitaxel for adults with untreated metastatic squamous non-small-cell lung cancer in line with NICE
• Approved for treating relapsed or refractory classical Hodgkin lymphoma in people aged 3 and older who have had a stem cell transplant or at least 2 previous therapies in line with NICE
• Approved with paclitaxel or nab‑paclitaxel for triple-negative, locally recurrent unresectable or metastatic breast cancer in adults who have not had chemotherapy for metastatic disease in line with NICE
• Approved for adjuvant treatment of renal cell carcinoma in adults in line with NICE
• Approved for the adjuvant treatment of resected stage 2B and 2C melanoma in people 12 years and over in line with NICE
• Approved with pemetrexed and platinum chemotherapy for untreated, metastatic, non-squamous non-small-cell lung cancer (NSCLC) in adults whose tumours have no epidermal growth factor receptor (EGFR)- or anaplastic lymphoma kinase (ALK)-positive mutations in line with NICE
• Approved plus chemotherapy with or without bevacizumab for persistent, recurrent or metastatic cervical cancer in adults in line with NICE
• Approved with lenvatinib for previously treated advanced or recurrent endometrial cancer in line with NICE and NHSE Specialised Commissioning guidance
• Approved for previously treated endometrial, biliary, colorectal, gastric or small intestine cancer with high microsatellite instability or mismatch repair deficiency in adults in line with NICE and NHSE Specialised Commissioning guidance
• Approved plus chemotherapy with or without bevacizumab for persistent, recurrent or metastatic cervical cancer in line with NICE
• Approved for relapsed or refractory classical Hodgkin lymphoma in people 3 years and over in line with NICE

• Approved with rituximab and bendamustine for treating relapsed or refractory diffuse large B-cell lymphoma in adults who cannot have a haematopoietic stem cell transplant in line with NICE
• Approved with rituximab, cyclophosphamide, doxorubicin and prednisolone (R‑CHP) for untreated diffuse large B-cell lymphoma (DLBCL) in adults - in line with NICE TA874.

Commissioner: NHS England

Only to be used in line with a current chemotherapy protocol from the North of England Cancer Alliance in line with the appropriate Network Site Specific Group’s clinical guidelines or chemotherapy algorithm

• 180mg powder for solution for infusion

• 20mg tablets
• Approved with dexamethasone for treating relapsed or refractory multiple myeloma after 4 or more treatments in adults in line with NICE
• Approved with bortezomib and dexamethasone for previously treated multiple myeloma in adults in line with NICE

• 40mg and 80mg capsules
• Approved for advanced thyroid cancer with RET alterations in people 12 years and older in line with NICE
• Approved for untreated RET fusion-positive advanced non-small-cell lung cancer in adults in line with NICE

• 10mg and 35mg hard capsules
• Approved treating symptomatic and inoperable plexiform neurofibromas associated with type 1 neurofibromatosis in children aged 3 and over in line with NICE

• 0.25mg and 1mg capsule
• Approved or HER2-negative, locally advanced or metastatic breast cancer with germline BRCA1 or BRCA2 mutations in adults in line with NICE

• Approved for the treatment of unresectable metastatic melanoma in line with NICE and NHS England Commissioning Policy (SSC1679).

• Approved for treating relapsed or refractory B-cell acute lymphoblastic leukaemia in people 25 years and under in line with NICE
• Will be funded by NHS England at the following commissioned centres: Newcastle University Teaching Hospitals, Leeds Teaching Hospitals, Sheffield Teaching Hospitals.

• Capsules: 890 mg and 1340 mg

Vial: powder for concentrate for infusion, 100 mg

• Approved in combination with rituximab for treating chronic lymphocytic leukaemia in adults who have had at least 1 previous therapy in line with NICE
• Approved in combination with azacitidine for untreated acute myeloid leukaemia when intensive chemotherapy is unsuitable in line with NICE
• Approved in combination with low dose cytarabine for untreated acute myeloid leukaemia in adults when intensive chemotherapy is unsuitable in line with NICE.
• Approved for the treatment of chronic lymphocytic leukaemia in adults:
  • with a 17p deletion or TP53 mutation and when a B‑cell receptor pathway inhibitor is unsuitable, or whose disease has progressed after a B‑cell receptor pathway inhibitor or
  • without a 17p deletion or TP53 mutation, and whose disease has progressed after both chemo‑immunotherapy and a B‑cell receptor pathway inhibitor in line with NICE

• 80mg capsule
• Approved for the treatment of chronic lymphocytic leukaemia in line with NICE and NHSE Specialised Commissioning guidance

• Named patient supply only.

• NECDAG approved relapsed or refractory acute promyelocytic leukaemia (APL).

• Approved for:
  
  • Relapsed multiple myeloma in line with in line with NICE.
  • Combination with an alkylating agent and a corticosteroid for the first-line treatment of multiple myeloma in line with NICE. 
  • Induction therapy for multiple myeloma in line with NICE.
  • Treatment of adults with mantle cell lymphoma that has not been treated before, if haemotopoietic stem cell transplantation is not suitable, in line with NICE.

• 50mg powder for concentrate for solution for infusion
• Approved for the treatment of relapsed or refractory systemic anaplastic large cell lymphoma in line with NICE and NHS England Commissioning Policy.
• Approved for the treatment of CD30-positive Hodgkin lymphoma in patients:
  • if they have already had autologous stem cell transplant
  • if they have already had at least 2 previous therapies when autologous stem cell transplant or multi-agent chemotherapy are not suitable. 
• Approved for the treatment of CD30-positive cutaneous T-cell lymphoma in line with NICE
• Approved in combination with cyclophosphamide, doxorubicin and prednisone for untreated systmic anaplastic large cell lymphoma in adults in line with NICE

• Approved for the first-line treatment of metastatic colorectal cancer in combination with FOLFOX in line with NICE (monotherapy or combination chemotherapy is not recommended for the treatment of people with metastatic colorectal cancer that has progressed after first-line chemotherapy -  as per NICE). 
• NECDAG approved for K-RAS wild type metastatic colorectal cancer; second line use in combination with chemotherapy in patients that have progressed on previous chemotherapy; third line use as a single agent in patients who have failed oxaliplatin- and irinotecan based therapy and who are intolerant to irinotecan. 
• Approved for locally advanced squamous cell carcinoma of the head and neck in line with NICE. 
• Approved for previously untreated metastatic colorectal cancer in line with NICE.
• Approved for the treatment of metastatic and/or recurrent squamous cell carcinoma of the head and neck (oral cavity only) in line with NICE and NHS England Commissioning Policy
• Note: cetuximab is not approved in combination with platinum-based chemotherapy for recurrent and/or metastatic squamous cell cancer of the head and neck as per NICE.

• Approved for the treatment of recurrent malignant glioma in line with NICE.
• Approved for newly diagnosed glioblastoma multiforme (GBM) in line with NICE.

• Also approved for second line use, as an alternative to docetaxel, in NSCLC in line with NICE.
• Monotherapy not approved for maintenance after platinum chemotherapy in advanced or metastatic NSCLC NICE.
• Approved for the treatment of locally advanced or metastatic nonsmall-cell lung cancer that has already been treated with non-targetted chemotherapy because of delayed confirmation of epidermal growth factor receptor tyrosine kinase (EGFR-TK) mutation status if; their cancer tests positive for EGFR-TK mutation; it is not know if the cancer is EGFR-TK mutation- positive because of problems with the test, and the cancer is very likely to be EGFR-TK mutation-positive and it responds to the first 2 cycles of treatment with erlotinib - in line with NICE.

• 100mg tablets
• 500mg capsules
• 500mg in 5ml suspension (unlicensed) is also approved
• When used to treat non-malignant conditions in accordance with shared care protocol  
  • County Durham and Darlington - Hydroxycarbamide Shared Care Guidance 
  • North Cumbria - Hydroxycarbamide Shared Care Guidance (Haematology conditions) 
  • North Cumbria - Hydroxycarbamide Shared Care Guidance (Psoriasis) 

• Approved for previously treated advanced melanoma in line with NICE.
• Approved for previously untreated advanced melanoma in line with NICE.
• Approved in combination with nivolumab for untreated renal cell carcinoma in line with NICE.

• Approved for previously untreated metastatic colorectal cancer in line with NICE.

• Approved for Dukes C colon cancer in combination with 5-fluorouracil
  and folinic acid in line with NICE.
• Approved for advanced and metastatic colorectal cancer in line with NICE.

• Approved as a possible treatment for adults with locally advanced or metastatic non-small-cell lung cancer if their cancer tests positive for the epidermal growth factor receptor tyrosine kinase (EGFR-TK) mutation and they have not had an EGFR-TK inhibitor before NICE and additional NHS England criteria.

• Approved as treatment for adults with advanced renal cell carcinoma when tyrosine kinase inhibitors or cytokines have not worked in line with NICE.

• Approved as an option for the treatment of chronic, accelerated blast phase Philidephia chromosome positive chronic myeloid leukaemia in adults when they have previously had 1 or more tyrosine kinase inhibitor and imatinib, nilotinib and dasatanib are not appropriate in line with NICE.

• Approved for treating anaplastic lymphoma kinase (ALK)-positive advanced non-small-cell lung cancer (NSCLC) in adults who have already had crizotinib in line with NICE.
• Approved for treating ALK-positive advanced non-small-cell lung cancer that has not been previously treated with an ALK inhibitor in line with NICE

• Approved for use in the treatment of renal cell carcinoma in line with NICE and NHS England Commissioning Policy
• Approved for the treatment of medullary thyroid cancer in line with NICE and NHS England Commissioning Policy
• Approved for use in untreated advanced renal cell carcinoma in line with NICE and NHS England Commissioning Policy
• Approved with nivolumab (Opdivo) for untreated advanced renal cell carcinoma in adults in line with NICE

• Approved for use in previously treated anaplastic lymphoma kinase positive non-small-cell-lung cancer in line with NICE and NHS England Commissioning Policy.
• Approved for untreated ALK-positive non-small-cell lung cancer in line with NICE and NHS England Commissioning Policy

• Approved in accordance with NICE and NHS England Commissioning Policy.

• Approved for the treatment of unresectable or metastatic BRAF V600 mutation-positive melanoma in line with NICE 
• Approved for the treatment of BRAF-mutated anaplastic thyroid cancer (ATC) in line with NHSE Specialised Commissioning Policy
• Approved with trametinib for treating BRAF V600 mutation-positive advanced non-small-cell lung cancer in adults in line with NICE
• Approved with trametinib (Spexotras) for treating BRAF V600E mutation-positive glioma in children and young people aged 1 year and over in line with NICE

• Approved for use in accordance with NICE and NHS EnglandCommissioning Policy

• Approved in combination with binimetinib for treating unresectable or metastatic BRAF V600 mutation-positive melanoma in adults in line with NICE


• Approved in combination with cetuximab (Erbitux) for treating BRAF V600E mutation-positive metastatic colorectal cancer in adults who have had previous systemic treatment

• 2.5mg, 5mg & 10mg tablets (Votubia®)
  • Approved for the treatment of angiomyolipomas associated with tuberous sclerosis in accordnace with NHS England Commissioning Policy.
  • Approved for the treatment of subependymal giant cell astrocytoma (SEGA) associated with tuberous sclerosis complex in accordnace line with NHS England Commissioning Policy.
• 5mg & 10mg tablets (Afinitor®)
  • Approved, in combination with exemestane, for the treatment of advanced human epidermal growth factor receptor 2 (HER2)-negative, hormone-receptor-positive breast cancer in postmenopausal women in accordance with NICE.
  • Approved for the treatment of advanced breast cancer after endocrine therapy in line with NICE.
  • Approved for the treatment of advanced renal cell carcinoma after previous treatment in line with NICE.
  • Approved for the treatment of unresectable or metastatic neuroendocrine tumours in people with progressive disease in line with NICE and NHS England Commissioning Policy

• Approved for first line use in locally advanced or metastatic NSCLC in line with NICE.

• Approved for previously treated chronic lymphocytic leukaemia and untreated chronic lymphocytic leukaemia with 17p deletion or TP53 mutation in line with NICE and NHS Commissioning Policy.
• Approved for treating relapsed or refractory mantle cell lymphoma in line with NICE and NHS England Commissioning Policy if:
  
  • they have had only 1 previous line of therapy
• Approved for untreated chronic lymphocytic leukaemia in line with NICE

• Approved for the first-line management of people with KIT (CD117)- positive unresectable and/or KIT (CD117)-positive metastatic gastrointestinal stromal tumours (GISTs) in line with NICE. 
• Approved for the adjuvant treatment of gastrointestinal stromal tumours (GISTs) after surgery when there is a high risk relapse of tumour NICE. 
• Approved for Philadelphia-chromosome-positive CML in the accelerated phase or with blast crisis in line with NICE.
• A standard-dose imatinib is recommended as an option for the first-line treatment of adults with chronic phase Philadelphia-chromosomepositive CML in line with NICE.

• 4mg & 10mg capsules
• Approved with everolimus for previously treated advanced renal cell carcinoma in line with NICE
• Approved to the treatment of differentiated thyroid cancer after radioactive iodine in line with NICE
• Approved for untreated advanced hepatocellular carcinoma in line with NICE

• Approved for the first-line treatment of adults with chronic phase Philadelphia-chromosome-positive CML in line with NICE and NHS Commissioning Policy

• Approved for the treatment of locally advanced, metastatic or locally recurrent non-small-cell lung cancer who have previously been treated been with first-line chemotherapy in accordance with NICE.
• Approved for treating idiopathic pumonary fibrosis in line with NICE

• Approved for advanced renal cell carcinoma in line with NICE

• 4.5mg, 9mg and 13.5mg tablets
• Approved for the treatment of relapsed or refractory advanced cholangiocarcinoma with FGFR2 fusion or rearrangement in line with NICE

• 15mg, 30mg & 45mg film-coated tablets
• Approved for the treatment of chronic myeloid leukaemia and acute lymphoblastic leukaemia in line with NICE and NHS England Commissioning Policy

• 40mg tablets
• Approved for treating unresectable or metastatic gastrointestinal stromal tumours in adults whose disease has progressed on, or who are intolerant to, prior treatment with imatinib and sunitinib in line with NICE and NHS England Commissioning Policy.
• Approved for treating advanced hepatocellular carcinoma in adults who have had sorafenib in line with NICE
• Approved as an option for metastatic colorectal cancer in adults who have had previous treatment (including fluoropyrimidine-based chemotherapy, anti‑VEGF therapy and anti‑EGFR therapy) or when these treatments are unsuitable - in line with NICE.

• Approved for the treatment of disease-related splenomegaly or symptoms in adults with primary myelofibrosis, post polycythaemia vera myelofibrosis or post essential thrombocythaemiaa myelofibrosis, only in people with intermediate-2 or high-risk disease in line with NICE.
• Approved for treating polycythaemia vera in line with NICE and NHSE Specialised Commissioning guidance

• 200mg tablets
• Approved for treatment of advanced hepatocellular carcinoma only for people with Child-Pugh grade A liver impairment in line with NICE and NHS Commissioning Policy.
• Approved for the treatment of differentiated thyroid cancer after radioactive iodine in line with NICE.
• Approved as maintenance for adults with FLT3-internal tandem duplication (FLT3-ITD) acute myeloid leukaemia (AML) undergoing allogeneic haematopoietic stem cell transplantation (allo-HSCT) in line with NHS England Specialised Commissioning Policy
  • Only available at The Newcastle upon Tyne Hospitals NHS Trust

• Approved for gastrointestinal stromal tumours (GISTs) in line with NICE.
• Approved for advanced and/or metastatic renal cell carcinoma in line with NICE.
• Sunitinib not approved for second line use in advanced and/or metastatic renal cell carcinoma NICE.
• Approved for the treatment of unresectable or metastatic neuroendocrine tumours in people with progressive disease in line with NICE and NHS England Commissioning Policy

• Approved in combination with dabrafenib for the treatment of unresectable or metastatic melanoma in line with NICE and NHS England Commissioning Policy.
• Approved for the treatment of BRAF-mutated anaplastic thyroid cancer (ATC) in line with NHSE Specialised Commissioning Policy

• Approved in combination with trastuzumab and capecitabine for HER2‑positive locally advanced or metastatic breast cancer in adults after 2 or more anti‑HER2 treatment therapies in line with NICE

• Approved for melanoma (BRAF V600 mutation positive, unresectable metastatic) in line with NICE.

• 80mg capsule

• Approved for the treatment of hormone relapsed metastatic prostate cancer treated with with docetaxel in line with NICE.

• Approved for early node-positive breast cancer in line with NICE. 
• Approved for hormone refractory metastatic prostate cancer in line with NICE.

• The following formulations are approved:
• 30mg in 5ml, 100mg in 16.7ml, and 150mg in 25ml concentrate for preparing IV infusion.
• Approved for the treatment of recurrent ovarian cancer in line with NICE.

• Note: Abraxane® 5mg in 1ml powder for suspension for infusion is restricted for use within its current license for metastatic breast cancer patients who cannot tolerate standard taxanes. 
• Approved in combination with a platinum-based compound or platinum-based therapy alone (cisplatin or carboplatin) for first line therapy in ovarian cancer in line with NICE.
• Approved in combination with a platinum-based drug (carboplatin or cisplatin) for second-line (or subsequent) therapy in ovarian cancer in line with NICE
• Approved metastatic breast cancer in line with NICE.
• Abraxane is not recommended for the adjuvant treatment of women with early node-positive breast cancer NICE.
• Approved in combination with gemcitabine for untreated metastatic pancreatic cancer in line with NICE and NHS England Commissioning Policy as of 5th December 2017

• Approved for relapsed NSCLC in line with NICE.
• Approved for recurrent or stage IVB cervical cancer in line with NICE.
• Approved for second-line (or subsequent) treatment in advanced ovarian cancer in line with NICE.
• Approved for the treatment of recurrent ovarian cancer in line with NICE.

Approved for the treatment of recurrent ovarian cancer in line with NICE.

• Approved for the neoadjuvant treatment of HER2-positive breast cancer in line with NICE and NHS Commissioning Policy


• Approved with trastuzumab and docetaxel for treating HER2-positive breast cancer in line with NICE and NHS Commissioning Policy


• Approved for adjuvant treatment of HER2-positive early stage breast cancer in line with NICE

• Approved for metastatic or locally advanced inoperable gastric cancers in line with NICE.
• Approved for early stage HER2-positive breast cancer in line with NICE.
• Approved for advanced HER2-positive breast cancer in line with NICE.
• Note: trastuzumab is not recommended in combination with an aromatase inhibitor for the first-line treatment in postmenopausal women with metastatic hormonereceptor- positive breast cancer that overexpresses HER2 - in line with NICE.
• Trastuzumab 600mg subcutaneous injection is approved by NHS England for HER2-positive breast cancer in line with NECN guidance.

• 100mg & 160mg powder for concentrate for solution for infusion
• Approved for the treatment of HER2-positive advanced breast cancer after trastuzumab and a taxane in line with NICE and NHS England Commissioning Policy
• Approved for human epidermal growth factor receptor 2 (HER2)‑positive early breast cancer in adults who have residual invasive disease in the breast or lymph nodes after neoadjuvant taxane-based and HER2‑targeted therapy in line with NICE

• Approved for use in previously treated Philadelphia-chromosome-negative acute lymphosblastic leukaemia in line with NICE and NHS England Commissioning Policy.
• Approved for the treatment of acute lymphoblastic leukaemia in remission with minimal residual disease activity in line with NICE
• Only to be used in line with a current chemotherapy protocol from the North of England Cancer Alliance in line with the appropriate Network Site Specific Group’s clinical guidelines or chemotherapy algorithm

• Approved for treating advanced non-small-cell lung cancer (NSCLC) with METex14 skipping alterations in adults in line with NICE.

• For Transplant indications  unless from a Trust/speciality that hasn't formaly repatriated it's patients or for patients who require weekly scripts for MDS boxes .            
• An azathioprine 50mg in 5ml suspension (unlicensed) is also available.

• For Transplant indications  unless from a Trust/speciality that hasn't formaly repatriated it's patients or for patients who require weekly scripts for MDS boxes . 

• Approved as second-line therapy in patients who do not tolerate mycophenolate mofetil.
• For Transplant indications  unless from a Trust/speciality that hasn't formaly repatriated it's patients or for patients who require weekly scripts for MDS boxes . 

• 200mg tablets
• Approved for chronic graft-versus-host disease in people 12 years and over after 2 or more systemic treatments in line with NICE

• Approved formulations include:
  • 10mg, 25mg, 50mg, and 100mg capsules;
  • 100mg in 1ml sugar free oral solution (oily).
  • Should be prescribed by brand for transplant indications   
• For Transplant indications  unless from a Trust/speciality that hasn't formally repatriated its patients or for patients who require weekly scripts for MDS boxes . 

• Approved for renal transplantation in children and adolescents in line with NICE.
• For Transplant indications  unless from a Trust/speciality that hasn't formally repatriated its patients or for patients who require weekly scripts for MDS boxes . 

Approved tacrolimus formulations include:

• 500 microgram, 1mg & 5mg capsules (Prograf® & Adoport®).
• 1mg in 1ml oral suspension (unlicensed) - this replaces 0.5mg/ml oral
  suspension. 
• 5mg in 1 ml concentrate for preparing IV infusion - approved for renal transplantation in children and adolescents in line with NICE.
• 500microgram, 1mg, 3mg & 5mg MR capsules (Advagraf®) approved for use for prophylaxis of organ rejection in kidney and liver transplantation. Advagraf® is also approved for use in patients who are currently prescribed Prograf®, and de novo patients should be prescribed Adoport®.
• 750microgram, 1 mg and 4 mg m/r tablets (Envarsus®)
  
  • approved for the treatment of renal and liver transplant patients who are suffering from neurotoxicity with other formulations or for patients requiring large doses of tacrolimus. 
• For Transplant indications  unless from a Trust/speciality that hasn't formally repatriated its patients or for patients who require weekly scripts for MDS boxes . 

• 7.9mg capsules
• Approved with mycophenolate mofetil for treating lupus nephritis in adults in line with NICE and NHSe Specialised Commissioning Policy (SSC2540)
• Only available from:
  
  • North Cumbria University Hospital NHS Trust
  • South Tyneside and Sunderland NHS Foundation Trust
  • South Tees Hopsitals NHS Foundation Trust
  • The Newcastle upon Tyne Hospitals NHS Foundation Trust

• NETAG approved for aplastic anaemia in adults (unlicensed).

• Used in the management of transplant rejection.

• Approved for limited use in adult renal transplant patients with high risk of acute organ rejection.
• Approved for severe graft versus host disease post haematopoietic stem cell transplantation.
• Approved for induction therapy in renal transplantation in children and adolescents in with combinations that include ciclosporin in line with NICE.

• Alemtuzumab 30mg in 1ml concentrate for IV infusion is approved for use in, lymphocytic leukaemia & prevention of graft vs. host disease in bone marrow transplant patients, and high-risk kidney and pancreas transplantation.

• Alemtuzumab 12mg in 1.2ml concentrate for IV infusion is approved for treating adults with active relapsing– remitting multiple sclerosis in line with NICE and NHS England commissioning policy. 

• Approved for  for maintenance treatment of locally advanced or metastatic urothelial cancer after platinum-based chemotherapy in adults in line with NICE
• as an option for treating metastatic Merkel cell carcinoma in adults who have not had chemotherapy for metastatic disease in line with NICE

• Approved for use in chronic lymphocytic leukaemia in combination with chlorambucil in patients who have co-morbitities that make full‑dose fludarabine‑based therapy unsuitable for them, only if bendamustine‑based therapy is not suitable and the company provides obinutuzumab with the discount agreed in the patient access scheme in line with NICE (subject to NHS England funding).
• Approved for the treatment of rituximab-refractory follicular lymphoma in combination bendamustine in line with NICE and NHS England Commissioning Policy
• Approved with bendamustine for follicular lymphoma that has not responded or has progressed up to 6 months after treatment with rituximab or a rituximab-containing regimen in adults in line with NICE
• Approved to prevent immune immune Thrombotic Thrombocytopenic Purpura (TTP) relapse in patients who are refractory or intolerant
  to rituximab (adults) in line with NHSE Commissioning Policy
  • Only available at The Newcastle upon Tyne Hospitals NHS Trust

• Approved for the treatment of relapsing-remitting multiple sclerosis in line with NICE
  

   

• 20mg/0.4ml solution for injection (pre-filled pens)
  • Approved for the treatment of relapsing-remitting multiple sclerosis in adults with active diseases defined by clinical or imaging features in line with NICE

NICE have approved rituximab for the following indications:

• First line use in NHL in combination with CHOP.
• Maintenance therapy in follicular NHL that has responded to first line induction therapy with rituximab in combination with chemotherapy.
• Stage III and IV follicular lymphoma in previously untreated people.
• Replased or refractory follicular NHL.
• Post-transplant lymphoproliferative disease.
• First line use in CLL in combination with fludarabine and cyclophosphamide.
• Combination with fludarabine and cyclophosphamide for relapsed or refractory CLL.
• Autoimmune haematological conditions (where conventional treatments have failed)
• Autoimmune haemolytic anaemia (AIHA), Evans syndrome, pure red cell aplasia (PRCA), & thrombocytopenia purpura (TTP).
• Combination with bendamustine for first line use in CLL (Binet stage B or C) in patients for whom fludarabine combination chemotherapy is not appropriate.Vasculitis (including Wegener’s granulomatosis in adults and children) that has not responded adequately to conventional treatment (e.g. corticosteroids, cyclophosphamide) in line with NICE and additional NHS England criteria.

NECDAG have approved rituximab for the following indications:

• Treatment of NLPHL
• Newly diagnosed mantle cell NHL in patients aged 
• In combination with bendamustine for patients with CLL not fit for FCR chemotherapy or for patients who relapse within 2 years of FCR chemotherapy and not fit for alemtuzumab.
• Salvage chemotherapy for patients relapsing > 12 months post 1st line therapy with R-CHOP.
• Standard NHL induction regimen in patients who cannot be given an anthracycline. Rituximab with other chemotherapy regimens is an alternative treatment option e.g. DECC, CVP for this group of patients, as part of their first line therapy. Also in addition to the MACOP-B regimen for the small number of young patients with DLBCL, subtype Primary Mediastinal B cell Lymphoma.
• Treatment of Hairy Cell Leukaemia (HCL) or  HCL varian (HCL-v) who:
  
  • relapse early after purine analogue therapy (< 2 years post treatment)
  • are refractory to purine analogues.

NTAG have approved rituximab for the following indications:

• Treatment of immune (idiopathic) thrombocytopenic purpura (ITP) in adults and children.

NHS England have approved rituximab for the following indications:

• Treatment of immunobullous disease
• Steroid Sensitive Nephrotic Syndrome in Children
• Steroid Resistant Nephrotic Syndrome in Children
• Acquired Haemophilia
• Cytopenia Complicating Primary Immunodeficiency
• Maintenance single agent therapy in FL, mantle cell lymphoma, marginal zone lymphoma and lymphoplasmacytic lymphoma in line with (SSC1434) - 1.4g solution for sc injection.
• Second line treatment for anti-NMDAR auto-immune encephalitis (all ages)
• Treatment of refractory myasthenia gravis in a specialised neuroscience centre
• Treatment of nodal/paranodal antibody positive inflammatory/autoimmune neuropathy in adults and post-pubescent children
• Treatment of IgM paraproteinaemic demyelinating peripheral neuropathy in adults
• Treatment of Thrombotic Thrombocytopenic Purpura (TTP)
• Treatment of Idiopathic Membranous Nephropathy (IMN)

North of Tyne, Gateshead and North Cumbria APC have approved rituxumab for the following indication:

• Autoimmune hepatitis in patients who have failed or who are intolerant of therapies such as azathioprine, mycophenolate mofetil, corticosteroids and tacrolimus.

For musculoskeletal indications see chapter 10

• 150mg subcutaneous injection
  • Approved for the treatment of highly active relapsing-remitting mutiple sclerosis that has failed to respond to other treatment in adults in line with NICE and NHS England Commissioning Policy. 
  • Subject to restricted use by EMA

• 231mg capsules
  • Approved for treating relapsing-remitting multiple sclerosis in line with NICE

• 40mg and 80mg tablet
• Approved for the treatment of EGFR mutation-positive non-small-cell lung cancer in line with NICE
• Approved for treating epidermal growth factor receptor (EGFR) T790M mutation-positive locally advanced or metastatic non-small-cell lung cancer (NSCLC) in adults in line with NICE 

• 20mg tablets
  
  • Approved for treating relapsing–remitting multiple sclerosis with active disease defined by clinical or imaging features in adults in line with NICE
  
  
  

• 0.25mg and 2mg tablets
  
  • approved for treating secondary progressive multiple sclerosis in adults in line with NICE
  
  
  

• Approved  for hepatitis B and C in accordance with NICE guidelines and NHS England Commissioning Policies. 

• Approved treating relapsing–remitting multiple sclerosis in adults in line with NICE.

• Approved as a option for treating adults with active relapsing-remitting multiple sclerosis that isn’t highly active or rapidly evolving severe relapsing-remitting multiple sclerosis NICE and NHS England Commissioning Policy. 

• Approved for the treatment of highly active relapsing–remitting multiple sclerosis in line with NICE and NHS England Commissioning Policy.


• Approved for patients who have progressed on glatiramer acetate and for those patients who are at high risk of progressive multifocal leukoencephalopathy (PML) in line with NHS EnglandClinical Commissioning Policy.

• Approved for treating multiple sclerosis in line with NICE and NHS Engand commissioning policy.

• Approved for multiple myeloma in line with NICE - approved for myelodysplastic syndrome with 5q deletion in line with NICE. 
• Approved in combination with dexamethasone for previously untreated multiple myeloma in line with NICE 
• Approved in combination with dexamethasone for multiple myeloma after one treatment with bortezomib
• Approved for maintenance treatment after an autologous stem cell transplant for newly diagnosed multiple myeloma in adults in line with NICE
• Approved with rituximab for previously treated follicular lymphoma (grade 1 to 3A) in adults in line with NICE

• For the treatment of multiple myeloma previously treated with lenalidomide and bortezomib in line with NICE and NHS Commissioning Policy

• Approved in combination with an alkylating agent and a corticosteroid for the first-line treatment of multiple myeloma in line with NICE. 
• Approved for the treatment of bleeding from bowel angiodysplasia in patients with an inherited/acquired bleeding disorder on specialist advice only.
• Approved for the treatment of severe epistaxis as a result of hereditary haemorrhagic telangiectasia (HHT) who have failed all other treatments.