Guidance and protocols

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Systemic Anti-Cancer Therapy Protocol Information

The following Systemic Anti-Cancer Therapy (SACT) clinical protocols and guidance have been developed by local clinicians, with support from the Somerset, Wiltshire, Avon and Gloucestershire (SWAG) provider Trusts, and Cancer Alliance. The information provided is for guidance only, and has no legal or official standing. The guidance does not override the responsibility of Healthcare Professionals to make decisions appropriate to the circumstances of each patient, in consultation with the patient and/or their guardian or carer. Availability of treatments may change, subject to NHS funding agreements. The protocols must be used in conjunction with local and national commissioning guidance.

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Funding

NATIONAL SACT DOSING GUIDANCE

BOPA Guideline for 6-mercaptopurine dosing in adult acute lymphoblastic leukaemia based on TPMT and NUDT15 genotypes

https://ukclinicalpharmacy.org/wp-content/uploads/2024/02/Guideline-for-6-mercaptopurine-dosing-in-adult-acute-lymphoblastic-leukaemia-based-on-TPMT-and-NUDT15-g.pdf

DPD (dihydropyridimine dehydrogesase) Guidance

https://www.theacp.org.uk/userfiles/file/resources/dpd-testing-ukcb-july-2020-final.pdf

The protocols are frequently updated, and more will be added to the website as they are completed. If you have any queries or suggestions, or would like to be involved in the development of these protocols, please contact: SSGMeetings@uhbw.nhs.uk

3-weekly Cisplatin & Radiotherapy (endometrial)

Abemaciclib

Abiraterone

ABVD

Acalabrutinib

Adjuvant Bleomycin, Etoposide and Cisplatin (BEP) 500

Adjuvant Capecitabine – Hepatobiliary

Adjuvant Carboplatin

Adjuvant Gemcitabine – Pancreas

Adjuvant Temozolomide

Afatinib

Alectinib

Alpelisib and Fulvestrant

Apalutamide

Arsenic Trioxide

Asciminib

Atezolizumab – NSCLC

Atezolizumab – Urothelial

Atezolizumab and Bevacizumab

Atezolizumab, Bevacizumab, Carboplatin and Paclitaxel

Atezolizumab, Carboplatin and Etoposide

Atezolizumab and Nab-paclitaxel

ATRA

Avelumab

Avelumab (Urothelial)

Axitinib

Azacitidine

BEACOPP 14 / Escalated BEACOPP

BEACOPPDac 14 / Escalated BEACOPDac

BEAM (Lymphoma)

Bendamustine 120 (NHL)

Bevacizumab

Bevacizumab and Lonsurf

Bevacizumab and Olaparib

Bleomycin, Etoposide and Cisplatin (BEP) 360

Bleomycin, Etoposide and Cisplatin (BEP) 500

Blinatumomab

Bone Protection Myeloma 2020

Bortezomib, Cyclophosphamide and Dexamethasone (VCD)

Bortezomib, Melphalan and Prednisolone (VMP)

Bortezomib, Thalidomide and Dexamethasone (VTD) – 21 day

Bortezomib, Thalidomide and Dexamethasone (VTD) – 28 day

Bosutinib

Brigatinib

Busulphan

Cabazitaxel

Cabozantinib

Cabozantinib

Capecitabine – Metastatic Breast

Capecitabine – Colorectal

Capecitabine and Oxaliplatin (XELOX)

Capecitabine and Radiotherapy – Colorectal

Capecitabine and Radiotherapy – Pancreas

Capecitabine and Temozolomide (CAPTEM) – Neuroendocrine Tumours

CapOx – Oxaliplatin and Capecitabine

Carboplatin – Metastatic Breast

Carboplatin – Ovary

Carboplatin and Etoposide – Ovary

Carboplatin and Etoposide – SCLC

Carboplatin and Etoposide (SCLC) (for CUP as per Lung Cancer Protocol)

Carboplatin and Fluorouracil

Carboplatin and Gemcitabine (Gynae)

Carboplatin and Gemcitabine (Bladder)

Carboplatin and Paclitaxel – Breast

Carboplatin and Paclitaxel – Gynaecology

Carboplatin and Paclitaxel – Anal

Carboplatin and Paclitaxel (for CUP as per Gynae Cancer Protocol)

Carboplatin, Paclitaxel and Radiotherapy – Oesophagus

Carboplatin and Pegylated Liposomal Doxorubicin Hydrochloride (Caelyx)

Carboplatin and Radiotherapy

Carboplatin and Vinorelbine

Carboplatin, Gemcitabine and Bevacizumab

Carboplatin, Paclitaxel and Bevacizumab

Carboplatin, Paclitaxel and Pembrolizumab

Carboplatin, Paclitaxel and Radiotherapy

Carboplatin, Paclitaxel, Bevacizumab and Pembrolizumab (Gynae)

Carboplatin, Pemetrexed and Pembrolizumab

Carfilzomib and Dexamethasone

CBOP-BEP

Cemiplimab

Ceritinib

Cetuximab

Cetuximab and Encorafenib

Cetuximab and Radiotherapy

Cetuximab, Carboplatin and Fluorouracil

Cetuximab, Cisplatin and Fluorouracil

ChIVPP

Chlorambucil

Cisplatin and Capecitabine

Cisplatin and Etoposide – Thymic

Cisplatin and Etoposide – SCLC

Cisplatin and Fluorouracil

Cisplatin and Gemcitabine – Biliary

Cisplatin and Gemcitabine – NSCLC

Cisplatin and Gemcitabine – Bladder

Cisplatin and Gemcitabine – Nasopharynx

Cisplatin and Pemetrexed

Cisplatin and Radiotherapy – Gynae

Cisplatin and Vinorelbine

Cisplatin, Vinorelbine and Radiotherapy

Cisplatin, Etoposide and Radiotherapy

Cladribine

Clofarabine and Cytarabine

Crizotinib

Cyclophosphamide, Doxorubicin and Vincristine (CAV)

Cyclophosphamide priming

Cyclophosphamide, Thalidomide and Dexamethasone (CTD and CTDa)

Dabrafenib

Dabrafenib and Trametinib

Dabrafenib and Trametinib (NSCLC)

Dabrafenib and Trametinib (Thyroid)

Dacarbazine

Dara-VTD

Daratumumab

Daratumumab, Bortezomib and Dexamethasone (DVd)

Daratumumab, Lenalidomide and Dexamethasone (DRd) – Myeloma

Darolutamide

Dasatinib

Denosumab

Dexamethasone, Rituximab and Cyclophosphamide

Docetaxel – Metastatic Breast

Docetaxel – NSCLC

Docetaxel – Prostate

Docetaxel and Carboplatin

Docetaxel and Cyclophosphamide

Docetaxel and Darolutamide

Docetaxel, Carboplatin, Trastuzumab and Pertuzumab (TCPH)

Docetaxel, Cisplatin and Fluorouracil (TPF)

Docetaxel, Doxorubicin, and Cyclophosphamide (TAC)

Docetaxel – Head and Neck

Docetaxel, Trastuzumab and Pertuzumab (TPH)

Docetaxel (UGI)

Dose Adjusted (DA)-EPOCH-R

Dostarlimab, Carboplatin and Paclitaxel

Dostarlimab (Endometrial)

Doxorubicin single agent

Durvalumab, Cisplatin and Gemcitabine

Durvalumab

EC (Epirubicin & Cyclophosphamide) / Carboplatin + Weekly Paclitaxel (Breast)

EC-Paclitaxel

EC-T (Epirubicin and Cyclophosphamide and Docetaxel) – Breast

EC-TPH (Epirubicin and Cyclophosphamide then Docetaxel, Pertuzumab and Trastuzumab)

Elranatamab (Multiple Myeloma)

Encorafenib and Binimetinib

Enhertu (Trastuzumab Deruxtecan)

Entrectinib – NSCLC / NTRK Gene Fusion Solid Tumours

Enzalutamide

Epirubicin

Epirubicin and Cyclophosphamide

Epirubicin, Cisplatin and Capecitabine (ECX)

Epirubicin, Cisplatin and Capecitabine (ECX – oesophagus) (for CUP as per Upper GI protocol)

Dose Dense EC-Paclitaxel

Epirubicin, Oxaliplatin and Capecitabine (EOX)

Epirubicin, Oxaliplatin and Capecitabine (EOX – oesophagus) (for CUP as per Upper GI protocol)

Eribulin

Erlotinib

Etoposide and Cisplatin (EP) 500

Etoposide, Ifosfamide and Cisplatin (VIP)

Everolimus

Everolimus and Exemestane

Everolimus and Lenvatinib

FLAG/Ida

Fluorouracil, Epirubicin (100) and Cyclophosphamide (FEC 100)

Fluorouracil, Epirubicin (75) and Cyclophosphamide (FEC 75)

Fluorouracil, Epirubicin and Cyclophosphamide – Docetaxel (FEC-T)

Fluorouracil, Epirubicin and Cyclophosphamide – Docetaxel, Pertuzumab and Trastuzumab (FEC-TPH)

Fluorouracil, Oxaliplatin and Docetaxel (FLOT)

Fludarabine, Cyclophosphamide and Rituximab (F-CR)

Fluorouracil, Epirubicin and Cyclophosphamide and Docetaxel + Carboplatin (FEC-T + Carboplatin)

FOLFIRINOX

Gefitinib

Gemcitabine

Gemcitabine and Capecitabine – Pancreas

Gemcitabine and Capecitabine (for CUP as per Upper GI protocol for pancreas)

Gemcitabine and Carboplatin – Metastatic Breast

Gemcitabine and Carboplatin – NSCLC

Gemcitabine and Carboplatin (for CUP as per Lung Cancer Protocol)

Gemcitabine and Dacarbazine

Gemcitabine and Docetaxel (Sarcoma)

Gemcitabine and Paclitaxel Albumin (Abraxane)

Gemcitabine and Radiotherapy – Pancreas

Gemcitabine and Radiotherapy – Bladder

Gemtuzumab Ozogamicin

Gilteritinib (AML)

Glofitamab

High Dose Carboplatin and Etoposide

High Dose Melphalan

High Dose Methotrexate and Cytarabine

High Dose Methotrexate for CNS Prophylaxis

Hydroxycarbamide

Ibrutinib

Imatinib – GIST

Imatinib – CML

Inotuzumab

Ipilimumab

Ipilimumab and Nivolumab

Ipilimumab and Nivolumab (Mesothelioma)

Irinotecan

Irinotecan and Modified de Gramont Fluorouracil (FOLFIRI)

Isatuximab, Pomalidomide and Dexamethasone (IsaPd)

Ivosidenib

Ixazomib, Lenalidomide and Dexamethasone (IRd)

LACE

Lapatinib and Capecitabine

Lenalidomide and Dexamethasone – first line

Lenalidomide and Dexamethasone – second and subsequent line

Lenalidomide and Rituximab

Lenalidomide Maintenance

Lenvatinib

Lenvatinib and Pembrolizumab – Renal

Lomustine

Lorlatinib

Low dose induction Etoposide and Cisplatin (EP)

MATRIX (Methotrexate, Cytarabine, Thiotepa and Rituximab)

Melphalan and Prednisolone

Melphalan, Prednisolone and Thalidomide (MPT)

Midostaurin

Mitomycin C and Fluorouracil and Radiotherapy

Mitomycin C and Fluorouracil

Mobocertinib – NSCLC

Modified de Gramont

Modified FOLFIRINOX – Pancreas

Nelarabine

Neoadjuvant Cisplatin and Fluorouracil

Neratinib

Nilotinib

Nintedanib and Docetaxel

Niraparib

Nivolumab – Head and Neck

Nivolumab – NSCLC

Nivolumab – Melanoma

Nivolumab – Renal

Nivolumab and Cabozantinib (RCC)

Nivolumab and Ipilimumab

Nivolumab and Ipilimumab – Colorectal

Nivolumab and Relatlimab – Melanoma

Nivolumab (Hodgkin Lymphoma)

Nivolumab Monotherapy – Colorectal (COVID-19)

Nivolumab Monotherapy (Urothelial)

Nivolumab, Pemetrexed and Platinum – NSCLC

Nivolumab (UGI)

NORDIC

(O) CHOP

(O) Cyclophosphamide, Vincristine and Prednisolone (O) CVP

Obinutuzumab and Bendamustine

Obinutuzumab and Venetoclax

Olaparib tablets

Olaparib tablets (Breast)

Olaparib tablets (prostate)

Oral Azacitidine (Onureg)

Oral Etoposide

Osimertinib

Oxaliplatin and Gemcitabine

Oxaliplatin and Modified de Gramont Fluorouracil (FOLFOX)

Oxaliplatin, Irinotecan and Fluorouracil (FOLFOXIRI)

Paclitaxel 3 weekly – Metastatic Breast

Paclitaxel 3 weekly – Ovary

Paclitaxel Albumin (Abraxane)

Paclitaxel, Ifosfamide and Cisplatin (TIP)

Paclitaxel weekly – Metastatic Breast

Paclitaxel weekly – Gastric

Paclitaxel weekly – Gynaecology

Paclitaxel weekly (for CUP as per Gynae protocol)

Palbociclib (Breast)

Palliative Cisplatin and Fluorouracil

Palliative Gemcitabine – Pancreas

Panitumumab

Panobinostat, Bortezomib and Dexamethasone

Pazopanib

Pegylated Liposomal Doxorubicin Hydrochloride (Caelyx)

Pegylated Liposomal Doxorubicin Hydrochloride – Caelyx (Sarcoma)

Pembrolizumab – NSCLC

Pembrolizumab – Melanoma

Pembrolizumab – Bladder

Pembrolizumab – Hodgkin

Pembrolizumab and Lenvatinib (Gynae)

Pembrolizumab and Paclitaxel/Nab-Paclitaxel (Breast)

Pembrolizumab, Carboplatin and Weekly Paclitaxel-EC

Pembrolizumab – Colorectal

Pembrolizumab (Head and Neck)

Pembrolizumab (MSI-H and DMMR Cancers)

Pembrolizumab, Oxaliplatin and Capecitabine (Oesophageal or Gastro-Oesophageal)

Pembrolizumab (RCC)

Pemetrexed Maintenance

Pixantrone

Plerixafor

POLA-R-CHP

Polatuzumab vedotin, Bendamustine & Rituximab (PBR) – Lymphoma

Pomalidomide

Ponatinib

Procarbazine, Lomustine and Vincristine (PCV)

(R) Bendamustine 70 (CLL)

(R) Bendamustine 90 (CLL)

(R) Bendamustine 90 (NHL)

(R) CHOEP

(R) Cockle

(R) CODOX-M (R) IVAC

(R ) Cyclophosphamide, Vincristine and Prednisolone (R) CVP

(R) DHAP

(R ) Doxorubicin, Cyclophosphamide, Vincristine and Prednisolone (R ) CHOP

(R) ICE

(R) Mini BEAM

(R) mini CHOP

R Venetoclax

Raltitrexed

Raltitrexed and Oxaliplatin (TOMOX)

Raltitrexed and Radiotherapy

Regorafenib

Ribociclib

Rituximab and Chlorambucil

Rituximab (B-ALL)

Rituximab maintenance

(Rituximab) Gemcitabine, Dexamethasone and Cisplatin (R) GDP

Rucaparib

Ruxolitinib

Selinexor and Dexamethasone

Selinexor, Bortezomib and Dexamethasone

Selpercatinib (Lung and Thyroid)

Sorafenib

Sotorasib (Lung)

Sunitinib – GIST

Sunitinib – Renal

Sunitinib (PNET)

SWAG Lymphoma Bone Protection SOP

Teclistamab

Temozolomide

Temozolomide and Radiotherapy

Tepotinib (Lung)

Thalidomide and Dexamethasone

Three Weekly Cisplatin and Radiotherapy

Tivozanib

Topotecan – SCLC

Topotecan – Archived Gynae

Trabectedin

Trametinib

Trastuzumab – Breast

Trastuzumab Emtansine (Kadcyla)

Trastuzumab (Herceptin)

Treosulfan

Trifluridine and Tipiracil (Lonsurf)

Trodelvy (Sacituzumab Govitecan)

Tucatinib, Capecitabine and Trastuzumab (Breast)

Vandetanib

VDC/IE

VDT PACE

Vemurafenib

Venetoclax

Venetoclax and Azacitidine (COVID-19 Protocol)

Vinblastine

Vinorelbine – Metastatic Breast

Vinorelbine – Thoracic

Vinorelbine (Fibromatosis)

VR-CAP

Vyxeos

Weekly carboplatin and paclitaxel (cervix)

Weekly Cisplatin and Radiotherapy

Weekly Fluorouracil (QUASAR)

Weekly Fluorouracil (Roswell Park)

Zanubrutinib

Zoledronic Acid

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