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BNSSG Paediatric Joint Formulary

8.2 Malignant disease

Last edited: 09-05-2024

First line drugs Second line drugs Specialist drugs Secondary care drugs

8.2.1 Antibody responsive malignancy

Dinutuximab beta (parenteral) (TLS Red)

Olaratumab (parenteral) (TLS Red)

  • NICE TA465 guidance for treating advanced soft tissue sarcoma in combination with doxorubicin. No longer funded as of 15th July 2019

Rituximab (parenteral & subcutaneous) (TLS Red)

  • Also see chapter 9 for treatment of immune thrombocytopenic purpura (ITP) Treatment
  • NICE TA243 for the first-line treatment of stage III-IV follicular lymphoma
  • NICE TA226 for the treatment of follicular non-Hodgkin’s lymphoma (maintenance treatment following response to first line chemotherapy)
  • NICE TA137 for the treatment of relapsed or refractory stage III or IV follicular non-Hodgkin's lymphoma
  • NICE TA174 for the first-line treatment of chronic lymphocytic leukaemia
  • NICE TA193 for the treatment of relapsed chronic lymphocytic leukaemia


8.2.2 Cytotoxic responsive malignancy

Alkylating Agents

Bendamustine (parenteral)

  • NICE TA216 Bendamustine for the first-line treatment of chronic lymphocytic leukaemia

Busulfan (Busulphan) (oral & parenteral) (TLS Red)

Chlorambucil (oral) (TLS Red)

Cyclophosphamide (oral & parenteral) (TLS Red)

Dacarbazine (parenteral) (TLS Red)

Ifosfamide (parenteral) (TLS Red)

Lomustine (oral) (TLS Red)

Melphalan (oral & parenteral) (TLS Red)

Thiotepa (parenteral) (TLS Red)

Treosulfan (parenteral) (TLS Red)



Daunorubicin (parenteral) (TLS Red)

Doxorubicin (parenteral) (TLS Red)

Idarubicin (oral) (TLS Red)

Epirubicin (parenteral) (TLS Red)



Cytarabine (parenteral) (TLS Red)

Fludarabine (oral & parenteral) (TLS Red)

  • NICE TA29 Guidance on the use of fludarabine for B-cell chronic lymphocytic leukaemia

Mercaptopurine (oral) (TLS Red)

  • Also used for Inflammatory Bowel disease see Chapter 1 – unlicensed indication (TLS Amber)

Methotrexate (parenteral & oral) (TLS Red)

Nelarabine (parenteral) (TLS Red)


Antineoplastic Antibiotics

Bleomycin (parenteral) (TLS Red)

Mitomycin (parenteral & bladder instillation) (TLS Red)

Crisantaspase (parenteral)


Platinum Compounds

Carboplatin (parenteral) (TLS Red)

Cisplatin (parenteral) (TLS Red)

Oxaliplatin (parenteral) (TLS Red)



Docetaxel (parenteral) (TLS Red)

  • Individualised for osteosarcoma


Podophyllotoxin Derivatives

Etoposide (oral & parenteral) (TLS Red)


Retinoid and Related Drugs

Tretinoin (oral) (TLS Red)


Ribonucleotide Reductase Inhibitors

Hydroxycarbamide (oral) (TLS Red)


Topoisomerase I Inhibitors

Irinotecan hydrochloride (parenteral) (TLS Red)

Topotecan (oral) (TLS Red)


Vinca Alkaloids

Vinblastine (parenteral) (TLS Red)

Vincristine (parenteral) (TLS Red)

Vindesine (parenteral) (TLS Red)

Vinorelbine (parenteral) (TLS Red)


8.2.3 Cytotoxic drug-induced side effects


Folinic acid (oral & parenteral) (TLS Red)


Uroprotective Drugs

Mesna (oral & parenteral) (TLS Red)


8.2.4 Hyperuricaemia associated with cytotoxic drugs

Urate oxidases

Specific indication:

Rasburicase (TLS Red)

  • Consultant Haematologist / Nephrologist prescription only for patients identified as being at high risk of tumour lysis syndrome, or where standard preventative measures are not possible or have failed


8.2.5 Targeted therapy responsive malignancy

Protein Kinase Inhibitors

Selumetinib (oral)

  • NHSE SSC 2412 Selumetinib for treating symptomatic and inoperable plexiform neurofibromas associated with type 1 neurofibromatosis in children aged 3 and over

Dabrafenib with Trametinib

  • NHSE SSC 2649 Dabrafenib with trametinib for treating BRAF V600E mutation-positive glioma in children and young people aged 1 year and over