Coronavirus (COVID-19): Interim cancer treatment options
Interim treatment options during the COVID-19 pandemic supported by the COVID-19 National Cancer Medicines Advisory Group.
The COVID-19 pandemic changes the balance of benefit to risk for patients receiving systemic anticancer therapy (SACT) and may impact on capacity available to deliver SACT services in NHSScotland. As part of the COVID-19 cancer treatment response strategy, interim governance arrangements for cancer medicines has been issued by Scottish Government Health Department. These arrangements are being led by the COVID 19 National Cancer Medicines Advisory Group (NCMAG) which will, wherever possible, oversee a ‘Once for Scotland’ approach to interim changes to practice in the treatment of adult patients.
Decisions on treatment will need to be made on an individual patient basis by clinicians in discussion with the patient and, where appropriate, the multidisciplinary team (MDT). There will also be decisions made which will apply to groups of patients, notwithstanding that individual documented patient discussions will still be required.
The aim of the interim treatment options summarised in the table below is to allow for greater flexibility in the management of cancer during COVID-19 pandemic to ensure clinicians have additional treatment options through this time. These changes have been proposed by specialist teams and supported by NCMAG in line with the interim cancer medicines governance framework.
Decisions regarding the provision of NHS services remain as matters for NHS Boards; and clinicians remain responsible for clinical decisions regarding the care of individual patients. The interim changes are valid during the COVID-19 pandemic period only and will be withdrawn at an appropriate time point. Each NHS board must ensure all internal governance arrangements are completed before medicines are prescribed. The benefits and risks of the use of a medicine should be clearly stated and discussed with the patient to allow informed consent.
Patients commenced on an interim treatment supported by NCMAG during the COVID-19 pandemic should be allowed to continue the treatment until it is considered appropriate by patient and clinician to stop or to switch to a different treatment. The following interim treatment changes have been and assessed by NCMAG and implemented in line with the SGHD framework but do not constitute SGHD guidance.
List of proposals supported by the National Cancer Medicines Advisory Group (last updated: 28 October 2021)
| Cancer type |
Treatment |
Interim use |
| Breast |
Trastuzumab | As treatment of adult patients with human epidermal growth factor receptor 2 (HER2) positive early breast cancer, following surgery, chemotherapy (neo-adjuvant or adjuvant) and radiotherapy (if applicable) |
| Gynaecological |
Olaparib |
As treatment without preceding chemotherapy in patients with high grade epithelial tubo-ovarian cancer who have a deleterious somatic or germline BRCA mutation who have a recent relapse of platinum sensitive disease |
| Gynaecological |
Olaparib in combination with bevacizumab |
As maintenance treatment of patients with stage IV BRCA mutant and wild type tubo-ovarian and primary peritoneal cancer following cessation of neoadjuvant chemotherapy when primary surgery has been delayed as a consequence of the COVID-19 pandemic |
| Leukaemia | Acalabrutinib | As monotherapy for the treatment of adult patients with previously untreated CLL without a del(17p) or TP53 mutation and who would otherwise be eligible for fludarabine-cyclophosphamide-rituximab (FCR) |
| Leukaemia |
Ibrutinib |
In addition to its SMC accepted indications, ibrutinib monotherapy may also be used for the treatment of adult patients with previously untreated chronic lymphocytic leukaemia (CLL) without a del (17p) or TP53 mutation and who would otherwise be offered fludarabine-cyclophosphamide-rituximab (FCR) |
| Myeloma |
Carfilzomib in combination with dexamethasone alone |
As treatment of adult patients with multiple myeloma who have received at least one prior therapy, with once-weekly carfilzomib dosing |
| Myeloma |
Daratumumab in combination with pomalidomide and dexamethasone |
For the treatment of adult patients with multiple myeloma who have received three prior lines of therapy |
| Myeloma |
Lenalidomide in combination with cyclophosphamide and dexamethasone (RCD) |
As first line therapy for transplant eligible patients with newly diagnosed myeloma |
| Myeloma | Lenalidomide in combination with dexamethasone | As first line treatment of patients with multiple myeloma who are not eligible for transplant |
| Myeloma | Pomalidomide in combination with dexamethasone | As second or third line treatment of relapsed and refractory multiple myeloma in patient who have progressed on previous treatment with a regimen containing lenalidomide |
| Supportive treatment |
Apixaban |
As prophylaxis of VTE in Multiple Myeloma in patients treated with immunomodulatory (IMiD) drugs thalidomide, lenalidomide and pomalidomide in combination regimens who would otherwise require administration of low weight molecular heparin by a person outside of their household |
| Urological |
Abiraterone plus prednisolone |
Newly diagnosed low risk metastatic hormone sensitive prostate cancer in combination with androgen depravation therapy, in patients who would otherwise receive docetaxel |
| Urological |
Pembrolizumab in combination with axitinib |
As first-line treatment of advanced renal cell carcinoma, in patients who would otherwise receive the licensed 3-weekly pembrolizumab regimen (Updated December 2020) |
| non-specific |
Granulocyte colony stimulating factor (GCSF) |
Prevention of neutropenic events in patients receiving cytotoxic systemic anti-cancer therapy (SACT) during COVID-19 |
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