BC Cancer Benefit Drug ListJuly 2018
Page 1 of 70
Class I
Restricted Funding (R)
DRUGDOSAGE
FORMTUMOUR
SITEAPPROVED INDICATIONS
PROTOCOL CODES
CLASS NOTES
abiraterone tablet Genitourinary palliative therapy for metastatic, castration-resistant prostate cancer UGUPABI R
acitretin capsule Lymphoma reversal of early dysplastic and neoplastic stem changes LYNOS I
afatinib tablet Lungfirst-line treatment of epidermal growth factor receptor mutation-positive advanced non-small cell lung cancer with afatinib
LUAVAFAT I
aldesleukin injectable Pediatricpediatric patients with high risk neuroblastoma treated on the ANBL0032 study
I
alemtuzumab injectable Lymphomatreatment of fludarabine-refractory B-chronic lymphocytic leukemia and T-prolymphocytic leukemia
LYALEM I
aminolevulinic acid (LEVULAN® KERASTICK®)
topical solution Skin & Melanoma topical therapy for skin cancer with PDT (Photodynamic Therapy) SMPDT I
Only reimbursable when prescribed by physicians in the
Skin Tumour Group within the Skin PDT Program of the BC Cancer
Agencyamsacrine injectable Leukemia LKNOS I
anagrelide capsule Leukemiapatients with thrombocytosis related to a myeloproliferative disorder who have had an inadequate response to or are intolerant of hydroxyurea and/or interferon
LKANAG I
anastrozole tablet Breastneoadjuvant or adjuvant therapy for breast cancer using anastrozole in postmenopausal women
BRAJANAS I
anastrozole tablet Breastadjuvant ovarian suppression and aromatase inhibitor in premenopausal women with high-risk early stage breast cancer
BRAJLHRHAI I
anastrozole tablet Breastfirst or second line hormonal treatment for advanced breast cancer in postmenopausal women
BRAVANAS I
anastrozole tablet Breasttherapy for advanced breast cancer using a LHRH agonist and an aromatase inhibitor
BRAVLHRHA I
anastrozole tablet Breasttherapy of advanced breast cancer using palbociclib with aromatase inhibitor
UBRAVPALAI I
anastrozole (cont'd) tablet Gynecologyhormonal treatment for advanced endometrial cancer in postmenopausal women with contraindications to tamoxifen or intolerant of tamoxifen
GOENDAI I
4. For queries regarding other indications not specified, please contact the BC Cancer Compassionate Access Program Office at 604.877.6000 x 6277 or [email protected]
DEFINITIONSReimbursed for active cancer or approved treatment or approved indication only.Reimbursed for approved indications only. Completion of the BC Cancer Compassionate Access Program Application (formerly Undesignated Indication Form) is necessary to provide the appropriate clinical information for each patient.
2. Not Otherwise Specified (NOS) code only applicable to Class I drugs where indicated.
NOTES1. BC Cancer will reimburse, to the Communities Oncology Network hospital pharmacy, the actual acquisition cost of a Benefit Drug, up to the maximum price as determined by BC Cancer, based on the current brand and contract price. Please contact the OSCAR Hotline at 1-888-355-0355 if more information is required.
3. Intrahepatic use of chemotherapy drugs is not reimbursable unless specified.
* denotes change
BC Cancer Benefit Drug ListJuly 2018
Page 2 of 70
DRUGDOSAGE
FORMTUMOUR
SITEAPPROVED INDICATIONS
PROTOCOL CODES
CLASS NOTES
anastrozole (cont'd) tablet Gynecology therapy for advanced ovarian cancer using an aromatase inhibitor GOOVAI I
arsenic trioxide injectable Leukemiafirst-line induction and consolidation therapy of acute promyelocytic leukemia using arsenic trioxide and tretinoin
LKATOATRA I
arsenic trioxide injectable Leukemiafirst-line induction and consolidation therapy of acute promyelocytic leukemia using arsenic trioxide, tretinoin and daunorubicin
LKATOP I
arsenic trioxide injectable Leukemiainduction and consolidation therapy of relapsed acute promyelocytic leukemia using arsenic trioxide
LKATOR I
asparaginase (KIDROLASE®)
injectable Lymphomatreatment of refractory or relapsing extranodal natural killer or T-cell lymphoma using asparaginase, methotrexate and dexamethasone
LYASPMEDEX I
asparaginase (KIDROLASE®)
injectable Lymphomatreatment of natural killer or T-cell lymphoma using dexamethasone, methotrexate, ifosfamide, asparaginase and etoposide
LYSMILE I
asparaginase (KIDROLASE®)
injectable Leukemia LKNOS, LYNOS I
asparaginase-erwinia (ERWINASE®)
injectable Lymphomatreatment of refractory or relapsing extranodal natural killer or T-cell lymphoma using asparaginase, methotrexate and dexamethasone
LYASPMEDEX I
asparaginase-erwinia (ERWINASE®)
injectable Lymphomareatment of natural killer or T-cell lymphoma using dexamethasone, methotrexate, ifosfamide, asparaginase and etoposide
LYSMILE I
asparaginase-erwinia (ERWINASE®)
injectable Leukemia patients allergic to KIDROLASE® LKNOS, LYNOS I
axitinib tablet Genitourinary therapy for metastatic renal cell carcinoma using axitinib UGUAXIT Razacitidine injectable Leukemia therapy of acute myeloid leukemia using azacitidine and sorafenib ULKAMLAS Razacitidine injectable Leukemia therapy of myelodysplastic syndrome ULKMDSA R
bacillus calmette guerin (BCG)
injectable Genitourinary therapy for high risk superficial transitional cell bladder cancer GUBCG I
bacillus calmette guerin (BCG) (cont'd)
injectable Genitourinarypalliative therapy for BCG-refractory superficial high-grade transitional cell carcinoma bladder with BCG and Interferon
GUBCGIFN I
bacillus calmette guerin (BCG)
injectable Skin & Melanoma malignant melanoma SMILBCG I
bendamustine injectable Lymphoma treatment of Non-Hodgkin Lymphoma with bendamustine ULYBEND R
bendamustine injectable Lymphoma treatment of Non-Hodgkin Lymphoma with bendamustine and rituximab ULYBENDR R
The three substrains of BCG available are considered
interchangeable by BC Cancer for the treatment of bladder cancer
(i.e., Montreal [PACIS] 120 mg = TICE [OncoTICE] 1 to 8 x 108
CFU = Connaught [ImmuCyst] 81 mg) BUT only the current contract brand is reimbursed at the current
contract price
patients allergic to KIDROLASE®
* denotes change
BC Cancer Benefit Drug ListJuly 2018
Page 3 of 70
DRUGDOSAGE
FORMTUMOUR
SITEAPPROVED INDICATIONS
PROTOCOL CODES
CLASS NOTES
treatment of relapsed chronic lymphocytic leukemia with bendamustine ULYCLLBEND R
bendamustine injectable Lymphomatreatment of previously untreated chronic lymphocytic leukemia (CLL) with bendamustine and rituximab
ULYCLLFBR R
bendamustine injectable Lymphomatreatment of rituximab-refractory follicular lymphoma with obinutuzumab in combination with bendamustine
ULYOBBEND* R
* denotes change
BC Cancer Benefit Drug ListJuly 2018
Page 4 of 70
DRUGDOSAGE
FORMTUMOUR
SITEAPPROVED INDICATIONS
PROTOCOL CODES
CLASS NOTES
bevacizumab injectable Gastrointestinalpalliative combination chemotherapy for metastatic colorectal cancer using irinotecan, bevacizumab and capecitabine
GICIRB I
bevacizumab injectable Gastrointestinalpalliative combination chemotherapy for metastatic colorectal cancer using oxaliplatin, bevacizumab and capecitabine
GICOXB I
bevacizumab (cont'd) injectable Gastrointestinalpalliative combination chemotherapy for metastatic colorectal cancer using irinotecan, fluorouracil, folinic acid (leucovorin) and bevacizumab
GIFFIRB I
bevacizumab (cont'd) injectable Gastrointestinalpalliative combination chemotherapy for metastatic colorectal cancer using oxaliplatin, fluorouracil, leucovorin, and bevacizumab
GIFFOXB I
bevacizumab (cont'd) injectable Neuro-Oncology patients with relapsed malignant gliomas CNBEV I
bevacizumab injectable Gynecologyprimary treatment of metastatic/recurrent cancer of the cervix with bevacizumab, carboplatin and paclitaxel
GOCXCATB I
bevacizumab injectable Gynecologytreatment of platinum resistant epithelial ovarian cancer with bevacizumab and gemcitabine UGOOVBEVG R
bevacizumab injectable Gynecologytreatment of platinum resistant epithelial ovarian cancer with bevacizumab and pegylated liposomal doxorubicin (CAELYX) UGOOVBEVLD R
bevacizumab injectable Gynecologytreatment of platinum resistant epithelial ovarian cancer with bevacizumab and paclitaxel UGOOVBEVP R
bevacizumab injectable Gynecologytreatment of platinum resistant epithelial ovarian cancer with bevacizumab and vinorelbine UGOOVBEVV R
bevacizumab (cont'd) injectable Sarcomatherapy for advanced solitary fibrous tumours and hemangiopericytoma using temozolomide and bevacizumab
USATEMBEV R
bexarotene capsule Lymphoma patients with refractory cutaneous T-cell lymphoma ULYMFBEX RApproval from Health Canada Special Access Programme is
required for each patient.
bicalutamide tablet Genitourinary nonsteroidal treatment of prostate cancer, at 50 mg po daily GUPNSAA INot reimbursed for vasomotor symptoms (hot flashes) or high
dose monotherapy
bleomycin injectable Gynecologytherapy of non-dysgerminomatous ovarian germ cell cancer using bleomycin, etoposide, and cisplatin
GOBEP I
bleomycin injectable Genitourinarycurative therapy for germ cell cancer using with bleomycin, etoposide, cisplatin for germ cell cancers
GUBEP I
bleomycin injectable Kaposi's Sarcomapalliative therapy for kaposi’s sarcoma using vinblastine alternating with vincristine
KSVB I
bleomycin injectable Lymphomatreatment of Hodgkin lymphoma with doxorubicin, bleomycin, vinblastine, and dacarbazine
LYABVD I
bleomycin injectableNot Otherwise Specified
Other tumour site code followed by ‘NOS’ (e.g. LYNOS)
I
blinatumomab injectable Leukemiatreatment of Philadelphia chromosome negative refractory or relapsed pre-B-cell acute lymphoblastic leukemia with blinatumomab
ULKBLIN R
Not reimbursed for pleurodesis
* denotes change
BC Cancer Benefit Drug ListJuly 2018
Page 5 of 70
DRUGDOSAGE
FORMTUMOUR
SITEAPPROVED INDICATIONS
PROTOCOL CODES
CLASS NOTES
bortezomib injectable Myelomamaintenance therapy for multiple myeloma using bortezomib for patients with the high-risk chromosome abnormality
MYBORMTN I
injectable Myelomatreatment of multiple myeloma using bortezomib, dexamethasone with or without cyclophosphamide as induction pre-stem cell transplant
MYBORPRE I
bortezomib injectable Myelomatreatment of relapsed multiple myeloma using bortezomib, dexamethasone with or without cyclophosphamide
MYBORREL I
bortezomib (cont'd) injectable Myelomatreatment of multiple myeloma using melphalan, prednisone and weekly bortezomib with the option of substituting cyclophosphamide for melphalan
MYMPBOR I
bosutinib tablet Leukemia treatment of chronic myeloid leukemia using bosutinib ULKCMLB R
brentuximab vedotin injectable Lymphomatreatment of Hodgkin lymphoma and anaplastic large cell lymphoma with brentuximab vedotin
ULYBRENTUX R
adjuvant therapy post-autologous stem cell transplant (ASCT) for Hodgkin Lymphoma using brentuximab vedotin
ULYAJBV R
bromocriptine tablet, capsule Neuro-Oncology therapy for pituitary adenomas using bromocriptine CNB I
buserelininjectable, long-acting injectable
Breastadjuvant ovarian suppression and aromatase inhibitor in premenopausal women with high-risk early stage breast cancer
BRAJLHRHAI I
buserelin (cont'd) injectable Breastneoadjuvant or adjuvant therapy for breast cancer using a LHRH agonist and tamoxifen
BRAJLHRHT I
buserelin injectable Breasttherapy for advanced breast cancer using a LHRH agonist and an aromatase inhibitor
BRAVLHRHA I
buserelin injectable Breastcombination therapy with tamoxifen as palliative therapy for metastatic breast cancer
BRAVLHRHT I
buserelin (cont'd) injectable Genitourinary therapy for prostate cancer using LHRH agonist GUPLHRH I
busulfan tabletNot Otherwise Specified
Tumour site code followed by ‘NOS’ (e.g. LKNOS)
I
busulfan injectable BMTmyeloablative conditioning therapy prior to hematopoietic stem cell transplantation for myeloid malignancies
BMTIVBUCY I
busulfan injectable Pediatric pediatric patients who cannot swallow oral busulfan I
cabazitaxel injectable Genitourinarypalliative therapy for metastatic castration resistant prostate cancer using cabazitaxel and prednisone
UGUPCABA R
cabergoline tablet Neuro-Oncology therapy for pituitary adenomas using cabergoline CNCAB I
Not reimbursed for endometriosis
* denotes change
BC Cancer Benefit Drug ListJuly 2018
Page 6 of 70
DRUGDOSAGE
FORMTUMOUR
SITEAPPROVED INDICATIONS
PROTOCOL CODES
CLASS NOTES
capecitabine tablet Breast therapy of adjuvant breast cancer using capecitabine BRAJCAP I
capecitabine tablet Breast
metastatic breast cancer as first line treatment if anthracyclines and taxanes contraindicated, or where sidfect profile and/or treatment delivery concerns favour initial use of BRAVCAP; second or third line treatment of metastatic breast cancer that has previously responded to an anthracycline and taxane
BRAVCAP I
capecitabine tablet Breast
combination with lapatinib in advanced breast cancer patients with HER-2 expressing breast cancer whose cancer has progressed on one prior therapy with trastuzumab (HERCEPTIN)-based protocol in the advanced setting or who has relapsed on or within 12 months of adjuvant trastuzumab (HERCEPTIN)
UBRAVLCAP R
capecitabine tablet Breastcombination with trastuzumab (HERCEPTIN) as second-line treatment of HER-2 positive metastatic breast cancer after prior treatment with trastuzumab (HERCEPTIN)
UBRAVTCAP R
capecitabine tablet Gastrointestinal adjuvant therapy of colon cancer using capecitabine GIAJCAP I
capecitabine tablet Gastrointestinaladjuvant combination chemotherapy for stage III and IIB colon cancer with oxaliplatin
GIAJCAPOX I
capecitabine (cont'd) tablet Gastrointestinalfirst line palliative therapy of metastatic or unresectable colorectal adenocarcinoma in a patient either not suitable for or refusing GIIRFUFA
GIAVCAP I
capecitabine tablet Gastrointestinalpalliative therapy of metastatic neuroendocrine cancer using temozolomide and capecitabine
GIAVTZCAP I
capecitabine (cont'd) tablet Gastrointestinalpalliative combination chemotherapy for metastatic colorectal cancer using irinotecan and capecitabine in patients unsuitable for GIFOLFIRI
GICAPIRI I
capecitabine (cont'd) tablet Gastrointestinalpalliative combination chemotherapy for metastatic colorectal cancer using oxaliplatin and capecitabine
GICAPOX I
capecitabine (cont'd) tablet Gastrointestinalcombination with mitomycin and radiation therapy as curative combined modality therapy for carcinoma of the anal canal
GICART I
capecitabine (cont'd) tablet Gastrointestinalpalliative combination chemotherapy for metastatic colorectal cancer using irinotecan, bevacizumab and capecitabine
GICIRB I
capecitabine (cont'd) tablet Gastrointestinalpalliative combination chemotherapy for metastatic colorectal cancer using oxaliplatin, bevacizumab and capecitabine
GICOXB I
capecitabine (cont'd) tablet Gastrointestinalcurative-intent combined modality therapy for cancer of the anal canal, using cisplatin, capecitabine and radiation therapy
GICPART I
capecitabine (cont'd) tablet Gastrointestinaladjuvant chemotherapy of gastric cancer patients with D2 resection (node negative) or ineligible for adjuvant chemoradiation using oxaliplatin and capecitabine
GIGAJCOX I
* denotes change
BC Cancer Benefit Drug ListJuly 2018
Page 7 of 70
DRUGDOSAGE
FORMTUMOUR
SITEAPPROVED INDICATIONS
PROTOCOL CODES
CLASS NOTES
capecitabine (cont'd) tablet Gastrointestinaladjuvant chemotherapy of gastric cancer patients with completely resected gastric cancer using cisplatin and capecitabine and radiation therapy
GIGAJCPRT I
capecitabine (cont'd) tablet Gastrointestinal
palliative therapy of metastatic or locally advanced gastric, gastroesophageal junction adenocarcinoma, esophageal squamous cell carcinoma, or anal squamous cell carcinoma using cisplatin and capecitabine
GIGAVCC I
capecitabine (cont'd) tablet Gastrointestinalpalliative treatment of metastatic or locally advanced gastric, gastroesophageal junction, or esophageal adenocarcinoma using cisplatin, capecitabine and trastuzumab (HERCEPTIN)
GIGAVCCT I
capecitabine (cont'd) tablet Gastrointestinaltreatment of operable cancer of the stomach, stomach-esophagus junction or lower 1/3 esophagus, given before and after surgery, using epirubicin, cisplatin and capecitabine
GIGECC I
capecitabine (cont'd) tablet Gastrointestinalpalliative therapy for metastatic or locally advanced gastric or esophagogastric cancer using epirubicin, oxaliplatin and capecitabine
GIGAVEOCAP I
capecitabine (cont'd) tablet Gastrointestinaladjuvant chemotherapy for resected pancreatic adenocarcinoma using capecitabine and gemcitabine
GIPAJGCAP I
capecitabine (cont'd) tablet Gastrointestinalsecond line treatment of metastatic or unresectable pancreatic adenocarcinoma using capecitabine GIPAVCAP I
capecitabine (cont'd) tablet Gastrointestinaladjuvant combination chemotherapy for stage III rectal cancer with oxaliplatin
GIRAJCOX I
capecitabine (cont'd) tablet Gastrointestinaladjuvant capecitabine therapy for stage II and III rectal cancer previously treated with preoperative radiotherapy
GIRCAP I
capecitabine (cont'd) tablet Gastrointestinalcombined modality adjuvant therapy for high risk rectal carcinoma using capecitabine and radiation therapy
GIRCRT I
capecitabine (cont'd) tablet Gastrointestinalcombined modality adjuvant therapy for high risk rectal carcinoma using capecitabine, infusional fluorouracil and radiation therapy
GIRINFRT I
capecitabine (cont'd) tablet Head and Necktreatment of recurrent or metastatic nasopharyngeal cancer with capecitabine
HNNAVCAP I
carboplatin injectable Breastadjuvant treatment of HER-2 positive breast cancer using carboplatin, docetaxel and trastuzumab (HERCEPTIN)
BRAJDCARBT I
carboplatin (cont'd) injectable Breastpalliative therapy for metastatic breast cancer using cisplatin and gemcitabine
BRAVGEMP I
carboplatin (cont'd) injectable Breastpalliative therapy for metastatic breast cancer using trastuzumab (HERCEPTIN), paclitaxel and carboplatin as first-line treatment for advanced breast cancer
BRAVTPCARB I
carboplatin injectable Neuro-Oncology carboplatin and etoposide in the treatment of recurrent ependymoma CNCARV I
carboplatin injectable Gastrointestinalfirst-line palliative chemotherapy for advanced gallbladder cancer and cholangiocarcinoma using gemcitabine and cisplatin
GIAVPG I
carboplatin injectable Gastrointestinalneoadjuvant treatment of esophageal and gastroesophageal carcinomas using carboplatin, paclitaxel and radiation therapy
GIENACTRT I
* denotes change
BC Cancer Benefit Drug ListJuly 2018
Page 8 of 70
DRUGDOSAGE
FORMTUMOUR
SITEAPPROVED INDICATIONS
PROTOCOL CODES
CLASS NOTES
carboplatin (cont'd) injectable Gynecologyprimary adjuvant treatment of adenocarcinoma/adenosquamous cancer of the cervix with carboplatin and paclitaxel preceding or following irradiation with or without cisplatin
GOCXAJCAT I
carboplatin (cont'd) injectable Gynecologytreatment of advanced/recurrent non-small cell cancer of the cervix with carboplatin and docetaxel
GOCXCAD I
carboplatin (cont'd) injectable Gynecologyprimary treatment of advanced/recurrent non-small cell cancer of the cervix with carboplatin and paclitaxel
GOCXCAT I
carboplatin injectable Gynecologyprimary treatment of metastatic/recurrent cancer of the cervix with bevacizumab, carboplatin and paclitaxel
GOCXCATB I
carboplatin injectable Gynecologytreatment of primarily advanced or recurrent endometrial cancer using carboplatin and docetaxel
GOENDCAD I
carboplatin (cont'd) injectable Gynecologytreatment of primary advanced or recurrent endometrial cancer using carboplatin and paclitaxel
GOENDCAT I
carboplatin injectable Gynecologyprimary treatment of invasive epithelial ovarian, fallopian tube and primary peritoneal cancer, with no visible residual tumour (moderate-high risk) using carboplatin and docetaxel
GOOVCADM I
carboplatin injectable Gynecologysecond line treatment using docetaxel and carboplatin for epithelial ovarian cancer relapsing after primary treatment
GOOVCADR I
carboplatin (cont'd) injectable Gynecologyprimary treatment of visible residual (extreme risk) invasive epithelial ovarian cancer using carboplatin and docetaxel
GOOVCADX I
carboplatin (cont'd) injectable Gynecologytreatment of advanced ovarian cancer in patients who have progressed or recurred following first-line platinum-based treatment using carboplatin and gemcitabine
GOOVCAG I
carboplatin (cont'd) injectable Gynecologyfirst or second line therapy for invasive epithelial ovarian cancer using single-agent carboplatin
GOOVCARB I
carboplatin (cont'd) injectable Gynecologyprimary treatment of invasive epithelial ovarian, fallopian tube and primary peritoneal cancer, with no visible residual tumour (moderate-high risk) using carboplatin and paclitaxel
GOOVCATM I
carboplatin (cont'd) injectable Gynecologysecond line treatment using paclitaxel and carboplatin for epithelial ovarian cancer relapsing after primary treatment
GOOVCATR I
carboplatin (cont'd) injectable Gynecologyprimary treatment of visible residual (extreme risk) invasive epithelial ovarian cancer in ambulatory care settings using paclitaxel and carboplatin
GOOVCATX I
carboplatin (cont'd) injectable Gynecologyprimary treatment of advanced epithelial ovarian, primary peritoneal, or fallopian tube carcinoma using carboplatin and weekly paclitaxel
GOOVDDCAT I
carboplatin (cont'd) injectable Gynecology
primary treatment of stage III less than or equal to 1 cm visible residual invasive epithelial ovarian cancer or stage 1 grade 3 or stage II grade 3 papillary serous ovarian cancer using intravenous and intraperitoneal paclitaxel and intraperitoneal carboplatin
GOOVIPPC I
* denotes change
BC Cancer Benefit Drug ListJuly 2018
Page 9 of 70
DRUGDOSAGE
FORMTUMOUR
SITEAPPROVED INDICATIONS
PROTOCOL CODES
CLASS NOTES
carboplatin (cont'd) injectable Gynecologysecond line treatment for epithelial ovarian cancer relapsing after primary treatment using pegylated liposomal doxorubicin (PLD) and carboplatin
GOOVPLDC I
carboplatin (cont'd) injectable Gynecologytreatment of small cell or neuroendocrine carcinoma of gynecologic system origin using paclitaxel, cisplatin, etoposide and carboplatin with radiation
GOSMCCRT I
carboplatin (cont'd) injectable Genitourinary palliative therapy for urothelial carcinoma using cisplatin and gemcitabine GUAVPG I
carboplatin (cont'd) injectable Genitourinary therapy for transitional cell cancers using carboplatin-vinblastine GUBCV Icarboplatin (cont'd) injectable Genitourinary adjuvant therapy for stage I high risk seminoma using carboplatin GUSCARB I
carboplatin (cont'd) injectable Genitourinary therapy of genitourinary small cell tumors with a platin and etoposide GUSCPE I
carboplatin (cont'd) injectable Genitourinarytherapy of genitourinary small cell tumors with a platin and etoposide with radiation
GUSCPERT I
carboplatin (cont'd) injectable Head and Necktreatment of advanced squamous cell carcinoma of the head and neck cancer using fluorouracil and platinum
HNAVFUP I
carboplatin (cont'd) injectable Head and Necktreatment for unresectable, locoregionally recurrent or metastatic squamous cell carcinoma of the head and neck using paclitaxel and cisplatin or carboplatin
HNAVPC I
carboplatin (cont'd) injectable Head and Necktreatment of recurrent or metastatic squamous cell carcinoma of the head and neck with platinum and docetaxel
HNAVPD I
carboplatin (cont'd) injectable Head and Necktreatment of recurrent and metastatic squamous cell cancer with platinum and etoposide
HNAVPE I
carboplatin (cont'd) injectable Head and Neckcombined chemotherapy (carboplatin and fluorouracil) and radiation treatment for locally advanced squamous cell carcinoma of the head and neck
HNLACAFRT I
carboplatin (cont'd) injectable Head and Necktreatment for advanced nasopharyngeal cancer of the head and neck using platinum and fluorouracil
HNNAVFUP I
carboplatin (cont'd) injectable Head and Necktreatment of recurrent and/or metastatic nasopharyngeal cancer with platinum and etoposide
HNNAVPE I
carboplatin (cont'd) injectable Head and Necktreatment of locoregionally recurrent and/or metastatic nasopharyngeal cancer with platinum and gemcitabine
HNNAVPG I
carboplatin (cont'd) injectable Head and Necktreatment of recurrent or metastatic nasopharyngeal carcinoma with carboplatin and paclitaxel
HNNAVPC I
carboplatin (cont'd) injectable Lungadjuvant carboplatin and paclitaxel following resection of stage I, II and IIIA non-small cell lung cancer
LUAJPC I
carboplatin (cont'd) injectable Lungfirst-line treatment of advanced non-small cell lung cancer with carboplatin and paclitaxel
LUAVPC I
carboplatin (cont'd) injectable Lungtreatment of advanced non-small cell lung cancer with platinum and gemcitabine
LUAVPG I
carboplatin (cont'd) injectable Lungfirst-line treatment of advanced non-small cell lung cancer with platinum and pemetrexed
LUAVPP I
* denotes change
BC Cancer Benefit Drug ListJuly 2018
Page 10 of 70
DRUGDOSAGE
FORMTUMOUR
SITEAPPROVED INDICATIONS
PROTOCOL CODES
CLASS NOTES
carboplatin (cont'd) injectable Lungtreatment of locally advanced non-small cell lung cancer using carboplatin and paclitaxel with radiation therapy
LULACATRT I
carboplatin (cont'd) injectable Lungtreatment of locally advanced non-small cell lung cancer using cisplatin and etoposide with radiation therapy
LULAPERT I
carboplatin (cont'd) injectable Lungtreatment of locally advanced non-small cell lung cancer using alternative dosing of cisplatin and etoposide with radiation therapy
LULAPE2RT I
carboplatin (cont'd) injectable Lung treatment of thymoma with cisplatin and etoposide LUOTPE I
carboplatin (cont'd) injectable Lung treatment of thymoma using cisplatin and etoposide with radiation therapy LUOTPERT I
carboplatin (cont'd) injectable Lungtherapy of extensive stage small cell lung cancer with cisplatin and etoposide
LUSCPE I
carboplatin (cont'd) injectable Lungtherapy of limited stage small cell lung cancer using cisplatin and etoposide with radiation
LUSCPERT I
carboplatin (cont'd) injectable Lungsecond line treatment of extensive stage small cell lung cancer (SCLC) with irinotecan with or without platinum
LUSCPI I
carboplatin (cont'd) injectable Lymphomatreatment of avanced stage large B-cell non-Hodgkin’s lymphoma with ifosfamide, carboplatin, etoposide and rituximab
ULYRICE R
carboplatin (cont'd) injectable Primary Unknownprimary treatment of cancer of unknown primary origin using carboplatin and paclitaxel
PUCAT I
carboplatin (cont'd) injectable Skin & Melanomatreatment of recurrent or metastatic Merkel cell carcinoma with cisplatin and etoposide
SMMCCPE I
carboplatin (cont'd) injectableNot Otherwise Specified
Other tumour site code followed by ‘NOS’ (e.g. HNNOS)
I
carfilzomib injectable Myelomatherapy of multiple myeloma using carfilzomib and dexamethasone with or without cyclophosphamide
UMYCARDEX R
carfilzomib injectable Myelomatherapy of multiple myeloma using carfilzomib, lenalidomide with dexamethasone
UMYCARLD R
carmustine injectable Lymphoma topical therapy in cutaneous T-cell lymphoma LYCARTOP I
carmustine injectableNot Otherwise Specified
Other tumour site code followed by ‘NOS’ (e.g. LKNOS)
I
cetuximab injectable Gastrointestinalpalliative third line treatment of metastatic colorectal cancer with wild-type KRAS using cetuximab and irinotecan
GIAVCETIR I
cetuximab (cont'd) injectable Head and Neckcombined cetuximab and radiation treatment for locally advanced squamous cell carcinoma of the head and neck
HNLACETRT I
* denotes change
BC Cancer Benefit Drug ListJuly 2018
Page 11 of 70
DRUGDOSAGE
FORMTUMOUR
SITEAPPROVED INDICATIONS
PROTOCOL CODES
CLASS NOTES
chlorambucil tablet Lymphoma low grade lymphoma and chronic lymphocytic leukemia LYCHLOR I
chlorambucil tablet Lymphomatreatment of indolent B-cell lymphoma and chronic lymphocytic leukemia with chlorambucil and rituximab
LYCHLRR I
chlorambucil tablet Lymphoma lymphoma palliative chemotherapy LYPALL I
chlorambucil (cont'd) tablet Lymphomatreatment of previously untreated chronic lymphocytic leukemia using obinutuzumab in combination with chlorambucil
ULYOBCHLOR R
chlorambucil (cont'd) tabletNot Otherwise Specified
Other tumour site code followed by ‘NOS’ (e.g. LKNOS, LYNOS)
I
cisplatin injectable Breastpalliative therapy for metastatic breast cancer using cisplatin and gemcitabine
BRAVGEMP I
cisplatin injectable Neuro-Oncologyadjuvant lomustine, cisplatin and vincristine in adult high-risk medulloblastoma or other primitive neuroectodermal tumour
CNCCV I
cisplatin injectable Gastrointestinalfirst-line palliative chemotherapy for advanced gallbladder cancer and cholangiocarcinoma using gemcitabine and cisplatin
GIAVPG I
cisplatin injectable Gastrointestinalcurative-intent combined modality therapy for cancer of the anal canal, using cisplatin, capecitabine and radiation therapy
GICPART I
cisplatin injectable Gastrointestinalcombined modality therapy for locally advanced esophageal cancer using fluorouracil and cisplatin
GIEFUPRT I
cisplatin (cont'd) injectable Gastrointestinalhepatic trans-arterial chemoembolization for primary liver cancer or liver metastasis
GIEMBOL I
Note: cisplatin solution and cisplatin powder (SAP) only funded when prescribed by
specialists at BC Cancer VC and Royal Jubilee Hospital
cisplatin (cont'd) injectable Gastrointestinalpalliative chemotherapy for upper gastrointestinal tract cancer (gastric, esophageal, gall bladder carcinoma and cholangiocarcinoma) and metastatic anal cancer using infusional fluorouracil and cisplatin
GIFUC I
cisplatin (cont'd) injectable Gastrointestinalcombined modality curative therapy for carcinoma of the anal canal using cisplatin, infusional fluorouracil and radiation therapy
GIFUPART I
cisplatin (cont'd) injectable Gastrointestinaladjuvant chemotherapy of gastric cancer patients with completely resected gastric cancer using cisplatin and capecitabine and radiation therapy
GIGAJCPRT I
* denotes change
BC Cancer Benefit Drug ListJuly 2018
Page 12 of 70
DRUGDOSAGE
FORMTUMOUR
SITEAPPROVED INDICATIONS
PROTOCOL CODES
CLASS NOTES
cisplatin (cont'd) injectable Gastrointestinal
palliative therapy of metastatic or locally advanced gastric, gastroesophageal junction adenocarcinoma, esophageal squamous cell carcinoma, or anal squamous cell carcinoma using cisplatin and capecitabine
GIGAVCC I
cisplatin (cont'd) injectable Gastrointestinalpalliative treatment of metastatic or locally advanced gastric, gastroesophageal junction, or esophageal adenocarcinoma using cisplatin, capecitabine and trastuzumab (HERCEPTIN)
GIGAVCCT I
cisplatin (cont'd)injectable Gastrointestinal
palliative treatment of metastatic or inoperable, locally advanced gastric or gastroesophageal junction adenocarcinoma using cisplatin, infusional fluorouracil and trastuzumab (HERCEPTIN)
GIGAVCFT I
cisplatin (cont'd) injectable Gastrointestinaltreatment of operable cancer of the stomach, stomach-esophagus junction or lower 1/3 esophagus, given before and after surgery, using epirubicin, cisplatin and capecitabine
GIGECC I
cisplatin (cont'd) injectable Gastrointestinalpalliative therapy of neuroendocrine tumours using cisplatin and etoposide
GIPE I
cisplatin (cont'd)injectable
Gastrointestinalhyperthermic intraperitoneal chemotherapy (HIPEC) for patients with peritoneal mesothelioma using doxorubicin, cisplatin and paclitaxel
GIPMHIPEC I
cisplatin (cont'd) injectable Gynecologytherapy of non-dysgerminomatous ovarian germ cell cancer using bleomycin, etoposide and cisplatin
GOBEP I
cisplatin (cont'd) injectable Gynecologyalternative treatment of gynecological malignancies using cisplatin and paclitaxel
GOCISP I
cisplatin (cont'd) injectable Gynecologytreatment of high risk squamous carcinoma, adenocarcinoma, or adenosquamous carcinoma of the cervix with concurrent cisplatin and radiation
GOCXCRT I
cisplatin (cont'd) injectable Gynecologytherapy of dysgerminomatous ovarian germ cell cancer using cisplatin and etoposide
GOEP I
cisplatin (cont'd) injectable Gynecology invasive epithelial ovarian cancer GOOVCIS I
cisplatin (cont'd) injectable Gynecologytreatment of small cell or neuroendocrine carcinoma of gynecologic system origin using paclitaxel, cisplatin, etoposide and carboplatin with radiation
GOSMCCRT I
cisplatin (cont'd) injectable Genitourinary adjuvant therapy for urothelial carcinoma using cisplatin and gemcitabine GUAJPG I
cisplatin (cont'd) injectable Genitourinary palliative therapy for urothelial carcinoma using cisplatin and gemcitabine GUAVPG I
cisplatin (cont'd) injectable Genitourinarycurative therapy for germ cell cancer using bleomycin, etoposide and cisplatin
GUBEP I
cisplatin (cont'd) injectable Genitourinarytreatment of locally advanced bladder cancer with weekly cisplatin and concurrent radiation
GUBPWRT I
cisplatin (cont'd) injectable Genitourinarytreatment of metastatic adrenalcortical cancer with doxorubicin, etoposide, cisplatin and mitotane
GUEDPM I
cisplatin (cont'd) injectable Genitourinary therapy for nonseminoma germ cell cancer using etoposide-cisplatin GUEP I
* denotes change
BC Cancer Benefit Drug ListJuly 2018
Page 13 of 70
DRUGDOSAGE
FORMTUMOUR
SITEAPPROVED INDICATIONS
PROTOCOL CODES
CLASS NOTES
cisplatin (cont'd) injectable Genitourinarycombined modality therapy for squamous cell cancer of the genitourinary system using fluorouracil and cisplatin with radiation
GUFUPRT I
cisplatin (cont'd) injectable Genitourinarytherapy for transitional cell cancers of the urothelium using methotrexate, vinblastine, doxorubicin and cisplatin
GUMVAC I
cisplatin (cont'd) injectable Genitourinaryneo-adjuvant therapy for urothelial carcinoma using cisplatin and gemcitabine
GUNAJPG I
cisplatin (cont'd) injectable Genitourinary therapy of genitourinary small cell tumors with a platin and etoposide GUSCPE I
cisplatin (cont'd) injectable Genitourinarytherapy of genitourinary small cell tumors with a platin and etoposide with radiation
GUSCPERT I
cisplatin (cont'd) injectable Genitourinarytherapy for relapsed testicular germ cell cancer using paclitaxel, ifosfamide and cisplatin
UGUTIP R
cisplatin (cont'd) injectable Genitourinaryconsolidation/ salvage treatment for germ cell cancer using vinblastine, cisplatin, ifosfamide and mesna
GUVEIP I
cisplatin (cont'd) injectable Genitourinarynonseminoma consolidation/salvage protocol using etoposide, cisplatin, ifosfamide, mesna
GUVIP2 I
cisplatin (cont'd) injectable Head and Necktreatment of advanced squamous cell carcinoma of the head and neck cancer using fluorouracil and platinum
HNAVFUP I
cisplatin (cont'd) injectable Head and Neckpalliative chemotherapy for advanced head and neck squamous cell carcinoma with weekly cisplatin
HNAVP I
cisplatin (cont'd) injectable Head and Necktreatment for unresectable, locoregionally recurrent or metastatic squamous cell carcinoma of the head and neck using paclitaxel and cisplatin or carboplatin
HNAVPC I
cisplatin (cont'd) injectable Head and Necktreatment of recurrent or metastatic squamous cell carcinoma of the head and neck with platinum and docetaxel
HNAVPD I
cisplatin (cont'd) injectable Head and Necktreatment of recurrent and metastatic squamous cell cancer with platinum and etoposide
HNAVPE I
cisplatin (cont'd) injectable Head and Necktreatment of locally advanced (alternate) head and neck cancer using cisplatin during radiation therapy
HNLAALTPRT I
cisplatin (cont'd) injectable Head and Necktreatment of locally advanced squamous cell carcinoma of the head and neck with docetaxel, cisplatin and infusional fluorouracil
UHNLADCF R
cisplatin (cont'd) injectable Head and Neckcombined chemotherapy (cisplatin) and radiation treatment for locally advanced squamous cell carcinoma of the head and neck
HNLAPRT I
cisplatin (cont'd) injectable Head and Necktreatment for advanced nasopharyngeal cancer of the head and neck using platinum and fluorouracil
HNNAVFUP I
cisplatin (cont'd) injectable Head and Neckpalliative chemotherapy for advanced head and neck nasopharyngeal carcinoma with weekly cisplatin
HNNAVP I
cisplatin (cont'd) injectable Head and Necktreatment of recurrent and/or metastatic nasopharyngeal cancer with platinum and etoposide
HNNAVPE I
cisplatin (cont'd) injectable Head and Necktreatment of locoregionally recurrent and/or metastatic nasopharyngeal cancer with platinum and gemcitabine
HNNAVPG I
cisplatin (cont'd) injectable Head and Neckinduction treatment of locally advanced nasopharyngeal cancer with cisplatin and gemcitabine
HNNLAPG I
* denotes change
BC Cancer Benefit Drug ListJuly 2018
Page 14 of 70
DRUGDOSAGE
FORMTUMOUR
SITEAPPROVED INDICATIONS
PROTOCOL CODES
CLASS NOTES
cisplatin (cont'd) injectable Head and Necktreatment of locally advanced nasopharyngeal cancer with concurrent cisplatin and radiation
HNNLAPRT I
cisplatin (cont'd) injectable Head and Necktreatment of advanced head and neck cancer using cisplatin and fluorouracil
HNSAVFUP I
cisplatin (cont'd) injectable Head and Necktreatment of advanced salivary gland cancers with cisplatin and vinorelbine
HNSAVNP I
cisplatin (cont'd) injectable Head and Necktreatment of advanced salivary gland cancers with platinum, doxorubicin and cyclophospahmide
HNSAVPAC I
cisplatin (cont'd) injectable Lungadjuvant cisplatin and vinorelbine following resection of non-small cell lung cancer
LUAJNP I
cisplatin (cont'd) injectable Lungfirst-line treatment of advanced non-small cell lung cancer with cisplatin and docetaxel
LUAVDC I
cisplatin (cont'd) injectable Lungtreatment for advanced non-small cell lung cancer with cisplatin and vinorelbine
LUAVNP I
cisplatin (cont'd) injectable Lungtreatment of advanced non-small cell lung cancer with platinum and gemcitabine
LUAVPG I
cisplatin (cont'd) injectable Lungfirst-line treatment of advanced non-small cell lung cancer with platinum and pemetrexed
LUAVPP I
cisplatin (cont'd) injectable Lungtreatment of locally advanced non-small cell lung cancer using cisplatin and etoposide with radiation therapy
LULAPERT I
cisplatin (cont'd) injectable Lungtreatment of locally advanced non-small cell lung cancer using alternative dosing of cisplatin and etoposide with radiation therapy
LULAPE2RT I
cisplatin (cont'd) injectable Lung treatment of malignant mesothelioma with platinum and gemcitabine LUMMPG I
cisplatin (cont'd) injectable Lung treatment of malignant mesothelioma with platinum and pemetrexed LUMMPP I
cisplatin (cont'd) injectable Lung treatment of thymoma with platinum, doxorubicin and cyclophosphamide LUOTPAC I
cisplatin (cont'd) injectable Lung treatment of thymoma with cisplatin and etoposide LUOTPE I
cisplatin (cont'd) injectable Lung treatment of thymoma using cisplatin and etoposide with radiation therapy LUOTPERT I
cisplatin (cont'd) injectable Lungtreatment of cancer of unknown primary involving the thorax with cisplatin and etoposide
LUPUPE I
cisplatin (cont'd) injectable Lungtherapy of extensive stage small cell lung cancer with cisplatin and etoposide
LUSCPE I
cisplatin (cont'd) injectable Lungtherapy of limited stage small cell lung cancer using cisplatin and etoposide with radiation
LUSCPERT I
cisplatin (cont'd) injectable Lungsecond line treatment of extensive stage small cell lung cancer (SCLC) with irinotecan with or without platinum
LUSCPI I
cisplatin (cont'd) injectable Lymphoma treatment of lymphoma with gemcitabine, dexamethasone and cisplatin LYGDP I
cisplatin (cont'd) injectable Lymphomatreatment of lymphoma with gemcitabine, dexamethasone and cisplatin with rituximab
LYGDPR I
* denotes change
BC Cancer Benefit Drug ListJuly 2018
Page 15 of 70
DRUGDOSAGE
FORMTUMOUR
SITEAPPROVED INDICATIONS
PROTOCOL CODES
CLASS NOTES
cisplatin (cont'd) injectable LymphomaTreatment of newly diagnosed nasal, extranodal natural killer (NK) or T-cell lymphoma, stage IE to IIE using concurrent radiation and weekly cisplatin followed by etoposide, ifosfamide, cisplatin and dexamethasone
LYVIPDRT I
cisplatin (cont'd) injectable Sarcoma adjuvant therapy for osteosarcoma using doxorubicin and cisplatin SAAJAP I
cisplatin (cont'd) injectable Sarcoma therapy of advanced osteosarcoma using doxorubicin and cisplatin SAAVAP I
cisplatin (cont'd) injectable Sarcomahyperthermic intraperitoneal chemotherapy (HIPEC) for patients with peritoneal desmoplastic small round cell tumour (DSRCT) using CISplatin
SAHIPEC I
cisplatin (cont'd) injectable Skin & Melanomatreatment of recurrent or metastatic Merkel cell carcinoma with cisplatin and etoposide
SMMCCPE I
cisplatin (cont'd) injectableNot Otherwise Specified
Other tumour site code followed by ‘NOS’ (e.g. HNNOS)
I
cladribine injectable Lymphoma hairy cell leukemia LYCDA I
clodronate capsule Breastbony metastases associated with breast cancer or acute bone pain secondary to metastatic breast cancer
BRAVCLOD I Not reimbursed for hypercalcemia
cobimetinib tablet Skin & Melanomatreatment of BRAF V600 mutation-positive unresectable or metastatic melanoma using vemurafenib and cobimetinib
USMAVVC R
cortisone tablet Genitourinarytreatment of metastatic adrenalcortical cancer with doxorubicin, etoposide, cisplatin and mitotane
GUEDPM I
cortisone tablet Genitourinary treatment of adrenal cortical cancer using mitotane GUMITO I
cortisone tabletNot Otherwise Specified
Other tumour site code followed by ‘NOS’ (e.g. GUNOS)
I
crizotinib tablet Lungsecond-line treatment of ALK-positive advanced non-small cell lung cancer (NSCLC) with crizotinib
ULUAVCRIZ R
crizotinib (cont'd) tablet Lungfirst-line treatment of ALK-positive advanced non-small cell lung cancer (NSCLC) with crizotinib
ULUAVCRIZF R
cyclophosphamide tablet, injectable BMTmyeloablative conditioning therapy prior to autologous and allogeneic hematopoietic stem cell transplantation for myeloid malignancies using IV busulfan and cyclophosphamide
BMTIVBUCY I
cyclophosphamide tablet, injectable Breastadjuvant therapy for breast cancer using doxorubicin and cyclophosphamide
BRAJAC I
cyclophosphamide (cont'd) tablet, injectable Breastadjuvant therapy for breast cancer using doxorubicin and cyclophosphamide followed by paclitaxel
BRAJACT I
* denotes change
BC Cancer Benefit Drug ListJuly 2018
Page 16 of 70
DRUGDOSAGE
FORMTUMOUR
SITEAPPROVED INDICATIONS
PROTOCOL CODES
CLASS NOTES
cyclophosphamide (cont'd) tablet, injectable Breastadjuvant therapy for breast cancer using dose dense therapy: doxorubicin and cyclophosphamide followed by paclitaxel
BRAJACTG I
cyclophosphamide (cont'd) tablet, injectable Breastadjuvant therapy for breast cancer using doxorubicin and cyclophosphamide followed by paclitaxel and trastuzumab (HERCEPTIN)
BRAJACTT I
cyclophosphamide tablet, injectable Breastadjuvant therapy for breast cancer using dose dense therapy: doxorubicin and cyclophosphamide followed by paclitaxel and trastuzumab (HERCEPTIN)
BRAJACTTG I
cyclophosphamide tablet, injectable Breastadjuvant therapy for early breast cancer using doxorubicin and cyclophosphamide followed by weekly paclitaxel
BRAJACTW I
cyclophosphamide (cont'd) tablet, injectable Breastadjuvant therapy for high-risk breast cancer using cyclophosphamide (oral), methotrexate and fluorouracil
BRAJCMFPO I
cyclophosphamide (cont'd) tablet, injectable Breastadjuvant therapy for breast cancer using cyclophosphamide, doxorubicin and docetaxel
UBRAJDAC R
cyclophosphamide (cont'd) tablet, injectable Breastadjuvant therapy for breast cancer using docetaxel and cyclophosphamide
BRAJDC I
cyclophosphamide (cont'd) tablet, injectable Breastadjuvant therapy for breast cancer using fluorouracil, epirubicin and cyclophosphamide
BRAJFEC I
cyclophosphamide (cont'd) tablet, injectable Breastadjuvant therapy for breast cancer using fluorouracil, epirubicin and cyclophosphamide and docetaxel
BRAJFECD I
cyclophosphamide (cont'd) tablet, injectableBreast
adjuvant therapy for breast cancer using fluorouracil, epirubicin and cyclophosphamide followed by docetaxel and trastuzumab (HERCEPTIN)
BRAJFECDT I
cyclophosphamide (cont'd) tablet, injectable Breastcombination with docEtaxel and concurrent trastuzumab (HERCEPTIN) as adjuvant treatment of HER-2 positive breast cancer
BRAJTDC I
cyclophosphamide (cont'd) tablet, injectable Breastpalliative therapy for metastatic breast cancer using doxorubicin and cyclophosphamide
BRAVAC I
cyclophosphamide (cont'd) tablet, injectable Breastpalliative therapy for advanced breast cancer using cyclophosphamide, methotrexate and fluorouracil
BRAVCMF I
cyclophosphamide (cont'd) tablet, injectable Breastpalliative therapy for metastatic breast cancer using metronomic low-dose oral cyclophosphamide and methotrexate
BRAVCMPO I
cyclophosphamide (cont'd) tablet, injectable Breasttreatment of locally advanced breast cancer using doxorubicin and cyclophosphamide followed by docetaxel
BRLAACD I
cyclophosphamide (cont'd) tablet, injectable Breasttreatment of locally advanced breast cancer using doxorubicin and cyclophosphamide followed by docetaxel and trastuzumab (HERCEPTIN)
BRLAACDT I
cyclophosphamide (cont'd) injectable Breastneoadjuvant therapy for breast cancer using dose dense therapy: paclitaxel followed by doxorubicin and cyclophosphamide
BRLATACG I
cyclophosphamide (cont'd) injectable Breasttreatment of locally advanced breast cancer using doxorubicin and cyclophosphamide followed by weekly paclitaxel
BRLATWAC I
* denotes change
BC Cancer Benefit Drug ListJuly 2018
Page 17 of 70
DRUGDOSAGE
FORMTUMOUR
SITEAPPROVED INDICATIONS
PROTOCOL CODES
CLASS NOTES
cyclophosphamide (cont'd) tablet, injectable Breasttherapy for locally advanced breast cancer using cyclophosphamide, epirubicin and fluorouracil
UBRLACEF R
cyclophosphamide (cont'd) tablet, injectable Gynecologypalliative therapy for relapsed/progressing epithelial ovarian, primary peritoneal, or fallopian tube carcinoma using metronomic low-dose oral cyclophosphamide
GOOVCYCPO I
cyclophosphamide (cont'd) tablet, injectable Gynecologytherapy for high-risk Gestational Trophoblastic Neoplasia (GTN) using etoposide, methotrexate, leucovorin (folinic acid), dactinomycin, cyclophosphamide and vincristine
GOTDEMACO I
cyclophosphamide (cont'd) tablet, injectable Head and Neckpalliative therapy for advanced salivary gland cancers using cyclophosphamide, doxorubicin and fluorouracil
HNSAVFAC I
cyclophosphamide (cont'd) tablet, injectable Head and Necktreatment of advanced salivary gland cancers with platinum, doxorubicin and cyclophospahmide
HNSAVPAC I
cyclophosphamide (cont'd) tablet, injectable Lungtreatment of thymoma/thymic carcinoma with cyclophosphamide, doxorubicin and vincristine
LUOTCAV I
cyclophosphamide (cont'd) tablet, injectable Lung treatment of thymoma with platinum, doxorubicin and cyclophosphamide LUOTPAC I
cyclophosphamide (cont'd) tablet, injectable Lungtreatment of extensive small cell lung cancer with cyclophosphamide, doxorubicin and vincristine
LUSCCAV I
cyclophosphamide (cont'd) tablet, injectable Lymphomatreatment of Hodgkin's disease using cyclophosphamide, vincristine and prednisone
LYCCOP I
cyclophosphamide (cont'd) tablet, injectable Lymphomatreatment of lymphoma with doxorubicin, cyclophosphamide, vincristine and prednisone
LYCHOP I
cyclophosphamide (cont'd) tablet, injectable Lymphomatreatment of lymphoma with doxorubicin, cyclophosphamide, vincristine, prednisone and rituximab
LYCHOPR I
cyclophosphamide (cont'd) tablet, injectable Lymphomatreatment of Burkitt’s Lymphoma and Leukemia with cyclophosphamide, vincristine, doxorubicin, methotrexate, leucovorin and rituximab
LYCODOXMR I
cyclophosphamide (cont'd) tablet, injectable Lymphomaadvanced indolent lymphoma using cyclophosphamide, vincristine and prednisone
LYCVP I
cyclophosphamide (cont'd) tablet, injectable Lymphomatreatment of Hodgkin's disease with cyclophosphamide, vinblastine, procarbazine and prednisone
LYCVPPABO I
cyclophosphamide (cont'd) tablet, injectable Lymphomatreatment of advanced indolent lymphoma using cyclophosphamide, vincristine, prednisone and rituximab
LYCVPR I
cyclophosphamide (cont'd) tablet, injectable Lymphomatherapy of lymphoma, Hodgkin's disease, chronic lymphocytic leukemia or multiple myeloma using cyclophosphamide
LYCYCLO I
cyclophosphamide (cont'd) tablet, injectable Lymphomatreatment of lymphoma with dose-adjusted etoposide, doxorubicin, vincristine, cyclophosphamide, prednisone and rituximab with intrathecal methotrexate
LYEPOCHR I
cyclophosphamide (cont'd) tablet, injectable Lymphomatreatment of chronic lymphocytic leukemia (CLL) or prolymphocytic leukemia with fludarabine, cyclophosphamide and rituximab
LYFCR I
* denotes change
BC Cancer Benefit Drug ListJuly 2018
Page 18 of 70
DRUGDOSAGE
FORMTUMOUR
SITEAPPROVED INDICATIONS
PROTOCOL CODES
CLASS NOTES
cyclophosphamide (cont'd) tablet, injectable Lymphoma lymphoma palliative chemotherapy LYPALL I
cyclophosphamide (cont'd) tablet, injectable Myelomatreatment of multiple myeloma using bortezomib, dexamethasone with or without cyclophosphamide as induction pre-stem cell transplant
MYBORPRE I
cyclophosphamide (cont'd) tablet, injectable Myelomatreatment of relapsed multiple myeloma using bortezomib, dexamethasone with or without cyclophosphamide
MYBORREL I
cyclophosphamide (cont'd) tablet, injectable Myelomatherapy of multiple myeloma using carfilzomib and dexamethasone with or without cyclophosphamide
UMYCARDEX R
cyclophosphamide (cont'd) tablet, injectable Myelomatreatment of multiple myeloma using melphalan, prednisone and weekly bortezomib with the option of substituting cyclophosphamide for melphalan
MYMPBOR I
cyclophosphamide (cont'd) tablet, injectable Myelomasingle dose cyclophosphamide priming therapy for multiple myeloma prior to autologous stem cell transplant
MYHDC I
cyclophosphamide (cont'd) tablet, injectable Sarcoma
SAIME alternating with SAVAC or SAVACM with filgrastim support at a TWO weekly interval for newly diagnosed Ewing's Sarcoma/Ewing’s Family of Tumours, Desmoplastic Intra-Abdominal Small Round Blue Cell Tumour or Rhabdomyosarcoma
SAALT2W I
cyclophosphamide (cont'd) tablet, injectable Sarcoma
SAIME alternating with SAVAC or SAVACM with filgrastim support at a THREE weekly interval for newly diagnosed Ewing's Sarcoma/Ewing’s Family of Tumours, Desmoplastic Intra-Abdominal Small Round Blue Cell Tumour or Rhabdomyosarcoma
SAALT3W I
cyclophosphamide (cont'd) tablet, injectable Sarcomasummary for treatment of recurrent/refractory neuroblastoma, ewing’s sarcoma, osteogenic sarcoma or rhabdomyosarcoma with topotecan/cyclophosphamide
SAAVTC I
cyclophosphamide (cont'd) tablet, injectable Sarcomatreatment of sarcomas with vincristine, doxorubicin and cyclophosphamide
SAVAC I
cyclophosphamide (cont'd) tablet, injectable Sarcomatreatment of sarcomas with pelvic primaries or chemotherapy induced hematuria using vincristine, doxorubicin, cyclophosphamide and mesna
SAVACM I
cyclophosphamide (cont'd) tablet, injectable Sarcomaadjuvant therapy for rhabdomyosarcoma using vincristine, dactinomycin and cyclophosphamide
SAVDC I
cyclophosphamide (cont'd) tablet, injectable Sarcomaadjuvant therapy for rhabdomyosarcoma using vincristine, dactinomycin, cyclophosphamide and mesna
SAVDCM I
cyclophosphamide (cont'd) tablet, injectableNot Otherwise Specified
Other tumour site code followed by ‘NOS’ (e.g. BRNOS)
I
cyclosporine capsule Lymphomacytopenias associated with lymphoproliferative disorder of large granular lymphocytes
LYCSPA I
cyclosporine capsule Lymphomatreatment of hemophagocytic lymphohistiocytosis with etoposide, dexamethasone and cycloSPORINE
HLHETCSPA I
* denotes change
BC Cancer Benefit Drug ListJuly 2018
Page 19 of 70
DRUGDOSAGE
FORMTUMOUR
SITEAPPROVED INDICATIONS
PROTOCOL CODES
CLASS NOTES
cytarabine injectable Leukemia Therapy of Acute Myeloid Leukemia Using Low dose Cytarabine LKAMLCYT I
cytarabine injectable Lymphomatreatment of Burkitt’s Lymphoma and Leukemia with cyclophosphamide, vincristine, doxorubicin, methotrexate, leucovorin and rituximab
LYCODOXMR I
cytarabine injectable Lymphoma treatment of lymphoma using intrathecal methotrexate and cytarabine LYIT I
cytarabine injectable LymphomaTreatment of Burkitt’s Lymphoma and Leukemia with Ifosfamide, Mesna, Etoposide, Cytarabine and Rituximab
LYIVACR I
cytarabine (cont'd) injectable Miscellaneous Originstherapy for solid tumours using intrathecal methotrexate and/or thiotepa and/or cytarabine
MOIT I
cytarabine (cont'd) injectableNot Otherwise Specified
Other tumour site code followed by ‘NOS’ (e.g. LYNOS)
I
dabrafenib capsule Skin & Melanomatreatment of BRAF V600 mutation-positive unresectable or metastatic melanoma using dabrafenib
USMAVDAB R
dabrafenib capsule Skin & Melanomatreatment of BRAF V600 mutation-positive unresectable or metastatic melanoma using dabrafenib and trametinib
USMAVDT R
dacarbazine injectable Lymphomatreatment of Hodgkin's disease with doxorubicin, bleomycin, vinblastine and dacarbazine
LYABVD I
dacarbazine (cont'd) injectable Sarcomaadjuvant treatment of patients with soft tissue sarcoma using doxorubicin and dacarbazine
SAAJADIC I
dacarbazine injectable Sarcomatreatment of patients with soft tissue sarcoma using doxorubicin and dacarbazine
SAAVADIC I
dacarbazine injectable Sarcoma high dose single agent dacarbazine for metastatic soft tissue sarcoma SADTIC I
dacarbazine injectable Skin & Melanomatherapy for metastatic malignant melanoma using high dose single agent dacarbazine
SMDTIC I
dacarbazine (cont'd) injectableNot Otherwise Specified
Other tumour site code followed by ‘NOS’ (e.g. SMNOS)
I
dactinomycin injectable Gynecologytherapy for high-risk Gestational Trophoblastic Neoplasia (GTN) using etoposide, methotrexate, leucovorin (folinic acid), dactinomycin, cyclophosphamide and vincristine
GOTDEMACO I
dactinomycin injectable Gynecologytherapy for low risk gestational trophoblastic neoplasia using methotrexate, leucovorin and actinomycin-D
GOTDLR I
dactinomycin injectable Sarcomaadjuvant therapy for rhabdomyosarcoma using vincristine, dactinomycin and cyclophosphamide
SAVDC I
dactinomycin (cont'd) injectable Sarcomaadjuvant therapy for rhabdomyosarcoma using vincristine, dactinomycin, cyclophosphamide and mesna
SAVDCM I
* denotes change
BC Cancer Benefit Drug ListJuly 2018
Page 20 of 70
DRUGDOSAGE
FORMTUMOUR
SITEAPPROVED INDICATIONS
PROTOCOL CODES
CLASS NOTES
dactinomycin injectableNot Otherwise Specified
Other tumour site code followed by ‘NOS’ (e.g. SANOS)
I
dasatinib tablet Leukemia chronic myeloid leukemia and Ph+ acute lymphoblastic leukemia ULKCMLD R
daunorubicin injectable Leukemiafirst-line induction and consolidation therapy of acute promyelocytic leukemia using arsenic trioxide, tretinoin and daunorubicin
LKATOP I
daunorubicin injectableNot Otherwise Specified
Other tumour site code followed by ‘NOS’ (e.g. KSNOS)
I
degarelix injectable Genitourinary therapy for prostate cancer using LHRH antagonist GUPLHRHA I
denosumab (XGEVA®) injectable Sarcomaneoadjuvant use in patients with non-metastatic operable giant cell tumour of the bone
USANADENO R
dexamethasone tablet Genitourinarypalliative therapy for metastatic castration resistant prostate cancer using abiraterone and prednisone after failure of docetaxel therapy
UGUPABI R
dexamethasone tablet Lymphomatreatment of hemophagocytic lymphohistiocytosis with etoposide, dexamethasone and cycloSPORINE
HLHETCSPA I
dexamethasone tablet Lymphomatreatment of refractory or relapsing extranodal natural killer or T-cell lymphoma using asparaginase, methotrexate and dexamethasone
LYASPMEDEX I
dexamethasone tablet Lymphoma treatment of lymphoma with gemcitabine, dexamethasone and cisplatin LYGDP I
dexamethasone tablet Lymphomatreatment of lymphoma with gemcitabine, dexamethasone and cisplatin with rituximab
LYGDPR I
dexamethasone tablet Lymphoma lymphoma palliative chemotherapy LYPALL I
dexamethasonetablet
Lymphomatreatment of natural killer or T-cell lymphoma using dexamethasone, methotrexate, ifosfamide, asparaginase and etoposide
LYSMILE I
dexamethasone
tablet
Lymphomatreatment of newly diagnosed nasal, extranodal natural killer (NK) or T-cell lymphoma, stage IE to IIE using concurrent radiation and weekly cisplatin followed by etoposide, ifosfamide, cisplatin and dexamethasone
LYVIPDRT I
dexamethasone (cont'd) tablet Myelomatreatment of multiple myeloma using bortezomib, dexamethasone with or without cyclophosphamide as induction pre-stem cell transplant
MYBORPRE I
dexamethasone tablet Myelomatreatment of relapsed multiple myeloma using bortezomib, dexamethasone with or without cyclophosphamide
MYBORREL I
dexamethasone tablet Myelomatherapy of multiple myeloma using carfilzomib and dexamethasone with or without cyclophosphamide
UMYCARDEX R
dexamethasone tablet Myelomatherapy of multiple myeloma using carfilzomib, lenalidomide with dexamethasone
UMYCARLD R
Not reimbursed for:anti-emetic treatment, steroid
replacement therapy, pre-taxane use, or appetite stimulation
* denotes change
BC Cancer Benefit Drug ListJuly 2018
Page 21 of 70
DRUGDOSAGE
FORMTUMOUR
SITEAPPROVED INDICATIONS
PROTOCOL CODES
CLASS NOTES
dexamethasonetablet Myeloma
treatment of previously untreated multiple myeloma and not eligible for stem cell transplant using lenalidomide with low-dose dexamethasone
UMYLDF R
dexamethasone (cont'd) tablet Myelomatherapy of relapsed multiple myeloma using lenalidomide with dexamethasone
UMYLDREL R
dexamethasone (cont'd)tablet Myeloma
treatment of multiple myeloma using melphalan, prednisone and weekly bortezomib with the option of substituting cyclophosphamide for melphalan
MYMPBOR I
dexamethasone tablet Myeloma therapy of multiple myeloma using pomalidomide with dexamethasone UMYPOMDEX R
dexamethasone (cont'd) tablet Supportive Carepatients with primary or metastatic disease exhibiting cerebral edema or CNS swelling; management of malignant brain tumours; management of CNS lymphoma
MODEXA I
dexamethasone (cont'd) tabletNot Otherwise Specified
Other tumour site code followed by ‘NOS’ (for e.g. CNNOS)
I
dexamethasone injectableNot Otherwise Specified
Other tumour site code followed by ‘NOS’ (e.g. BRNOS)
I
dexrazoxane injectable Pediatricpediatric patients with neuroblastoma treated on the CCG AEWS1031 protocol
I
dexrazoxane (cont'd) injectable Pediatricpediatric patients with rhabdomyosarcoma treated on the COG ARST08P1 protocol
I
docetaxel injectable Breastadjuvant therapy for breast cancer using cyclophosphamide, doxorubicin and docetaxel
UBRAJDAC R
docetaxel (cont'd) injectable Breastadjuvant treatment for high-risk node negative or node positive patients who are not considered candidates for a standard 6-8 cycle anthracycline or anthracycline plus taxane regimen
BRAJDC I
docetaxel (cont'd) injectable Breastadjuvant treatment of HER-2 positive breast cancer using carboplatin, docetaxel and trastuzumab (HERCEPTIN)
BRAJDCARBT I
docetaxel (cont'd) injectable Breastadjuvant therapy for breast cancer using fluorouracil, epirubicin and cyclophosphamide and docetaxel
BRAJFECD I
docetaxel (cont'd) injectable Breastcombination with trastuzumab (HERCEPTIN) after FEC regimen as adjuvant therapy for breast cancer
BRAJFECDT I
docetaxel (cont'd) injectable Breastcombination with cycylophosphamide and concurrent trastuzumab (HERCEPTIN) as adjuvant treatment of HER-2 positive breast cancer
BRAJTDC I
docetaxel (cont'd) injectable Breastcombination with doxorubicin and cyclophosphamide as treatment of locally advanced breast cancer
BRLAACD I
Not reimbursed for:anti-emetic treatment, steroid
replacement therapy, pre-taxane use, or appetite stimulation
* denotes change
BC Cancer Benefit Drug ListJuly 2018
Page 22 of 70
DRUGDOSAGE
FORMTUMOUR
SITEAPPROVED INDICATIONS
PROTOCOL CODES
CLASS NOTES
docetaxel (cont'd) injectable Breasttreatment of locally advanced breast cancer using doxorubicin and cyclophosphamide followed by docetaxel and trastuzumab (HERCEPTIN)
BRLAACDT I
docetaxel (cont'd) injectable Breastfirst, second, or third line treatment of metastatic breast cancer patients with ECOG performance status 0, 1, or 2, and greater than 3 month life expectancy
BRAVDOC I
docetaxel (cont'd) injectable Breastweekly docetaxel regimen for metastatic breast cancer patients with poor tolerance to 3-weekly docetaxel regimen (BRAVDOC) or high doses of dexamethasone used in BRAVDOC
BRAVDOC7 I
docetaxel (cont'd) injectable Breastpalliative therapy for metastatic breast cancer using gemcitabine and docetaxel
BRAVGEMD I
docetaxel (cont'd) injectable Breastpalliative therapy for metastatic breast cancer using pertuzumab, trastuzumab (HERCEPTIN) and docetaxel as first-line treatment for advanced breast cancer
BRAVPTRAD I
docetaxel (cont'd) injectable Breastwith trastuzumab (HERCEPTIN) as first-line treatment for advanced breast cancer refractory to anthracycline adjuvant chemotherapy
BRAVTRAD I
docetaxel (cont'd) injectable Gastrointestinalpalliative treatment of metastatic esophagogastric adenocarcinoma with docetaxel
GIAVDOC I
docetaxel (cont'd) injectable Gastrointestinalperioperative treatment of resectable adenocarcinoma of the stomach, gastroesophageal junction or lower 1/3 esophagus using docetaxel, oxaliplatin, infusional fluorouracil, and leucovorin
UGIGFLODOC R
docetaxel (cont'd) injectable Gynecologycombination with carboplatin as primary treatment of advanced/recurrent non-small cell cancer of the cervix in ambulatory care settings
GOCXCAD I
docetaxel (cont'd) injectable Gynecologytreatment of primarily advanced or recurrent endometrial cancer using carboplatin and docetaxel
GOENDCAD I
docetaxel (cont'd) injectable Gynecologyprimary treatment of invasive epithelial ovarian, fallopian tube and primary peritoneal cancer, with no visible residual tumour (moderate-high risk)
GOOVCADM I
docetaxel (cont'd) injectable Gynecologysecond line treatment using docetaxel and carboplatin for epithelial ovarian cancer relapsing after primary treatment
GOOVCADR I
docetaxel (cont'd) injectable Gynecologyprimary treatment of visible residual (extreme risk) invasive epithelial ovarian cancer
GOOVCADX I
docetaxel (cont'd) injectable Gynecologytreatment of progressive, platinum-refractory epithelial ovarian carcinoma, primary peritoneal
GOOVDOC I
docetaxel (cont'd) injectable Gynecologycombination with gemcitabine for advanced or recurrent uterine sarcoma cancer
GOSADG I
docetaxel (cont'd) injectable Genitourinary intravesical use for bladder cancer if BCG and mitomycin C not available GUNOS I
docetaxel (cont'd) injectable Genitourinary palliative therapy for metastatic hormone refractory prostate cancer GUPDOC I
* denotes change
BC Cancer Benefit Drug ListJuly 2018
Page 23 of 70
DRUGDOSAGE
FORMTUMOUR
SITEAPPROVED INDICATIONS
PROTOCOL CODES
CLASS NOTES
docetaxel (cont'd) injectable Genitourinaryfirst-line treatment of castration sensitive, metastatic prostate cancer using docetaxel and androgen deprivation therapy with LHRH agonist or LHRH antagonist with or without antiandrogen, or surgical castration
GUPDOCADT I
docetaxel (cont'd) injectable Head and Necktreatment of recurrent or metastatic squamous cell carcinoma of the head and neck with docetaxel
HNAVDOC I
docetaxel (cont'd) injectable Head and Necktreatment of recurrent or metastatic squamous cell carcinoma of the head and neck with platinum and docetaxel
HNAVPD I
docetaxel (cont'd) injectable Head and Necktreatment of locally advanced squamous cell carcinoma of the head and neck with docetaxel, cisplatin and infusional fluorouracil
UHNLADCF R
docetaxel (cont'd) injectable Lungcombination with cisplatin as first line treatment of advanced non-small lung cancer
LUAVDC I
docetaxel (cont'd) injectable Lung second-line treatment of non-small cell lung cancer LUAVDOC I
docetaxel (cont'd) injectable Sarcomacombination with gemcitabine as second or third line therapy for soft tissue sarcomas
SAAVGEMD I
doxorubicin injectable Breastadjuvant therapy for breast cancer using doxorubicin and cyclophosphamide
BRAJAC I
doxorubicin injectable Breastadjuvant therapy for breast cancer using doxorubicin and cyclophosphamide followed by paclitaxel
BRAJACT I
doxorubicin injectable Breastadjuvant therapy for breast cancer using dose dense therapy: doxorubicin and cyclophosphamide followed by paclitaxel
BRAJACTG I
doxorubicin injectable Breastadjuvant therapy for breast cancer using doxorubicin and cyclophosphamide followed by paclitaxel and trastuzumab (HERCEPTIN)
BRAJACTT I
doxorubicin (cont'd) injectable Breastadjuvant therapy for breast cancer using dose dense therapy: doxorubicin and cyclophosphamide followed by paclitaxel and trastuzumab (HERCEPTIN)
BRAJACTTG I
doxorubicin injectable Breastadjuvant therapy for early breast cancer using doxorubicin and cyclophosphamide followed by weekly paclitaxel
BRAJACTW I
doxorubicin (cont'd) injectable Breastadjuvant therapy for breast cancer using cyclophosphamide, doxorubicin and docetaxel
UBRAJDAC R
doxorubicin injectable Breast palliative therapy for metastatic breast cancer using weekly doxorubicin BRAVA7 I
doxorubicin (cont'd) injectable Breastpalliative therapy for metastatic breast cancer using doxorubicin and cyclophosphamide
BRAVAC I
doxorubicin (cont'd) injectable Breasttreatment of locally advanced breast cancer using doxorubicin and cyclophosphamide followed by docetaxel
BRLAACD I
doxorubicin (cont'd) injectable Breasttreatment of locally advanced breast cancer using doxorubicin and cyclophosphamide followed by docetaxel and trastuzumab (HERCEPTIN)
BRLAACDT I
doxorubicin (cont'd) injectable Breastneoadjuvant therapy for breast cancer using dose dense therapy: paclitaxel followed by doxorubicin and cyclophosphamide
BRLATACG I
* denotes change
BC Cancer Benefit Drug ListJuly 2018
Page 24 of 70
DRUGDOSAGE
FORMTUMOUR
SITEAPPROVED INDICATIONS
PROTOCOL CODES
CLASS NOTES
doxorubicin (cont'd) injectable Breasttreatment of locally advanced breast cancer using doxorubicin and cyclophosphamide followed by weekly paclitaxel
BRLATWAC I
doxorubicin (cont'd) injectable Gastrointestinal palliative therapy for hepatoma using doxorubicin GIA I
doxorubicin (cont'd) injectable Gastrointestinaltransarterial chemoembolization (TACE) of hepatocellular carcinoma using drug-eluting bead (DEB) loaded with doxorubicin
UGIDEBTACE R
doxorubicin (cont'd) injectable Gastrointestinalhepatic trans-arterial chemoembolization for primary liver cancer or liver metastasis
GIEMBOL INote: only funded when prescribed by specialists at BC Cancer VC &
Royal Jubilee Hospital
doxorubicin (cont'd) injectable Gastrointestinalpalliative therapy for pancreatic endocrine tumours using streptozocin and doxorubicin
GIENDO2 I
* denotes change
BC Cancer Benefit Drug ListJuly 2018
Page 25 of 70
DRUGDOSAGE
FORMTUMOUR
SITEAPPROVED INDICATIONS
PROTOCOL CODES
CLASS NOTES
doxorubicin (cont'd) injectable Gastrointestinalhyperthermic intraperitoneal chemotherapy (HIPEC) for patients with peritoneal mesothelioma using doxorubicin, cisplatin and paclitaxel
GIPMHIPEC I
doxorubicin (cont'd) injectable Genitourinary palliative therapy for advanced adrenal cortical cancer using doxorubicin GUAVD I
doxorubicin (cont'd) injectable Genitourinarytreatment of metastatic adrenalcortical cancer with doxorubicin, etoposide, cisplatin and mitotane
GUEDPM I
doxorubicin (cont'd) injectable Genitourinarytherapy for transitional cell cancers of the urothelium using methotrexate, vinblastine, doxorubicin and cisplatin
GUMVAC I
doxorubicin (cont'd) injectable Gynecology for use in patients with advanced endometrial cancer GOENDD Idoxorubicin (cont'd) injectable Gynecology for use in patients with advanced uterine sarcoma GOSAD Idoxorubicin (cont'd) injectable Head and Neck palliative therapy for advanced thyroid cancers using doxorubicin HNOTAVD I
doxorubicin (cont'd) injectable Head and Neckpalliative therapy for advanced salivary gland cancers using cyclophosphamide, doxorubicin and fluorouracil
HNSAVFAC I
doxorubicin (cont'd) injectable Head and Necktreatment of advanced salivary gland cancers with platinum, doxorubicin and cyclophospahmide
HNSAVPAC I
doxorubicin (cont'd) injectable Lungtreatment of thymoma/thymic carcinoma with cyclophosphamide, doxorubicin and vincristine
LUOTCAV I
doxorubicin (cont'd) injectable Lung treatment of thymoma with platinum, doxorubicin, and cyclophosphamide LUOTPAC I
doxorubicin (cont'd) injectable Lungtreatment of extensive small cell lung cancer with cyclophosphamide, doxorubicin and vincristine
LUSCCAV I
doxorubicin (cont'd) injectable Lymphomatreatment of Hodgkin's disease with doxorubicin, bleomycin, vinblastine and dacarbazine
LYABVD I
doxorubicin (cont'd) injectable Lymphomatreatment of lymphoma with doxorubicin, cyclophosphamide, vincristine and prednisone
LYCHOP I
doxorubicin (cont'd) injectable Lymphomatreatment of lymphoma with doxorubicin, cyclophosphamide, vincristine, prednisone and rituximab
LYCHOPR I
doxorubicin (cont'd) injectable Lymphomacentral nervous system prophylaxis with high dose methotrexate, CHOP and rituximab in diffuse large B-cell lymphoma
LYCHOPRMTX I
doxorubicin (cont'd) injectable Lymphomatreatment of burkitt’s lymphoma and leukemia with cyclophosphamide, vincristine, doxorubicin, methotrexate, leucovorin and rituximab
LYCODOXMR I
doxorubicin (cont'd) injectable Lymphomatreatment of lymphoma with dose-adjusted etoposide, doxorubicin, vincristine, cyclophosphamide, prednisone and rituximab with intrathecal methotrexate
LYEPOCHR I
doxorubicin (cont'd) injectable Lymphoma lymphoma palliative chemotherapy LYPALL I
doxorubicin (cont'd) injectable Sarcomatherapy for advanced soft tissue sarcoma using doxorubicin, ifosfamide-mesna
SAAI I
doxorubicin (cont'd) injectable Sarcomadoxorubicin for adjuvant use for patients with non-metastatic operable large high grade soft tissue sarcoma
SAAJA I
Not reimbursed for bladder instillations
* denotes change
BC Cancer Benefit Drug ListJuly 2018
Page 26 of 70
DRUGDOSAGE
FORMTUMOUR
SITEAPPROVED INDICATIONS
PROTOCOL CODES
CLASS NOTES
doxorubicin (cont'd) injectable Sarcomaadjuvant treatment of patients with soft tissue sarcoma using doxorubicin and dacarbazine
SAAJADIC I
doxorubicin (cont'd) injectable Sarcoma adjuvant therapy for osteosarcoma using doxorubicin and cisplatin SAAJAP I
doxorubicin (cont'd) injectable Sarcoma
SAIME alternating with SAVAC or SAVACM with filgrastim support at a TWO weekly interval for newly diagnosed Ewing's Sarcoma/Ewing’s Family of Tumours, Desmoplastic Intra-Abdominal Small Round Blue Cell Tumour or Rhabdomyosarcoma
SAALT2W I
cyclophosphamide (cont'd) tablet, injectable Sarcoma
SAIME alternating with SAVAC or SAVACM with filgrastim support at a THREE weekly interval for newly diagnosed Ewing's Sarcoma/Ewing’s Family of Tumours, Desmoplastic Intra-Abdominal Small Round Blue Cell Tumour or Rhabdomyosarcoma
SAALT3W I
doxorubicin (cont'd) injectable Sarcoma therapy for advanced soft tissue sarcoma using doxorubicin SAAVA I
doxorubicin (cont'd) injectable Sarcomatreatment of patients with soft tissue sarcoma using doxorubicin and dacarbazine
SAAVADIC I
doxorubicin (cont'd) injectable Sarcoma therapy of advanced osteosarcoma using doxorubicin and cisplatin SAAVAP I
doxorubicin (cont'd) injectable Sarcomatreatment of sarcomas with vincristine, doxorubicin and cyclophosphamide
SAVAC I
doxorubicin (cont'd) injectable Sarcomatreatment of sarcomas with pelvic primaries or chemotherapy induced hematuria using vincristine, doxorubicin, cyclophosphamide and mesna
SAVACM I
doxorubicin (cont'd) injectableNot Otherwise Specified
Other tumour site code followed by ‘NOS’ (e.g. BRNOS)
I
doxorubicin – pegylated liposomaL (CAELYX®)
injectable Gynecology treatment of platinum resistant epithelial ovarian cancer with bevacizumab and pegylated liposomal doxorubicin (CAELYX)
UGOOVBEVLD R
doxorubicin – pegylated liposomaL (CAELYX®)
injectable Gynecologytreatment of epithelial ovarian cancer relapsing after primary treatment using pegylated liposomal doxorubicin (CAELYX)
GOOVLDOX I
doxorubicin – pegylated liposomaL (CAELYX®)
injectable Gynecology treatment of epithelial ovarian cancer relapsing after primary treatment using pegylated liposomal doxorubicin (CAELYX) and carboplatin
GOOVPLDC I
doxorubicin – pegylated liposomaL (CAELYX®)
injectable Kaposi's Sarcoma Kaposi’s sarcoma KSLDO I
drug-eluting bead (DEB) loaded with doxorubicin
other Gastrointestinaltransarterial chemoembolization (TACE) of hepatocellular carcinoma using drug-eluting bead (DEB) loaded with doxorubicin
UGIDEBTACE R
enzalutamide tablet Genitourinarypalliative therapy for metastatic castration resistant prostate cancer using enzalutamide
UGUPENZ R
* denotes change
BC Cancer Benefit Drug ListJuly 2018
Page 27 of 70
DRUGDOSAGE
FORMTUMOUR
SITEAPPROVED INDICATIONS
PROTOCOL CODES
CLASS NOTES
epirubicin injectable Breastadjuvant therapy for breast cancer using fluorouracil, epirubicin and cyclophosphamide
BRAJFEC I
epirubicin injectable Breastadjuvant therapy for breast cancer using fluorouracil, epirubicin and cyclophosphamide and docetaxel
BRAJFECD I
epirubicin (cont'd) injectable Breastadjuvant therapy for breast cancer using fluorouracil, epirubicin and cyclophosphamide followed by docetaxel and trastuzumab (HERCEPTIN)
BRAJFECDT I
epirubicin (cont'd) injectable Breasttherapy for locally advanced breast cancer using cyclophosphamide, epirubicin and fluorouracil
UBRLACEF R
epirubicin (cont'd) injectable Gastrointestinalpalliative therapy for metastatic or locally advanced gastric or esophagogastric cancer using epirubicin, oxaliplatin and capecitabine
GIGAVEOCAP I
epirubicin (cont'd) injectable Gastrointestinalpalliative therapy for metastatic or locally advanced gastric or esophagogastric cancer using epirubicin, oxaliplatin and infusional fluorouracil
GIGAVEOF I
epirubicin (cont'd) injectable Gastrointestinaltreatment of operable cancer of the stomach, stomach-esophagus junction or lower 1/3 esophagus, given before and after surgery, using epirubicin, cisplatin and capecitabine
GIGECC I
epirubicin (cont'd) injectable Genitourinary intravesical use for bladder cancer if BCG and mitomycin C not available GUNOS I
epirubicin (cont'd) injectableNot Otherwise Specified
Other tumour site code followed by ‘NOS’ (e.g. BRNOS)
I
eribulin injectable Breast palliative therapy for metastatic breast cancer using eribulin UBRAVERIB R
erlotinib tablet Lung second or third line treatment of advanced non-small cell lung cancer LUAVERL I
erlotinib tablet Lungmaintenance therapy of advanced non-small cell lung cancer after first-line chemotherapy
LUAVMTNE I
estramustine capsule Genitourinary hormone-independent prostate cancer GUEMCYT I
etoposidecapsule/ injectable
Neuro-Oncology carboplatin and etoposide in the treatment of recurrent ependymoma CNCARV I
etoposidecapsule/ injectable
Neuro-Oncologypalliative treatment of patients with recurrent malignant gliomas and ependymoma using low dose etoposide
CNETO I
etoposidecapsule/ injectable
Neuro-Oncologytherapy for recurrent malignant brain tumours using temozolomide and etoposide
CNTMZETO I
etoposidecapsule/ injectable
Gastrointestinalpalliative therapy of neuroendocrine tumours using cisplatin and etoposide
GIPE I
etoposidecapsule/ injectable
Gynecologytherapy of non-dysgerminomatous ovarian germ cell cancer using bleomycin, etoposide and cisplatin
GOBEP I
etoposidecapsule/ injectable
Gynecologytherapy of dysgerminomatous ovarian germ cell cancer using cisplatin and etoposide
GOEP I
* denotes change
BC Cancer Benefit Drug ListJuly 2018
Page 28 of 70
DRUGDOSAGE
FORMTUMOUR
SITEAPPROVED INDICATIONS
PROTOCOL CODES
CLASS NOTES
etoposidecapsule/ injectable
Gynecologytreatment of relapsed/progressing epithelial ovarian, primary peritoneal, or fallopian tube carcinoma using etoposide
GOOVETO I
etoposidecapsule/ injectable
Gynecologytreatment of small cell or neuroendocrine carcinoma of gynecologic system origin using paclitaxel, cisplatin, etoposide and carboplatin with radiation
GOSMCCRT I
etoposide (cont'd)capsule/ injectable
Gynecologytherapy for high-risk Gestational Trophoblastic Neoplasia (GTN) using etoposide, methotrexate, leucovorin (folinic acid), dactinomycin, cyclophosphamide and vincristine
GOTDEMACO I
etoposide (cont'd)capsule/ injectable
Genitourinarycurative therapy for germ cell cancer using bleomycin, etoposide and cisplatin
GUBEP I
etoposide (cont'd)capsule/ injectable
Genitourinarytreatment of metastatic adrenalcortical cancer with doxorubicin, etoposide, cisplatin and mitotane
GUEDPM I
etoposidecapsule/ injectable
Genitourinary therapy for nonseminoma germ cell cancer using etoposide-cisplatin GUEP I
etoposide (cont'd)capsule/ injectable
Genitourinary therapy of genitourinary small cell tumours with a platin and etoposide GUSCPE I
etoposide (cont'd)capsule/ injectable
Genitourinarytherapy of genitourinary small cell tumors with a platin and etoposide with radiation
GUSCPERT I
etoposidecapsule/ injectable
Genitourinarynonseminoma consolidation/salvage protocol using etoposide, cisplatin, ifosfamide, mesna
GUVIP2 I
etoposide (cont'd)capsule/ injectable
Head and Necktreatment of recurrent and metastatic squamous cell cancer with platinum and etoposide
HNAVPE I
etoposide (cont'd)capsule/ injectable
Head and Necktreatment of recurrent and/or metastatic nasopharyngeal cancer with platinum and etoposide
HNNAVPE I
etoposide (cont'd)capsule/ injectable
Lungtreatment of locally advanced non-small cell lung cancer using cisplatin and etoposide with radiation
LULAPERT I
etoposide (cont'd)capsule/ injectable
Lungtreatment of locally advanced non-small cell lung cancer using alternative dosing of cisplatin and etoposide with radiation therapy
LULAPE2RT I
etoposide (cont'd)capsule/ injectable
Lung treatment of thymoma with cisplatin and etoposide LUOTPE I
etoposide (cont'd)capsule/ injectable
Lung treatment of thymoma using cisplatin and etoposide with radiation therapy LUOTPERT I
etoposide (cont'd)capsule/ injectable
Lungtreatment of cancer of unknown primary involving the thorax with cisplatin and etoposide
LUPUPE I
etoposide (cont'd)capsule/ injectable
Lungtherapy of extensive stage small cell lung cancer with cisplatin and etoposide
LUSCPE I
etoposide (cont'd)capsule/ injectable
Lungtherapy of limited stage small cell lung cancer using cisplatin and etoposide with radiation
LUSCPERT I
etoposide (cont'd)capsule/ injectable
Lungpalliative therapy of extensive stage small cell lung cancer with oral etoposide
LUSCPOE I
etoposide (cont'd)capsule/ injectable
Lymphomatreatment of hemophagocytic lymphohistiocytosis with etoposide, dexamethasone and cycloSPORINE
HLHETCSPA I
* denotes change
BC Cancer Benefit Drug ListJuly 2018
Page 29 of 70
DRUGDOSAGE
FORMTUMOUR
SITEAPPROVED INDICATIONS
PROTOCOL CODES
CLASS NOTES
etoposide (cont'd)capsule/ injectable
Lymphomatreatment of lymphoma with dose-adjusted etoposide, doxorubicin, vincristine, cyclophosphamide, prednisone and rituximab with intrathecal methotrexate
LYEPOCHR I
etoposide (cont'd)capsule/ injectable
Lymphomatreatment of burkitt’s lymphoma and leukemia with ifosfamide, mesna, etoposide, cytarabine and rituximab
LYIVACR I
etoposide (cont'd)capsule/ injectable
Lymphoma lymphoma palliative chemotherapy LYPALL I
etoposide (cont'd)capsule/ injectable
Lymphomatreatment of advanced stage Large B-Cell Non-Hodgkin’s Lymphoma with ifosfamide, carboplatin, etoposide and rituximab
ULYRICE R
etoposide (cont'd)capsule/ injectable
Lymphomatreatment of natural killer or T-cell lymphoma using dexamethasone, methotrexate, ifosfamide, asparaginase and etoposide
LYSMILE I
etoposide (cont'd)capsule/ injectable
Lymphomatreatment of newly diagnosed nasal, extranodal natural killer (NK) or T-cell lymphoma, stage IE to IIE using concurrent radiation and weekly cisplatin followed by etoposide, ifosfamide, cisplatin and dexamethasone
LYVIPDRT I
etoposide (cont'd)capsule/ injectable
Sarcoma
SAIME alternating with SAVAC or SAVACM with filgrastim support at a TWO weekly interval for newly diagnosed Ewing's Sarcoma/Ewing’s Family of Tumours, Desmoplastic Intra-Abdominal Small Round Blue Cell Tumour or Rhabdomyosarcoma
SAALT2W I
etoposide (cont'd)capsule/ injectable
SAIME alternating with SAVAC or SAVACM with filgrastim support at a THREE weekly interval for newly diagnosed Ewing's Sarcoma/Ewing’s Family of Tumours, Desmoplastic Intra-Abdominal Small Round Blue Cell Tumour or Rhabdomyosarcoma
SAALT3W I
etoposide (cont'd)capsule/ injectable
Sarcoma3-Day etoposide & ifosfamide-mesna for patients with advanced soft tissue or bony sarcomas
SAAVIME3 I
etoposide (cont'd)capsule/ injectable
Sarcoma etoposide, ifosfamide-mesna (SAIME) for use in sarcomas SAIME I
etoposide (cont'd)capsule/ injectable
Skin & Melanomatreatment of recurrent or metastatic Merkel cell carcinoma with cisplatin and etoposide
SMMCCPE I
etoposide (cont'd)capsule/ injectable
Not Otherwise Specified
Other tumour site code followed by ‘NOS’ (e.g. HNNOS)
I
everolimus tablet Breast therapy for advanced breast cancer using everolimus and exemestane BRAVEVEX I
everolimus tablet Gastrointestinaltreatment of advanced neuroendocrine tumours of gastrointestinal origin (non-functional) using everolimus
UGINETEV R
everolimus tablet Gastrointestinal palliative treatment of advanced pancreatic neuroendocrine tumours UGIPNEVER R
everolimus tablet Genitourinary therapy for advanced renal cancer using everolimus GUEVER I
everolimus tablet Lungtreatment of advanced neuroendocrine tumours of lung origin (non-functional) using everolimus
ULUNETEV R
Note: AFINITOR® DISPERZTM
formulation not funded
* denotes change
BC Cancer Benefit Drug ListJuly 2018
Page 30 of 70
DRUGDOSAGE
FORMTUMOUR
SITEAPPROVED INDICATIONS
PROTOCOL CODES
CLASS NOTES
exemestane tablet Breastneoadjuvant or adjuvant therapy for breast cancer using exemestane in postmenopausal women
BRAJEXE I
exemestane tablet Breastadjuvant ovarian suppression and aromatase inhibitor in premenopausal women with high-risk early stage breast cancer
BRAJLHRHAI I
exemestane tablet Breast therapy for advanced breast cancer using everolimus and exemestane BRAVEVEX I
exemestane tablet Breastfirst or second line hormonal treatment for advanced breast cancer in postmenopausal women
BRAVEXE I
exemestane (cont'd) tablet Breasttherapy for advanced breast cancer using a LHRH agonist and an aromatase inhibitor
BRAVLHRHA I
exemestane (cont'd) tablet Gynecologyhormonal treatment for advanced endometrial cancer in postmenopausal women
GOENDAI I
filgrastim (GRASTOFIL®) injectablefor inpatient administration only - see BC PharmaCare Special Authority Form for indications covered
FILGRASTIM(Note: NEUPOGEN® brand will only be reimbursed for inpatient administration for pediatric use)
fludarabine injectable/ tablet Lymphomatreatment of chronic lymphocytic leukemia (CLL) or prolymphocytic leukemia with fludarabine, cyclophosphamide and rituximab
LYFCR I
fludarabine injectable/ tablet Lymphoma chronic lymphocytic leukemia or low grade lymphoma LYFLU I
fludarabine injectable/ tablet Lymphomacombination with rituximab for treatment of chronic lymphocytic leukemia or prolymphocytic leukemia and relapsed indolent lymphoma
LYFLUDR I
fludarabine injectable/ tablet Pediatric pediatric patients with AML treated on the CCG-2961 study I
fludrocortisone tablet Genitourinarytreatment of metastatic adrenalcortical cancer with doxorubicin, etoposide, cisplatin and mitotane
GUEDPM I
fludrocortisone (cont'd) tablet Genitourinary mineralocorticoid deficiency associated with mitotane use GUMITO I
fluorouracil injectable Breastadjuvant therapy for high-risk breast cancer using cyclophosphamide (oral), methotrexate and fluorouracil
BRAJCMFPO I
fluorouracil (cont'd) injectable Breastadjuvant therapy for breast cancer using fluorouracil, epirubicin and cyclophosphamide
BRAJFEC I
fluorouracil injectable Breastadjuvant therapy for breast cancer using fluorouracil, epirubicin and cyclophosphamide and docetaxel
BRAJFECD I
fluorouracil (cont'd) injectable Breastadjuvant therapy for breast cancer using fluorouracil, epirubicin and cyclophosphamide followed by docetaxel and trastuzumab (HERCEPTIN)
BRAJFECDT I
fluorouracil (cont'd) injectable Breastpalliative therapy for advanced breast cancer using cyclophosphamide, methotrexate and fluorouracil
BRAVCMF I
fluorouracil (cont'd) injectable Breasttherapy for locally advanced breast cancer using cyclophosphamide, epirubicin and fluorouracil
UBRLACEF R
* denotes change
BC Cancer Benefit Drug ListJuly 2018
Page 31 of 70
DRUGDOSAGE
FORMTUMOUR
SITEAPPROVED INDICATIONS
PROTOCOL CODES
CLASS NOTES
fluorouracil (cont'd) injectable Gastrointestinaladjuvant combination chemotherapy for stage III and stage IIB colon cancer using oxaliplatin, fluorouracil and folinic acid (leucovorin)
GIAJFFOX I
fluorouracil (cont'd) injectable Gastrointestinaladjuvant therapy of colon cancer using fluorouracil injection and infusion and leucovorin infusion
GIAJFL I
fluorouracil (cont'd) injectable Gastrointestinalpalliative combination chemotherapy for metastatic colorectal cancer using fluorouracil injection and infusion and folinic acid (leucovorin) infusion
GIAVFL I
fluorouracil (cont'd) injectable Gastrointestinalcombined modality therapy for locally advanced esophageal cancer using oxaliplatin, fluorouracil, leucovorin, and radiation therapy
GIEFFOXRT I
fluorouracil (cont'd) injectable Gastrointestinalcombined modality therapy for locally advanced esophageal cancer using fluorouracil and cisplatin
GIEFUPRT I
fluorouracil (cont'd) injectable Gastrointestinalhepatic trans-arterial chemoembolization for primary liver cancer or liver metastasis
GIEMBOL INote: only funded when prescribed by specialists at BC Cancer VC &
Royal Jubilee Hospital
fluorouracil (cont'd) injectable Gastrointestinalpalliative therapy for pancreatic endocrine tumours using streptozocin and doxorubicin
GIENDO2 I
fluorouracil (cont'd) injectable Gastrointestinalpalliative combination chemotherapy for metastatic colorectal cancer using irinotecan, fluorouracil, folinic acid (leucovorin) and bevacizumab
GIFFIRB I
fluorouracil (cont'd) injectable Gastrointestinalpalliative combination chemotherapy for metastatic colorectal cancer using irinotecan, fluorouracil, leucovorin, and panitumumab
UGIFFIRPAN* R
fluorouracil (cont'd) injectable Gastrointestinalpalliative combination chemotherapy for metastatic colorectal cancer using oxaliplatin, fluorouracil, leucovorin, and bevacizumab
GIFFOXB I
fluorouracil (cont'd) injectable Gastrointestinalpalliative combination chemotherapy for metastatic colorectal cancer using oxaliplatin, fluorouracil, leucovorin, and panitumumab
UGIFFOXPAN R
fluorouracil (cont'd) injectable Gastrointestinalpalliative combination chemotherapy for advanced pancreatic adenocarcinoma using irinotecan, oxaliplatin, fluorouracil and folinic acid (leucovorin)
GIFIRINOX I
fluorouracil (cont'd) injectable Gastrointestinalpalliative combination chemotherapy for metastatic colorectal cancer using irinotecan, fluorouracil and folinic acid (leucovorin)
GIFOLFIRI I
fluorouracil (cont'd) injectable Gastrointestinalpalliative combination chemotherapy for metastatic colorectal cancer using oxaliplatin, fluorouracil and folinic acid (leucovorin)
GIFOLFOX I
fluorouracil (cont'd) injectable Gastrointestinalcombined modality curative therapy for carcinoma of the anal canal using mitomycin, fluorouracil and radiation therapy
GIFUART I
* denotes change
BC Cancer Benefit Drug ListJuly 2018
Page 32 of 70
DRUGDOSAGE
FORMTUMOUR
SITEAPPROVED INDICATIONS
PROTOCOL CODES
CLASS NOTES
fluorouracil (cont'd) injectable Gastrointestinalpalliative chemotherapy for upper gastrointestinal tract cancer (gastric, esophageal, gall bladder carcinoma and cholangiocarcinoma) and metastatic anal cancer using infusional fluorouracil and cisplatin
GIFUC I
fluorouracil (cont'd) injectable Gastrointestinalcombined modality curative therapy for carcinoma of the anal canal using cisplatin, infusional fluorouracil and radiation therapy
GIFUPART I
fluorouracil (cont'd) injectable Gastrointestinaladjuvant chemotherapy of gastric cancer patients with D2 resection (node negative) or ineligible for adjuvant chemoradiation using oxaliplatin, fluorouracil, and leucovorin
GIGAJFFOX I
fluorouracil (cont'd) injectable Gastrointestinalpalliative treatment of metastatic or inoperable, locally advanced gastric or gastroesophageal junction adenocarcinoma using cisplatin, infusional fluorouracil and trastuzumab (HERCEPTIN)
GIGAVCFT I
fluorouracil (cont'd) injectable Gastrointestinalpalliative therapy for metastatic or locally advanced gastric or esophagogastric cancer using epirubicin, oxaliplatin and infusional fluorouracil
GIGAVEOF I
fluorouracil (cont'd) injectable Gastrointestinalperioperative treatment of resectable adenocarcinoma of the stomach, gastroesophageal junction or lower 1/3 esophagus using docetaxel, oxaliplatin, infusional fluorouracil, and leucovorin
UGIGFLODOC R
fluorouracil (cont'd) injectable Gastrointestinalpalliative combination chemotherapy for metastatic gastric or esophageal adenocarcinoma using irinotecan, fluorouracil and folinic acid (leucovorin)
GIGFOLFIRI I
fluorouracil (cont'd) injectable Gastrointestinalhyperthermic intraperitoneal chemotherapy (HIPEC) for patients with peritoneal carcinomatosis from limited advanced colorectal and appendiceal carcinomas using oxaliplatin and fluorouracil
GIHIPEC I
fluorouracil (cont'd) injectable Gastrointestinaladjuvant combination chemotherapy for stage III rectal cancer using oxaliplatin, fluorouracil and folinic acid (leucovorin)
GIRAJFFOX I
fluorouracil (cont'd) injectable Gastrointestinalcombined modality adjuvant therapy for high risk rectal carcinoma using capecitabine, infusional fluorouracil and radiation therapy
GIRINFRT I
fluorouracil (cont'd) injectable Genitourinarycombined modality therapy for squamous cell cancer of the genitourinary system using fluorouracil and cisplatin with radiation
GUFUPRT I
fluorouracil (cont'd) injectable Head and Neckfluorouracil and leucovorin for recurrent head and neck cancer (squamous cell carcinoma)
HNAVFUFA I
fluorouracil (cont'd) injectable Head and Necktreatment of advanced squamous cell carcinoma of the head and neck cancer using fluorouracil and platinum
HNAVFUP I
fluorouracil (cont'd) injectable Head and Neckcombined chemotherapy (carboplatin and fluorouracil) and radiation treatment for locally advanced squamous cell carcinoma of the head and neck
HNLACAFRT I
fluorouracil (cont'd) injectable Head and Necktreatment of locally advanced squamous cell carcinoma of the head and neck with docetaxel, cisplatin and infusional fluorouracil
UHNLADCF R
fluorouracil (cont'd) injectable Head and Neckfluorouracil and leucovorin for recurrent head and neck cancer (nasopharyngeal)
HNNAVFUFA I
fluorouracil (cont'd) injectable Head and Necktreatment for advanced nasopharyngeal cancer of the head and neck using platinum and fluorouracil
HNNAVFUP I
* denotes change
BC Cancer Benefit Drug ListJuly 2018
Page 33 of 70
DRUGDOSAGE
FORMTUMOUR
SITEAPPROVED INDICATIONS
PROTOCOL CODES
CLASS NOTES
fluorouracil (cont'd) injectable Head and Neckpalliative therapy for advanced salivary gland cancers using cyclophosphamide, doxorubicin and fluorouracil
HNSAVFAC I
fluorouracil (cont'd) injectable Head and Necktreatment of advanced head and neck cancer using cisplatin and fluorouracil
HNSAVFUP I
fluorouracil (cont'd) injectableNot Otherwise Specified
Other tumour site code followed by ‘NOS’ (e.g. HNNOS)
I
fluorouracil topical cream Skin & Melanoma skin cancer SMNOS I
flutamide tablet Genitourinary nonsteroidal treatment of prostate cancer GUPNSAA INot reimbursed for vasomotor
symptoms (hot flashes)
gefitinib tablet Lungfirst-line treatment of epidermal growth factor receptor mutation-positive advanced NSCLC
LUAVGEFF I
gemcitabine injectable Breast palliative therapy for metastatic breast cancer using gemcitabine BRAVGEM I
gemcitabine injectable Breastpalliative therapy for metastatic breast cancer using gemcitabine and docetaxel
BRAVGEMD I
gemcitabine (cont'd) injectable Breastas palliative therapy for metastatic breast cancer using cisplatin and gemcitabine
BRAVGEMP I
gemcitabine injectable Breast treatment of metastatic breast cancer using gemcitabine and paclitaxel BRAVGEMT I
gemcitabine (cont'd) injectable Gastrointestinalfirst-line palliative chemotherapy for advanced gallbladder cancer and cholangiocarcinoma using gemcitabine and cisplatin
GIAVPG I
gemcitabine (cont'd) injectable Gastrointestinaladjuvant chemotherapy for resected pancreatic adenocarcinoma using capecitabine and gemcitabine
GIPAJGCAP I
gemcitabine (cont'd) injectable Gastrointestinal adjuvant chemotherapy for pancreatic adenocarcinoma using gemcitabine GIPAJGEM I
gemcitabine injectable Gastrointestinalpalliative chemotherapy for pancreatic adenocarcinoma, gallbladder cancer, and cholangiocarcinoma using gemcitabine
GIPGEM I
gemcitabine (cont'd) injectable Gastrointestinalfirst line treatment of locally advanced and metastatic pancreatic cancer with paclitaxel-nab (ABRAXANE®) and gemcitabine
GIPGEMABR I
gemcitabine injectable Gynecologytreatment of platinum resistant epithelial ovarian cancer with bevacizumab and gemcitabine
UGOOVBEVG R
gemcitabine injectable Gynecologytreatment of advanced ovarian cancer in patients who have progressed or recurred following first-line platinum-based treatment using carboplatin and gemcitabine
GOOVCAG I
gemcitabine injectable Gynecologypalliative chemotherapy for re-treatment of ovarian, tubal, and peritoneal cancer using gemcitabine
GOOVGEM I
gemcitabine (cont'd) injectable Gynecologycombination with docetaxel for advanced or recurrent uterine sarcoma cancer
GOSADG I
gemcitabine (cont'd) injectable Genitourinary adjuvant therapy for urothelial carcinoma using cisplatin and gemcitabine GUAJPG I
gemcitabine (cont'd) injectable Genitourinarycombination with cisplatin for advanced transitional cell carcinoma of the bladder
GUAVPG I
* denotes change
BC Cancer Benefit Drug ListJuly 2018
Page 34 of 70
DRUGDOSAGE
FORMTUMOUR
SITEAPPROVED INDICATIONS
PROTOCOL CODES
CLASS NOTES
gemcitabine (cont'd) injectable Genitourinary combination with cisplatin as neoadjuvant therapy for urothelial carcinoma GUNAJPG I
gemcitabine (cont'd) injectable Genitourinary intravesical use for bladder cancer if BCG and mitomycin C not available GUNOS I
gemcitabine (cont'd) injectable Genitourinarycombination palliative therapy with paclitaxel in patients with relapsed, cisplatin-refractory germ cell cancers not amenable to cure with surgery or chemotherapy (patients relapsed after BMT are potentially eligible)
UGUTAXGEM R
gemcitabine (cont'd) injectable Head and Necktreatment of loco-regionally recurrent and/or metastatic nasopharyngeal cancer with gemcitabine
HNNAVGEM I
gemcitabine (cont'd) injectable Head and Necktreatment of local-regionally recurrent and/or metastatic nasopharyngeal cancer with platinum and gemcitabine
HNNAVPG I
gemcitabine (cont'd) injectable Head and Neckas induction treatment of locally advanced nasopharyngeal cancer with cisplatin and gemcitabine
HNNLAPG I
* denotes change
BC Cancer Benefit Drug ListJuly 2018
Page 35 of 70
DRUGDOSAGE
FORMTUMOUR
SITEAPPROVED INDICATIONS
PROTOCOL CODES
CLASS NOTES
gemcitabine (cont'd) injectable Lungcombination with cisplatin or carboplatin as treatment of advanced non-small cell lung cancer
LUAVPG I
gemcitabine (cont'd) injectable Lung treatment of malignant mesothelioma with platinum and gemcitabine LUMMPG I
gemcitabine (cont'd) injectable Lymphoma treatment of lymphoma with gemcitabine, dexamethasone and cisplatin LYGDP I
gemcitabine (cont'd) injectable Lymphoma in combination with dexamethasone, cisplatin and rituximab for lymphoma LYGDPR I
gemcitabine (cont'd) injectable Lymphoma palliative chemotherapy of lymphomas LYPALL I
gemcitabine (cont'd) injectable Sarcomacombination with docetaxel as second or third line therapy for soft tissue sarcomas
SAAVGEMD I
goserelininjectable/ long acting injectable
Breastadjuvant ovarian suppression and aromatase inhibitor in premenopausal women with high-risk early stage breast cancer
BRAJLHRHAI I
goserelininjectable/ long acting injectable
Breastneoadjuvant or adjuvant therapy for breast cancer using a LHRH agonist and tamoxifen
BRAJLHRHT I
goserelin (cont'd)injectable/ long acting injectable
Breasttherapy for advanced breast cancer using a LHRH agonist and an aromatase inhibitor
BRAVLHRHA I
goserelin (cont'd)injectable/ long acting injectable
Breastcombination therapy with tamoxifen palliative therapy for metastatic breast cancer
BRAVLHRHT I
goserelin (cont'd)injectable/ long acting injectable
Genitourinary therapy for prostate cancer using LHRH agonist GUPLHRH I
hydrocortisone tablet, injectable Lymphomatreatment of hemophagocytic lymphohistiocytosis with etoposide, dexamethasone and cycloSPORINE
HLHETCSPA I
hydrocortisone (cont'd) tablet, injectableNot Otherwise Specified
Other tumour site code followed by ‘NOS’ (e.g. LYNOS)
I
hydroxyurea capsule Leukemia
Myeloid neoplasms, including but not limited to: Acute myeloid leukemia, Myelodysplastic syndromes (e.g. Refractory anemia), Myeloproliferative disease (e.g. Chronic myeloid leukemia, Polycythemia, Essential thrombocythemia)
LKNOS I
hydroxyurea capsule LymphomaLymphoid neoplasms, including but not limited to: Lymphoproliferative disease, Myeloma
LYNOS I
ibritumomab 90Y (ZEVALIN®)
injectable LymphomaPalliative therapy for lymphoma using radioimmunotherapy: rituximab-priming for ibritumomab 90Y (ZEVALIN®) ULYRITZ R
ibrutinib capsule Lymphomatreatment of previously untreated chronic lymphocytic leukemia or small lymphocytic lymphoma with chromosome 17p deletion
ULYFIBRU R
Not reimbursed for endometriosis
Not reimbursed for supportive care
* denotes change
BC Cancer Benefit Drug ListJuly 2018
Page 36 of 70
DRUGDOSAGE
FORMTUMOUR
SITEAPPROVED INDICATIONS
PROTOCOL CODES
CLASS NOTES
ibrutinib capsule Lymphomatreatment of relapsed or refractory chronic lymphocytic leukemia or small lymphocytic lymphoma
ULYIBRU R
ibrutinib capsule Lymphoma treatment of relapsed/refractory mantle-cell lymphoma using ibrutinib ULYMIBRU R
idarubicin injectableNot Otherwise Specified
Tumour site code followed by ‘NOS’ (e.g. BRNOS)
I
* denotes change
BC Cancer Benefit Drug ListJuly 2018
Page 37 of 70
DRUGDOSAGE
FORMTUMOUR
SITEAPPROVED INDICATIONS
PROTOCOL CODES
CLASS NOTES
idelalisib tablet Lymphomatreatment of relapsed/refractory chronic lymphocytic leukemia or small lymphocytic lymphoma using idelalisib and rituximab
ULYIDELAR R
ifosfamide injectable Genitourinarytherapy for relapsed testicular germ cell cancer using paclitaxel, lfosfamide and cisplatin
UGUTIP R
ifosfamide injectable Genitourinaryconsolidation/ salvage treatment for germ cell cancer using vinblastine, cisplatin, ifosfamide and mesna
GUVEIP I
ifosfamide injectable Genitourinarynonseminoma consolidation/salvage protocol using etoposide, cisplatin, ifosfamide, mesna
GUVIP2 I
ifosfamide (cont'd) injectable Lymphomatreatment of burkitt’s lymphoma and leukemia with ifosfamide, mesna, etoposide, cytarabine and rituximab
LYIVACR I
ifosfamide (cont'd) injectable Lymphomatreatment of advanced stage Large B-Cell Non-Hodgkin’s Lymphoma with ifosfamide, carboplatin, etoposide and rituximab
ULYRICE R
ifosfamide (cont'd) injectable Lymphomatreatment of natural killer or T-cell lymphoma using dexamethasone, methotrexate, ifosfamide, asparaginase and etoposide
LYSMILE I
ifosfamide (cont'd) injectable Lymphomatreatment of newly diagnosed nasal, extranodal natural killer (NK) or T-cell lymphoma, stage IE to IIE using concurrent radiation and weekly cisplatin followed by etoposide, ifosfamide, cisplatin and dexamethasone
LYVIPDRT I
ifosfamide injectable Sarcomatherapy for advanced soft tissue sarcoma using doxorubicin, ifosfamide-mesna
SAAI I
ifosfamide (cont'd) injectable Sarcoma
SAIME alternating with SAVAC or SAVACM with filgrastim support at a TWO weekly interval for newly diagnosed Ewing's Sarcoma/Ewing’s Family of Tumours, Desmoplastic Intra-Abdominal Small Round Blue Cell Tumour or Rhabdomyosarcoma
SAALT2W I
ifosfamide (cont'd) injectable Sarcoma
SAIME alternating with SAVAC or SAVACM with filgrastim support at a THREE weekly interval for newly diagnosed Ewing's Sarcoma/Ewing’s Family of Tumours, Desmoplastic Intra-Abdominal Small Round Blue Cell Tumour or Rhabdomyosarcoma
SAALT3W I
ifosfamide injectable Sarcoma therapy for advanced soft tissue sarcoma using ifosfamide SAAVI I
ifosfamide injectable Sarcoma3-Day etoposide & ifosfamide-mesna for patients with advanced soft tissue or bony sarcomas
SAAVIME3 I
ifosfamide injectable Sarcoma etoposide, ifosfamide-mesna (SAIME) for use in sarcomas SAIME I
ifosfamide (cont'd) injectableNot Otherwise Specified
Other tumour site code followed by ‘NOS’ (e.g. LYNOS)
I
* denotes change
BC Cancer Benefit Drug ListJuly 2018
Page 38 of 70
DRUGDOSAGE
FORMTUMOUR
SITEAPPROVED INDICATIONS
PROTOCOL CODES
CLASS NOTES
imatinib capsule/tablet Leukemiatherapy for chronic myeloid leukemia and Ph+ acute lymphoblastic leukemia
LKCMLI I
imatinib capsule/tablet Pediatricpediatric patients with Philadelphia chromosome positive acute lymphoblastic leukemia
I
imatinib capsule/tablet Sarcomaadjuvant therapy of C-Kit positive high risk gastrointestinal stromal cell tumours
SAAJGI I
imatinib capsule/tablet Sarcomaadvanced c-kit positive and c-kit negative gastrointestinal stromal cell tumours
SAAVGI I
capsule/tablet Sarcomaadvanced c-kit positive gastrointestinal stromal cell tumors using 800 mg dosing of imatinib
SAAVGIDD I
capsule/tablet Skin & Melanoma treatment of advanced c-kit melanoma using imatinib USMAVI R
imiquimod topical cream Skin & Melanomatopical immunotherapy for in-transit melanoma metastases, cutaneous lymphoma, basal cell carcinoma using imiquimod SMIMI I
interferon alfa injectable Genitourinarypalliative therapy for BCG-refractory superficial high-grade transitional cell carcinoma bladder with BCG and interferon bladder cancer
GUBCGIFN I
interferon alfa injectable Genitourinarymetastatic renal cell carcinoma in patients with the following characteristics: performance status 0-1; disease evaluable for response
GUKIFN I
interferon alfa injectable Leukemia LKNOS Iinterferon alfa injectable Lymphoma lymphoma palliative therapy LYPALL Iinterferon alfa (cont'd) injectable Lymphoma LYNOS Iinterferon alfa injectable Myeloma MYNOS I
interferon alfa injectable Skin & Melanomaadjuvant therapy of melanoma patients with palpable lymph nodes or fully resected recurrent disease in lymph nodes
SMAJIFN I
interferon alfa injectable Skin & Melanoma basal cell carcinoma SMNOS Iinterferon alfa eyedrops Ocular topical therapy for ocular malignancies OCIFN I
ipilimumab injectable Skin & Melanomafirst-line treatment of unresectable or metastatic melanoma using ipilimumab
USMAVFIPI R
ipilimumab injectable Skin & Melanomatreatment of advanced and metastatic melanoma after prior systemic therapy
USMAVIPI R
irinotecan injectable Gastrointestinalpalliative third line treatment of metastatic colorectal cancer with wild-type KRAS using cetuximab and irinotecan
GIAVCETIR I
irinotecan (cont'd) injectable Gastrointestinalpalliative combination chemotherapy for metastatic colorectal cancer using irinotecan and capecitabine in patients unsuitable for GIFOLFIRI
GICAPIRI I
irinotecan injectable Gastrointestinalpalliative combination chemotherapy for metastatic colorectal cancer using irinotecan, bevacizumab and capecitabine
GICIRB I
irinotecan injectable Gastrointestinalpalliative combination chemotherapy for metastatic colorectal cancer using irinotecan, fluorouracil, folinic acid (leucovorin) and bevacizumab
GIFFIRB I
Not reimbursed for hepatitis, Kaposi’s Sarcoma
* denotes change
BC Cancer Benefit Drug ListJuly 2018
Page 39 of 70
DRUGDOSAGE
FORMTUMOUR
SITEAPPROVED INDICATIONS
PROTOCOL CODES
CLASS NOTES
irinotecan injectable Gastrointestinalpalliative combination chemotherapy for metastatic colorectal cancer using irinotecan, fluorouracil, leucovorin, and panitumumab
UGIFFIRPAN* R
* denotes change
BC Cancer Benefit Drug ListJuly 2018
Page 40 of 70
DRUGDOSAGE
FORMTUMOUR
SITEAPPROVED INDICATIONS
PROTOCOL CODES
CLASS NOTES
irinotecan (cont'd) injectable Gastrointestinalpalliative combination chemotherapy for advanced pancreatic adenocarcinoma using irinotecan, oxaliplatin, fluorouracil and folinic acid (leucovorin)
GIFIRINOX I
irinotecan (cont'd) injectable Gastrointestinalpalliative combination chemotherapy for metastatic colorectal cancer using irinotecan, fluorouracil and folinic acid (leucovorin)
GIFOLFIRI I
irinotecan (cont'd) injectable Gastrointestinalsecond line palliative combination chemotherapy for metastatic gastric or esophageal adenocarcinoma using irinotecan, fluorouracil and folinic acid (leucovorin)
GIGFOLFIRI I
irinotecan injectable Gastrointestinal palliative chemotherapy for metastatic colorectal cancer using irinotecan GIIR I
irinotecan injectable Gastrointestinalpalliative therapy for metastatic colorectal cancer in patients who may not tolerate the 3-weekly irinotecan schedule of GIIR
GIIRINALT I
irinotecan injectable Lungsecond line treatment of extensive stage small cell lung cancer (SCLC) with irinotecan with or without platinum
LUSCPI I
irinotecan (cont'd) injectable Pediatricpediatric patients treated on the COG protocol ARST0531 for intermediate-risk rhabdomyosarcoma
I
irinotecan (cont'd) injectable Pediatricpediatric patients with recurrent pediatric neuroblastoma treated on the COG protocol ANBL0421
I
irinotecan (cont'd) injectable Pediatricpediatric patients with high risk renal tumors treated on the COG protocol AREN0321
I
irinotecan (cont'd) injectable Pediatricpediatric patients with high risk rhabdomyosarcoma treated on the COG protocol ARSTO431
I
irinotecan (cont'd) injectable Pediatricpediatric patients with rhabdomyosarcoma treated on the COG ARST08P1 protocol
I
irinotecan (cont'd) injectable Pediatricpediatric patients with recurrent/refractory medulloblastomas/CNS PNET of childhood treated on the COG ACNS0821 protocol
I
isotretinoin (ACCUTANE) capsule Pediatric pediatric patients with high risk neuroblastoma I
isotretinoin (ACCUTANE™) capsule Pediatricpediatric patients treated on the COG protocol ACNS0332 for above average risk medulloblastoma/PNE
I
lanreotide injectable Neuro-Oncology treatment of growth hormone secreting pituitary adenoma using lanreotide CNLAN I
lanreotide (cont'd) injectable Gastrointestinalsymptomatic management of functional carcinoid and neuroendocrine tumours of the GI Tract using lanreotide
UGILAN R
lapatinib tablet Breast
combination with lapatinib in advanced breast cancer patients with HER-2 expressing breast cancer whose cancer has progressed on one prior therapy with trastuzumab (HERCEPTIN)-based protocol in the advanced setting or who has relapsed on or within 12 months of adjuvant trastuzumab (HERCEPTIN)
UBRAVLCAP R
lenalidomide capsule Leukemia therapy of myelodysplastic syndrome using lenalidomide ULKMDSL R
lenalidomide capsule Myelomatherapy of multiple myeloma using carfilzomib, lenalidomide with dexamethasone
UMYCARLD R
* denotes change
BC Cancer Benefit Drug ListJuly 2018
Page 41 of 70
DRUGDOSAGE
FORMTUMOUR
SITEAPPROVED INDICATIONS
PROTOCOL CODES
CLASS NOTES
lenalidomide capsule Myelomatreatment of previously untreated multiple myeloma and not eligible for stem cell transplant using lenalidomide with low-dose dexamethasone
UMYLDF R
* denotes change
BC Cancer Benefit Drug ListJuly 2018
Page 42 of 70
DRUGDOSAGE
FORMTUMOUR
SITEAPPROVED INDICATIONS
PROTOCOL CODES
CLASS NOTES
lenalidomide (cont'd) capsule Myelomatherapy of relapsed multiple myeloma using lenalidomide with dexamethasone
UMYLDREL R
lenalidomide capsule Myeloma maintenance therapy of multiple myeloma using lenalidomide UMYLENMTN R
lenvatinib capsule Head and Necktherapy for locally recurrent or metastatic, RAI-refractory differentiated thyroid cancer using lenvatinib UHNOTLEN R
letrozole tablet Breastneoadjuvant or adjuvant therapy for breast cancer using letrozole in postmenopausal women
BRAJLET I
letrozole (cont'd) tablet Breastadjuvant ovarian suppression and aromatase inhibitor in premenopausal women with high-risk early stage breast cancer
BRAJLHRHAI I
letrozole tablet Breastfirst or second line hormonal treatment for advanced breast cancer in postmenopausal women
BRAVLET I
letrozole tablet Breasttherapy for advanced breast cancer using a LHRH agonist and an aromatase inhibitor
BRAVLHRHA I
letrozole tablet Breasttherapy of advanced breast cancer using palbociclib with aromatase inhibitor
UBRAVPALAI R
letrozole tablet Gynecologyhormonal treatment for advanced endometrial cancer in postmenopausal women with contraindications to tamoxifen or intolerant of tamoxifen
GOENDAI I
letrozole tablet Gynecologyhormonal treatment for advanced ovarian cancer in postmenopausal women
GOOVAI I
leucovorin calcium tablet, injectable Gastrointestinaladjuvant combination chemotherapy for Stage III and Stage IIB colon cancer using oxaliplatin, fluorouracil and folinic acid (Leucovorin)
GIAJFFOX I
leucovorin calcium tablet, injectable Gastrointestinaladjuvant therapy of colon cancer using fluorouracil injection and infusion and leucovorin infusion
GIAJFL I
leucovorin calcium (cont'd) tablet, injectable Gastrointestinalpalliative combination chemotherapy for metastatic colorectal cancer using fluorouracil injection and infusion and folinic acid (leucovorin) infusion
GIAVFL I
leucovorin calcium (cont'd) tablet, injectable Gastrointestinalcombined modality therapy for locally advanced esophageal cancer using oxaliplatin, fluorouracil, leucovorin, and radiation therapy
GIEFFOXRT I
leucovorin calcium (cont'd) tablet, injectable Gastrointestinalpalliative combination chemotherapy for metastatic colorectal cancer using irinotecan, fluorouracil, folinic acid (leucovorin) and bevacizumab
GIFFIRB I
leucovorin calcium (cont'd) injectable Gastrointestinalpalliative combination chemotherapy for metastatic colorectal cancer using irinotecan, fluorouracil, leucovorin, and panitumumab
UGIFFIRPAN* R
leucovorin calcium (cont'd) tablet, injectable Gastrointestinalpalliative combination chemotherapy for metastatic colorectal cancer using oxaliplatin, fluorouracil, leucovorin, and bevacizumab
GIFFOXB I
leucovorin calcium (cont'd) tablet, injectable Gastrointestinalpalliative combination chemotherapy for metastatic colorectal cancer using oxaliplatin, fluorouracil, leucovorin, and panitumumab
UGIFFOXPAN R
* denotes change
BC Cancer Benefit Drug ListJuly 2018
Page 43 of 70
DRUGDOSAGE
FORMTUMOUR
SITEAPPROVED INDICATIONS
PROTOCOL CODES
CLASS NOTES
leucovorin calcium tablet, injectable Gastrointestinalpalliative combination chemotherapy for advanced pancreatic adenocarcinoma using irinotecan, oxaliplatin, fluorouracil and folinic acid (leucovorin)
GIFIRINOX I
leucovorin calcium tablet, injectable Gastrointestinalpalliative combination chemotherapy for metastatic colorectal cancer using irinotecan, fluorouracil and folinic acid (leucovorin)
GIFOLFIRI I
* denotes change
BC Cancer Benefit Drug ListJuly 2018
Page 44 of 70
DRUGDOSAGE
FORMTUMOUR
SITEAPPROVED INDICATIONS
PROTOCOL CODES
CLASS NOTES
leucovorin calcium (cont'd) tablet, injectable Gastrointestinalpalliative combination chemotherapy for metastatic colorectal cancer using oxaliplatin, fluorouracil and folinic acid (leucovorin)
GIFOLFOX I
leucovorin calcium (cont'd) tablet, injectable Gastrointestinaladjuvant chemotherapy of gastric cancer patients with D2 resection (node negative) or ineligible for adjuvant chemoradiation using oxaliplatin, fluorouracil, and leucovorin
GIGAJFFOX I
leucovorin calcium (cont'd) tablet, injectable Gastrointestinalperioperative treatment of resectable adenocarcinoma of the stomach, gastroesophageal junction or lower 1/3 esophagus using docetaxel, oxaliplatin, infusional fluorouracil, and leucovorin
UGIGFLODOC R
leucovorin calcium (cont'd) tablet, injectable Gastrointestinalpalliative combination chemotherapy for metastatic gastric or esophageal adenocarcinoma using irinotecan, fluorouracil and folinic acid (leucovorin)
GIGFOLFIRI I
leucovorin calcium (cont'd) tablet, injectable Gastrointestinaladjuvant combination chemotherapy for stage III rectal cancer using oxaliplatin, fluorouracil and folinic acid (leucovorin)
GIRAJFFOX I
leucovorin calcium (cont'd) tablet, injectable Gynecologytherapy for high-risk Gestational Trophoblastic Neoplasia (GTN) using etoposide, methotrexate, leucovorin (folinic acid), dactinomycin, cyclophosphamide and vincristine
GOTDEMACO I
leucovorin calcium (cont'd) tablet, injectable Gynecologytherapy for low risk gestational trophoblastic neoplasia using methotrexate, leucovorin and actinomycin-D
GOTDLR I
leucovorin calcium (cont'd) tablet, injectable Head and Neckfluorouracil and leucovorin for recurrent head and neck cancer (squamous cell carcinoma)
HNAVFUFA I
leucovorin calcium (cont'd) tablet, injectable Head and Neckfluorouracil and leucovorin for recurrent head and neck cancer (nasopharyngeal)
HNNAVFUFA I
leucovorin calcium (cont'd) tablet, injectable Lymphomacentral nervous system prophylaxis with high dose methotrexate, CHOP and rituximab in diffuse large B-cell lymphoma
LYCHOPRMTX I
leucovorin calcium (cont'd) tablet, injectable Lymphomatreatment of Burkitt’s Lymphoma and Leukemia with cyclophosphamide, vincristine, doxorubicin, methotrexate, leucovorin and rituximab
LYCODOXMR I
leucovorin calcium (cont'd) tablet, injectable Lymphomatreatment of Primary Intracerebral Lymphoma with high dose methotrexate and rituximab
LYHDMRP I
leucovorin calcium (cont'd) tablet, injectable Lymphomatreatment of Primary Intracerebral Lymphoma with high dose methotrexate
LYHDMTXP I
leucovorin calcium (cont'd) tablet, injectable Lymphomatreatment of Leptomeningeal Lymphoma or recurrent Intracerebral Lymphoma with high dose methotrexate
LYHDMTXR I
leucovorin calcium (cont'd) tablet, injectable Miscellaneous Origins meningeal disease using high dose methotrexate with leucovorin rescue MOHDMTX I
leucovorin calcium (cont'd) tablet, injectable Sarcomatreatment of osteosarcoma using high dose methotrexate with leucovorin rescue
SAHDMTX I
leucovorin calcium (cont'd) tablet, injectableNot Otherwise Specified
Other tumour site code followed by ‘NOS’ (e.g. LYNOS)
I
* denotes change
BC Cancer Benefit Drug ListJuly 2018
Page 45 of 70
DRUGDOSAGE
FORMTUMOUR
SITEAPPROVED INDICATIONS
PROTOCOL CODES
CLASS NOTES
leuprolide injectable, long acting injectable
Breastadjuvant ovarian suppression and aromatase inhibitor in premenopausal women with high-risk early stage breast cancer
BRAJLHRHAI I
leuprolide injectable, long acting injectable
Breastneoadjuvant or adjuvant therapy for breast cancer using a LHRH agonist and tamoxifen
BRAJLHRHT I
leuprolide (cont'd)injectable, long acting injectable
Breasttherapy for advanced breast cancer using a LHRH agonist and an aromatase inhibitor
BRAVLHRHA I
leuprolide injectable, long acting injectable
Breastcombination therapy with tamoxifen palliative therapy for metastatic breast cancer
BRAVLHRHT I
leuprolide injectable, long acting injectable
Genitourinary therapy for prostate cancer using LHRH agonist GUPLHRH I
lomustine capsule Neuro-Oncology lomustine for treatment of recurrent malignant brain tumors CNCCNU I
lomustine capsule Neuro-Oncologyadjuvant lomustine, cisplatin and vincristine in adult high-risk medulloblastoma or other primitive neuroectodermal tumour
CNCCV I
lomustine (cont'd) capsule Neuro-Oncologymodified PCV chemotherapy of brain tumours using procarbazine, lomustine and vincristine
CNMODPCV I
lomustine (cont'd) capsule Lymphoma lymphoma palliative chemotherapy LYPALL I
lomustine capsule Skin & Melanoma second line treatment for metastatic malignant melanoma using lomustine SMCCNU I
lomustine (cont'd) capsuleNot Otherwise Specified
Other tumour site code followed by ‘NOS’ (e.g. CNNOS)
I
mechlorethamine injectableNot Otherwise Specified
Tumour site code followed by ‘NOS’ (e.g. LUNOS)
I
medroxyprogesterone tablet Gynecology non-aromatase inhibitor hormonal treatment of endometrial cancer GOENDH INot reimbursed for appetite stimulation or replacement
therapy.megestrol tablet Breast breast cancer BRAVMEG Imegestrol tablet Gynecology non-aromatase inhibitor hormonal treatment of endometrial cancer GOENDH I
melphalan tablet, injectable BMTconditioning therapy for autologous stem cell transplant using high dose melphalan in the treatment of multiple myeloma
BMTMM0301 I
melphalan tablet, injectable Myeloma treatment of multiple myeloma using melphalan and prednisone MYMP I
melphalan tablet, injectable Myelomatreatment of multiple myeloma using melphalan, prednisone and weekly bortezomib with the option of substituting cyclophosphamide for melphalan
MYMPBOR I
Not reimbursed for appetite stimulation or symptom
Leuprolide acetate IM (LUPRON®) and SC (ELIGARD®) injectables are both reimbursable
for prostate cancer indications (GUPLHRH). Not reimbursed for
endometriosis.
* denotes change
BC Cancer Benefit Drug ListJuly 2018
Page 46 of 70
DRUGDOSAGE
FORMTUMOUR
SITEAPPROVED INDICATIONS
PROTOCOL CODES
CLASS NOTES
melphalan tablet, injectableNot Otherwise Specified
Other tumour site code followed by ‘NOS’ (e.g. LKNOS)
I
6-mercaptopurine tabletNot Otherwise Specified
Tumour site code followed by ‘NOS’ (e.g. LKNOS)
I
* denotes change
BC Cancer Benefit Drug ListJuly 2018
Page 47 of 70
DRUGDOSAGE
FORMTUMOUR
SITEAPPROVED INDICATIONS
PROTOCOL CODES
CLASS NOTES
mesna injectable Genitourinaryconsolidation/ salvage treatment for germ cell cancer using vinblastine, cisplatin, ifosfamide and mesna
GUVEIP I
mesna injectable Genitourinarynonseminoma consolidation/salvage protocol using etoposide, cisplatin, ifosfamide, mesna
GUVIP2 I
mesna (cont'd) injectable LymphomaTreatment of Burkitt’s lymphoma and leukemia with ifosfamide, mesna, etoposide, cytarabine and rituximab
LYIVACR I
mesna injectable Sarcomatherapy for advanced soft tissue sarcoma using doxorubicin, ifosfamide-mesna
SAAI I
mesna (cont'd) injectable Sarcoma
SAIME alternating with SAVAC or SAVACM with filgrastim support at a TWO weekly interval for newly diagnosed Ewing's Sarcoma/Ewing’s Family of Tumours, Desmoplastic Intra-Abdominal Small Round Blue Cell Tumour or Rhabdomyosarcoma
SAALT2W I
mesna (cont'd) injectable Sarcoma
SAIME alternating with SAVAC or SAVACM with filgrastim support at a THREE weekly interval for newly diagnosed Ewing's Sarcoma/Ewing’s Family of Tumours, Desmoplastic Intra-Abdominal Small Round Blue Cell Tumour or Rhabdomyosarcoma
SAALT3W I
mesna (cont'd) injectable Sarcoma therapy for advanced soft tissue sarcoma using ifosfamide SAAVI I
mesna injectable Sarcoma3-Day etoposide & ifosfamide-mesna for patients with advanced soft tissue or bony sarcomas
SAAVIME3 I
mesna (cont'd) injectable Sarcoma etoposide, ifosfamide-mesna (SAIME) for use in sarcomas SAIME I
mesna (cont'd) injectable Sarcomatreatment of sarcomas with pelvic primaries or chemotherapy induced hematuria using vincristine, doxorubicin, cyclophosphamide and mesna
SAVACM I
mesna (cont'd) injectable Sarcomaadjuvant therapy for rhabdomyosarcoma using vincristine, dactinomycin, cyclophosphamide and mesna
SAVDCM I
mesna (cont'd) injectable Supportive Caremesna dosage modification for hematuria secondary to oxazaphosphorines
SCMESNA I
mesna (cont'd) injectableNot Otherwise Specified
Other tumour site code followed by ‘NOS’ (e.g. SANOS)
I
methotrexate tablet, injectable Breastadjuvant therapy for high-risk breast cancer using cyclophosphamide (oral), methotrexate and fluorouracil
BRAJCMFPO I
methotrexate (cont'd) tablet, injectable Breastpalliative therapy for advanced breast cancer using cyclophosphamide, methotrexate and fluorouracil
BRAVCMF I
methotrexate tablet, injectable Gynecologytherapy for high-risk Gestational Trophoblastic Neoplasia (GTN) using etoposide, methotrexate, leucovorin (folinic acid), dactinomycin, cyclophosphamide and vincristine
GOTDEMACO I
Approved for use ONLY as an uro-protector for ifosfamide or high
dose cyclophosphamide
Not reimbursed for rheumatoid arthritis, psoriasis.
* denotes change
BC Cancer Benefit Drug ListJuly 2018
Page 48 of 70
DRUGDOSAGE
FORMTUMOUR
SITEAPPROVED INDICATIONS
PROTOCOL CODES
CLASS NOTES
methotrexate (cont'd) tablet, injectable Gynecologytherapy for low risk gestational trophoblastic neoplasia using methotrexate, leucovorin and actinomycin-D
GOTDLR I
methotrexate tablet, injectable Genitourinarytherapy for transitional cell cancers of the urothelium using methotrexate, vinblastine, doxorubicin and cisplatin
GUMVAC I
methotrexate tablet, injectable Head and Necktreatment of head and neck cancer using methotrexate as standard therapy
HNAVM I
methotrexate (cont'd) tablet, injectable Kaposi's Sarcoma therapy for Kaposi's Sarcoma using vinblastine-vincristine KSVB I
methotrexate (cont'd) tablet, injectable Lymphomatreatment of hemophagocytic lymphohistiocytosis with etoposide, dexamethasone and cycloSPORINE
HLHETCSPA I
methotrexate (cont'd) tablet, injectable Lymphomatreatment of refractory or relapsing extranodal natural killer or T-cell lymphoma using asparaginase, methotrexate and dexamethasone
LYASPMEDEX I
methotrexate (cont'd) tablet, injectable Lymphomacentral nervous system prophylaxis with high dose methotrexate, CHOP and rituximab in diffuse large B-cell lymphoma
LYCHOPRMTX I
methotrexate (cont'd) tablet, injectable Lymphomatreatment of burkitt’s lymphoma and leukemia with cyclophosphamide, vincristine, doxorubicin, methotrexate, leucovorin and rituximab
LYCODOXMR I
methotrexate (cont'd) tablet, injectable Lymphomatreatment of lymphoma with dose-adjusted etoposide, doxorubicin, vincristine, cyclophosphamide, prednisone and rituximab with intrathecal methotrexate
LYEPOCHR I
methotrexate (cont'd) tablet, injectable Lymphomatreatment of primary intracerebral lymphoma with high dose methotrexate and rituximab
LYHDMRP I
methotrexate (cont'd) tablet, injectable Lymphoma treatment of primary intracerebral lymphoma with high dose methotrexate LYHDMTXP I
methotrexate (cont'd) tablet, injectable Lymphomatreatment of leptomeningeal lymphoma or recurrent intracerebral lymphoma with high dose methotrexate
LYHDMTXR I
methotrexate (cont'd) tablet, injectable Lymphoma treatment of lymphoma using intrathecal methotrexate and cytarabine LYIT I
methotrexate (cont'd) tablet, injectable Lymphomatreatment of Burkitt’s Lymphoma and Leukemia with ifosfamide, mesna, etoposide, cytarabine and rituximab
LYIVACR I
methotrexate (cont'd) tablet, injectable Lymphoma lymphoma palliative chemotherapy LYPALL I
methotrexate (cont'd) tablet, injectable Lymphomatreatment of natural killer or T-cell lymphoma using dexamethasone, methotrexate, ifosfamide, asparaginase and etoposide
LYSMILE I
methotrexate (cont'd) tablet, injectable Miscellaneous Origins meningeal disease using high dose methotrexate with leucovorin rescue MOHDMTX I
methotrexate (cont'd) tablet, injectable Miscellaneous Originstherapy for solid tumours using intrathecal methotrexate and/or thiotepa and/or cytarabine
MOIT I
methotrexate (cont'd) tablet, injectable Sarcomatreatment of osteosarcoma using high dose methotrexate with leucovorin rescue
SAHDMTX I
methotrexate (cont'd) tablet, injectable Sarcomapalliative therapy for aggressive fibromatosis using weekly or alternate week methotrexate and vinblastine intravenously
SAMV I
Not reimbursed for rheumatoid arthritis, psoriasis.
* denotes change
BC Cancer Benefit Drug ListJuly 2018
Page 49 of 70
DRUGDOSAGE
FORMTUMOUR
SITEAPPROVED INDICATIONS
PROTOCOL CODES
CLASS NOTES
methotrexate (cont'd) tablet, injectableNot Otherwise Specified
Other tumour site code followed by ‘NOS’ (e.g. MYNOS)
I
methoxypsoralen injectable Lymphomatreatment of Cutaneous T-cell Lymphoma (Sézary syndrome) with extracorporeal photopheresis
ULYMFECP R
methyl aminolevulinate (METVIX®)
topical cream Skin & Melanoma topical therapy for skin cancer with PDT (Photodynamic Therapy) SMPDT I
Only reimbursable when prescribed by physicians in the
Skin Tumour Group within the Skin PDT Program of the BC Cancer
Agency
mitomycin injectable Gastrointestinalcombined modality therapy for carcinoma of the anal canal using mitomycin, capecitabine and radiation therapy
GICART I
mitomycin injectable Gastrointestinalcombined modality therapy for locally advanced esophageal cancer using fluorouracil and cisplatin
GIEFUPRT I
mitomycin injectable Gastrointestinalhepatic trans-arterial chemoembolization for primary liver cancer or liver metastasis
GIEMBOL IOnly funded when prescribed by specialists at BC Cancer VC &
Royal Jubilee Hospital
mitomycin (cont'd) injectable Gastrointestinalcombined modality curative therapy for carcinoma of the anal canal using mitomycin, fluorouracil and radiation therapy
GIFUART I
mitomycin (cont'd) injectable Gastrointestinalchemotherapy of pseudomyxoma peritonei using intraperitoneal mitomycin and fluorouracil
GIFUIP I
mitomycin (cont'd) injectable Gastrointestinalhyperthermic intraperitoneal chemotherapy (HIPEC) for patients with peritoneal carcinomatosis from limited advanced colorectal and appendiceal carcinomas using oxaliplatin and fluorouracil
GIHIPEC I
mitomycin (cont'd) injectable Genitourinarycombined modality therapy for squamous cell cancer of the genitourinary system using fluorouracil and cisplatin with radiation
GUFUPRT I
mitomycin injectable Genitourinary intravesical use for bladder cancer GUBMITO Imitomycin eye drops Ocular eye drops as topical therapy for ocular malignancies OCMITO I
mitomycin (cont'd) injectableNot Otherwise Specified
Other tumour site code followed by ‘NOS’ (e.g. GUNOS)
I
mitotane tablet Genitourinary treatment of advanced adrenal cortical cancer GUMITO I
mitotane tablet Genitourinarytreatment of metastatic adrenalcortical cancer with doxorubicin, etoposide, cisplatin and mitotane
GUEDPM I
mitoxantrone injectable Genitourinarypalliative therapy for hormone-refractory prostate cancer using mitoxantrone and prednisone
GUPMX I
mitoxantrone injectableNot Otherwise Specified
Other tumour site code followed by ‘NOS’ (e.g. BRNOS)
I
nilotinib tablet Leukemia treatment of chronic myeloid leukemia using nilotinib ULKCMLN R
Not reimbursed for rheumatoid arthritis, psoriasis.
* denotes change
BC Cancer Benefit Drug ListJuly 2018
Page 50 of 70
DRUGDOSAGE
FORMTUMOUR
SITEAPPROVED INDICATIONS
PROTOCOL CODES
CLASS NOTES
nilutamide tablet Genitourinaryprostate carcinoma patients who are intolerant to bicalutamide or flutamide, at 150 mg po daily
GUPNSAA INot reimbursed for vasomotor
symptoms (hot flashes)
* denotes change
BC Cancer Benefit Drug ListJuly 2018
Page 51 of 70
DRUGDOSAGE
FORMTUMOUR
SITEAPPROVED INDICATIONS
PROTOCOL CODES
CLASS NOTES
nivolumab injectable Genitourinary treatment of metastatic or advanced renal cell carcinoma using nivolumab UGUAVNIV R
nivolumab injectable Head and Neckpalliative therapy for unresectable, platinum-refractory, recurrent or metastatic squamous cell cancer of the head and neck using nivolumab
UHNAVNIV R
nivolumab injectable Lung treatment of advanced non-small cell lung cancer using nivolumab ULUAVNIV R
nivolumab injectable Skin & Melanoma treatment of unresectable or metastatic melanoma using nivolumab USMAVNIV R
obinutuzumab injectable Lymphomatreatment of previously untreated chronic lymphocytic leukemia using obinutuzumab in combination with chlorambucil
ULYOBCHLOR R
obinutuzumab injectable Lymphomatreatment of rituximab-refractory follicular lymphoma with obinutuzumab in combination with bendamustine
ULYOBBEND* R
octreotide injectable Neuro-Oncology treatment of growth hormone secreting pituitary adenoma CNOCTLAR I
octreotide injectable Gastrointestinalneuroendocrine tumours of the mid-gut or pancreas (including carcinoid tumours and VIPoma) with symptoms due to ectopic hormone secretion
GINOS I
octreotidelong acting injectable
Neuro-Oncology treatment of growth hormone secreting pituitary adenoma CNOCTLAR I
octreotidelong acting injectable
Gastrointestinalneuroendocrine tumours of the mid-gut or pancreas (including carcinoid tumours and VIPoma) with symptoms due to ectopic hormone secretion
UGIOCTLAR R
oxaliplatin injectable Gastrointestinaladjuvant combination chemotherapy for stage III and IIB colon cancer with capecitabine
GIAJCAPOX I
oxaliplatin (cont'd) injectable Gastrointestinaladjuvant combination chemotherapy for stage III and IIB colon cancer with fluorouracil and folinic acid
GIAJFFOX I
oxaliplatin injectable Gastrointestinaladjuvant combination chemotherapy for node-positive colon cancer using oxaliplatin and raltitrexed in patients intolerant to fluorouracil or capecitabine
UGIAJRALOX R
oxaliplatin injectable Gastrointestinalpalliative combination chemotherapy for metastatic colorectal cancer using oxaliplatin and capecitabine
GICAPOX I
oxaliplatin injectable Gastrointestinalpalliative combination chemotherapy for metastatic colorectal cancer using oxaliplatin, bevacizumab and capecitabine
GICOXB I
oxaliplatin (cont'd) injectable Gastrointestinalcombined modality therapy for locally advanced esophageal cancer using oxaliplatin, fluorouracil, leucovorin, and radiation therapy
GIEFFOXRT I
oxaliplatin injectable Gastrointestinalpalliative combination chemotherapy for metastatic colorectal cancer using oxaliplatin, fluorouracil, leucovorin, and bevacizumab
GIFFOXB I
oxaliplatin injectable Gastrointestinalpalliative combination chemotherapy for metastatic colorectal cancer using oxaliplatin, fluorouracil, leucovorin, and panitumumab
UGIFFOXPAN R
oxaliplatin (cont'd) injectable Gastrointestinalpalliative combination chemotherapy for advanced pancreatic adenocarcinoma using irinotecan, oxaliplatin, fluorouracil and folinic acid (leucovorin)
GIFIRINOX I
* denotes change
BC Cancer Benefit Drug ListJuly 2018
Page 52 of 70
DRUGDOSAGE
FORMTUMOUR
SITEAPPROVED INDICATIONS
PROTOCOL CODES
CLASS NOTES
oxaliplatin injectable Gastrointestinalpalliative combination chemotherapy for metastatic colorectal cancer with fluorouracil and folinic acid
GIFOLFOX I
* denotes change
BC Cancer Benefit Drug ListJuly 2018
Page 53 of 70
DRUGDOSAGE
FORMTUMOUR
SITEAPPROVED INDICATIONS
PROTOCOL CODES
CLASS NOTES
oxaliplatin (cont'd) injectable Gastrointestinaladjuvant chemotherapy of gastric cancer patients with D2 resection (node negative) or ineligible for adjuvant chemoradiation using oxaliplatin and capecitabine
GIGAJCOX I
oxaliplatin injectable Gastrointestinaladjuvant chemotherapy of gastric cancer patients with D2 resection (node negative) or ineligible for adjuvant chemoradiation using oxaliplatin, fluorouracil, and leucovorin
GIGAJFFOX I
oxaliplatin (cont'd) injectable Gastrointestinalpalliative therapy for metastatic or locally advanced gastric or esophagogastric cancer using epirubicin, oxaliplatin and capecitabine
GIGAVEOCAP I
oxaliplatin injectable Gastrointestinalpalliative therapy for metastatic or locally advanced gastric or esophagogastric cancer using epirubicin, oxaliplatin and infusional fluorouracil
GIGAVEOF I
oxaliplatin injectable Gastrointestinalperioperative treatment of resectable adenocarcinoma of the stomach, gastroesophageal junction or lower 1/3 esophagus using docetaxel, oxaliplatin, infusional fluorouracil, and leucovorin
UGIGFLODOC R
oxaliplatin (cont'd) injectable Gastrointestinalhyperthermic intraperitoneal chemotherapy (HIPEC) for patients with peritoneal carcinomatosis from limited advanced colorectal and appendiceal carcinomas using oxaliplatin and fluorouracil
GIHIPEC I
oxaliplatin injectable Gastrointestinaladjuvant combination chemotherapy for stage III rectal cancer with capecitabine
GIRAJCOX I
oxaliplatin injectable Gastrointestinaladjuvant combination chemotherapy for stage III rectal cancer with fluorouracil and folinic acid
GIRAJFFOX I
paclitaxel injectable Breastadjuvant therapy for breast cancer using doxorubicin and cyclophosphamide followed by paclitaxel
BRAJACT I
paclitaxel injectable Breastsequential combination in combination with doxorubicin and cyclophosphamide as adjuvant therapy for breast cancer using dose dense therapy
BRAJACTG I
paclitaxel injectable Breastadjuvant therapy for breast cancer using doxorubicin and cyclophosphamide followed by paclitaxel and trastuzumab (HERCEPTIN)
BRAJACTT I
paclitaxel (cont'd) injectable Breastadjuvant therapy for breast cancer using dose dense therapy: doxorubicin and cyclophosphamide followed by paclitaxel and trastuzumab (HERCEPTIN)
BRAJACTTG I
paclitaxel injectable Breastadjuvant therapy for early breast cancer using doxorubicin and cyclophosphamide followed by weekly paclitaxel
BRAJACTW I
paclitaxel injectable Breastadjuvant therapy for breast cancer using weekly paclitaxel and trastuzumab (HERCEPTIN) BRAJTTW I
paclitaxel injectable Breast treatment of metastatic breast cancer using gemcitabine and paclitaxel BRAVGEMT I
paclitaxel (cont'd) injectable Breastpalliative therapy for metastatic breast cancer using pertuzumab, trastuzumab (HERCEPTIN), and paclitaxel as first-line treatment for advanced breast cancer
BRAVPTRAT I
paclitaxel (cont'd) injectable Breast palliative therapy for metastatic breast cancer using paclitaxel BRAVTAX I
* denotes change
BC Cancer Benefit Drug ListJuly 2018
Page 54 of 70
DRUGDOSAGE
FORMTUMOUR
SITEAPPROVED INDICATIONS
PROTOCOL CODES
CLASS NOTES
paclitaxel (cont'd) injectable Breastcombination with paclitaxel and carboplatin as palliative therapy for metastatic breast cancer as first-line treatment for recurrent breast cancer refractory to anthracycline chemotherapy
BRAVTPCARB I
paclitaxel (cont'd) injectable Breastwith paclitaxel as first-line treatment for advanced breast cancer refractory to anthracycline adjuvant chemotherapy
BRAVTRAP I
paclitaxel injectable Breastpalliative therapy for metastatic breast cancer using weekly paclitaxel (given weekly for 3 weeks out of 4 weeks) (replaces BRAVT7)
BRAVTW I
paclitaxel (cont'd) injectable Breastneoadjuvant therapy for breast cancer using dose dense therapy: paclitaxel followed by doxorubicin and cyclophosphamide
BRLATACG I
paclitaxel injectable Breasttreatment of locally advanced breast cancer using doxorubicin and cyclophosphamide followed by weekly paclitaxel
BRLATWAC I
paclitaxel (cont'd) injectable Gastrointestinalneoadjuvant treatment of esophageal and gastroesophageal carcinomas using carboplatin, paclitaxel and radiation therapy
GIENACTRT I
paclitaxel (cont'd) injectable Gastrointestinalsecond-line therapy for metastatic or locally advanced gastric or gastroesophageal junction cancer using weekly paclitaxel and ramucirumab
UGIGAVRAMT R
paclitaxel (cont'd) injectable Gastrointestinalhyperthermic intraperitoneal chemotherapy (HIPEC) for patients with peritoneal mesothelioma using doxorubicin, cisplatin and paclitaxel
GIPMHIPEC I
paclitaxel (cont'd) injectable Gynecologyalternative treatment of gynecological malignancies using cisplatin and paclitaxel
GOCISP I
paclitaxel (cont'd) injectable Gynecologyprimary adjuvant treatment of adenocarcinoma/adenosquamous cancer of the cervix with carboplatin and paclitaxel preceding or following irradiation with or without cisplatin
GOCXAJCAT I
paclitaxel (cont'd) injectable Gynecologycombination with carboplatin as primary treatment of advanced/recurrent non-small cell cancer of the cervix in ambulatory care settings
GOCXCAT I
paclitaxel (cont'd) injectable Gynecology primarily advanced or recurrent endometrial cancer GOENDCAT I
paclitaxel (cont'd) injectable Gynecologyprimary treatment of invasive epithelial ovarian, fallopian tube and primary peritoneal cancer, with no visible residual tumour (moderate-high risk)
GOOVCATM I
paclitaxel (cont'd) injectable Gynecologyovarian cancer relapsing after complete remission of at least 4 months’ duration in response to primary treatment with carboplatin and paclitaxel
GOOVCATR I
paclitaxel (cont'd) injectable Gynecologyprimary treatment of visible residual (extreme risk) invasive epithelial ovarian cancer
GOOVCATX I
paclitaxel (cont'd) injectable Gynecologyprimary treatment of metastatic/recurrent cancer of the cervix with bevacizumab, carboplatin and paclitaxel
GOCXCATB I
paclitaxel (cont'd) injectable Gynecologytreatment of platinum resistant epithelial ovarian cancer with bevacizumab and paclitaxel UGOOVBEVP R
* denotes change
BC Cancer Benefit Drug ListJuly 2018
Page 55 of 70
DRUGDOSAGE
FORMTUMOUR
SITEAPPROVED INDICATIONS
PROTOCOL CODES
CLASS NOTES
paclitaxel (cont'd) injectable Gynecologyprimary treatment of advanced epithelial ovarian, primary peritoneal, or fallopian tube carcinoma using carboplatin and weekly paclitaxel
GOOVDDCAT I
* denotes change
BC Cancer Benefit Drug ListJuly 2018
Page 56 of 70
DRUGDOSAGE
FORMTUMOUR
SITEAPPROVED INDICATIONS
PROTOCOL CODES
CLASS NOTES
paclitaxel (cont'd) injectable Gynecologyprimary treatment of stage III less than or equal to 1 cm visible residual invasive epithelial ovarian cancer using intravenous and intraperitoneal paclitaxel and intraperitoneal carboplatin
GOOVIPPC I
paclitaxel (cont'd) injectable Gynecologyprogressive, platinum-refractory ovarian carcinoma, primary peritoneal carcinoma or fallopian tube carcinoma
GOOVTAX3 I
paclitaxel (cont'd) injectable Gynecologyprimary management of any gynecologic small cell cancer as part of a combined modality regimen
GOSMCCRT I
paclitaxel (cont'd) injectable Genitourinarycombination palliative therapy with gemcitabine in patients with relapsed, cisplatin-refractory germ cell cancers not amenable to cure with surgery or chemotherapy (patients relapsed after BMT are potentially eligible
UGUTAXGEM R
paclitaxel (cont'd) injectable Genitourinarytherapy for relapsed testicular germ cell cancer using paclitaxel, lfosfamide and cisplatin
UGUTIP R
paclitaxel (cont'd) injectable Head and Necktreatment for unresectable, locoregionally recurrent or metastatic squamous cell carcinoma of the head and neck using paclitaxel and cisplatin or carboplatin
HNAVPC I
paclitaxel (cont'd) injectable Head and Necktreatment of recurrent or metastatic nasopharyngeal carcinoma with carboplatin and paclitaxel
HNNAVPC I
paclitaxel (cont'd) injectable Lungadjuvant carboplatin and paclitaxel following resection of stage I, II and IIIA non-small cell lung cancer
LUAJPC I
paclitaxel (cont'd) injectable Lungcombination with carboplatin as first line treatment of advanced non-small cell lung cancer
LUAVPC I
paclitaxel (cont'd) injectable Lungtreatment of locally advanced non-small cell lung cancer using carboplatin and paclitaxel with radiation therapy
LULACATRT I
paclitaxel (cont'd) injectable Primary Unknownprimary treatment of cancer of unknown primary origin using carboplatin and paclitaxel
PUCAT I
paclitaxel (cont'd) injectable Pediatrictreatment of recurrent or resistant pediatric malignant germ cell tumors with paclitaxel, ifosfamide and carboplatin (COG protocol AGCT0521)
I
paclitaxel-nab (ABRAXANE®)
injectable Breast palliative therapy for metastatic breast cancer BRAVABR I
paclitaxel-nab (ABRAXANE®) (cont'd)
injectable Gastrointestinalfirst line treatment of locally advanced and metastatic pancreatic cancer with paclitaxel-nab (ABRAXANE®) and gemcitabine
GIPGEMABR I
palbociclib capsule Breasttherapy of advanced breast cancer using palbociclib with aromatase inhibitor
UBRAVPALAI R
pamidronate injectable Breast adjuvant treatment of post-menopausal women using pamidronate UBRAJPAM R
pamidronate injectable Breastbony metastases associated with breast cancer for patients who do not tolerate oral clodronate
BRAVCLOD I
pamidronate injectable Breast acute bone pain secondary to metastatic breast cancer BRAVPAM Ipamidronate injectable Myeloma multiple myeloma MYPAM I
Not reimbursed for hypercalcemia
* denotes change
BC Cancer Benefit Drug ListJuly 2018
Page 57 of 70
DRUGDOSAGE
FORMTUMOUR
SITEAPPROVED INDICATIONS
PROTOCOL CODES
CLASS NOTES
panitumumab injectable Gastrointestinalpalliative third-line treatment of metastatic colorectal cancer using panitumumab with wild type KRAS
GIAVPANI I
panitumumab injectable Gastrointestinalpalliative combination chemotherapy for metastatic colorectal cancer using irinotecan, fluorouracil, leucovorin, and panitumumab
UGIFFIRPAN* R
panitumumab injectable Gastrointestinalpalliative combination chemotherapy for metastatic colorectal cancer using oxaliplatin, fluorouracil, leucovorin, and panitumumab
UGIFFOXPAN R
pazopanib tablet Genitourinary palliative therapy for renal cell carcinoma using pazopanib UGUPAZO Rpegaspargase (ONCASPAR®)
injectable Pediatric pediatric patients with leukemia or lymphoma I
peginterferon alfa-2a injectable Leukemia therapy of chronic myeloid neoplasms and hypereosinophilic syndrome LKPEGIFN I
pembrolizumab injectable Lungsecond-line treatment of advanced non-small cell lung cancer using pembrolizumab
ULUAVPMB R
pembrolizumab injectable Lungfirst-line treatment of advanced non-small cell lung cancer using pembrolizumab
ULUAVPMBF R
pembrolizumab injectable Skin & Melanoma treatment of unresectable or metastatic melanoma using pembrolizumab USMAVPEM R
pemetrexed injectable Lung second-line treatment of advanced non-small cell lung cancer LUAVPEM I
pemetrexed injectable Lungmaintenance therapy of advanced non-small cell lung cancer after first-line chemotherapy
ULUAVPMTN R
pemetrexed injectable Lungfirst-line treatment of advanced non-small cell lung cancer with platinum and pemetrexed
LUAVPP I
pemetrexed (cont'd) injectable Lung treatment of malignant mesothelioma with platinum and pemetrexed LUMMPP I
pertuzumab injectable Breastpalliative therapy for metastatic breast cancer using pertuzumab, trastuzumab (HERCEPTIN) and docetaxel as first-line treatment for advanced breast cancer
BRAVPTRAD I
pertuzumab (cont'd) injectable Breastpalliative therapy for metastatic breast cancer using pertuzumab, trastuzumab (HERCEPTIN), and paclitaxel as first-line treatment for advanced breast cancer
BRAVPTRAT I
plerixafor injectable hematopoietic stem cell mobilization PLERIXAFOR I
pomalidomide capsule Myeloma therapy of multiple myeloma using pomalidomide with dexamethasone UMYPOMDEX R
ponatinib tablet Leukemiatreatment of chronic myeloid leukemia and Ph+ acute lymphoblastic leukemia using ponatinib
ULKCMLP R
porfimer (PHOTOFRIN®) injectable Gastrointestinalphotodynamic therapy in patients with high-grade dysplasia associated with Barrett's esophagus, and who are not candidates for surgery
UGI0 R
prednisolone suspension Pediatric pediatric patients I
prednisone tablet Genitourinarypalliative therapy for metastatic castration resistant prostate cancer sing cabazitaxel and predniSONE
UGUPCABA R
* denotes change
BC Cancer Benefit Drug ListJuly 2018
Page 58 of 70
DRUGDOSAGE
FORMTUMOUR
SITEAPPROVED INDICATIONS
PROTOCOL CODES
CLASS NOTES
prednisone (cont'd) tablet Genitourinarypalliative therapy for metastatic castration resistant prostate cancer using abiraterone and prednisone after failure of docetaxel therapy
UGUPABI R
prednisone tablet Genitourinary palliative therapy for metastatic hormone refractory prostate cancer GUPDOC I
prednisone (cont'd) tablet Genitourinarypalliative therapy for hormone-refractory prostate cancer using mitoxantrone and prednisone
GUPMX I
* denotes change
BC Cancer Benefit Drug ListJuly 2018
Page 59 of 70
DRUGDOSAGE
FORMTUMOUR
SITEAPPROVED INDICATIONS
PROTOCOL CODES
CLASS NOTES
prednisone (cont'd) tablet Lymphomatreatment of Hodgkin's disease using cyclophosphamide, vincristine and prednisone
LYCCOP I
prednisone tablet Lymphomatreatment of lymphoma with doxorubicin, cyclophosphamide, vincristine and prednisone
LYCHOP I
prednisone (cont'd) tablet Lymphomatreatment of lymphoma with doxorubicin, cyclophosphamide, vincristine, prednisone and rituximab
LYCHOPR I
prednisone tablet Lymphomacentral nervous system prophylaxis with high dose methotrexate, CHOP and rituximab in diffuse large B-cell lymphoma
LYCHOPRMTX I
prednisone tablet Lymphomaadvanced indolent lymphoma using cyclophosphamide, vincristine and prednisone
LYCVP I
prednisone tablet Lymphomatreatment of advanced indolent lymphoma using cyclophosphamide, vincristine, prednisone and rituximab
LYCVPR I
prednisone tablet Lymphomatherapy of lymphoma, Hodgkin's disease, chronic lymphocytic leukemia or multiple myeloma using cyclophosphamide
LYCYCLO I
prednisone (cont'd) tablet Lymphomatreatment of lymphoma with dose-adjusted etoposide, doxorubicin, vincristine, cyclophosphamide, prednisone and rituximab with intrathecal methotrexate
LYEPOCHR I
prednisone (cont'd) tablet Lymphoma lymphoma palliative chemotherapy LYPALL I
prednisone (cont'd) tablet Myelomatreatment of multiple myeloma using bortezomib, dexamethasone with or without cyclophosphamide as induction pre-stem cell transplant
MYBORPRE I
prednisone (cont'd) tablet Myelomatreatment of relapsed multiple myeloma using bortezomib, dexamethasone with or without cyclophosphamide
MYBORREL I
prednisone (cont'd) tablet Myeloma treatment of multiple myeloma using melphalan and prednisone MYMP I
prednisone (cont'd) tablet Myelomatreatment of multiple myeloma using melphalan, prednisone and weekly bortezomib with the option of substituting cyclophosphamide for melphalan
MYMPBOR I
prednisone (cont'd) tabletNot Otherwise Specified
Other tumour site code followed by ‘NOS’ (e.g. LKNOS)
I
procarbazine capsule Neuro-Oncologymodified PCV chemotherapy of brain tumours using procarbazine, lomustine and vincristine
CNMODPCV I
procarbazine capsule Neuro-Oncology standard procarbazine for second-line treatment of recurrent brain tumor CNPROC I
procarbazine (cont'd) capsule Lymphomatreatment of Hodgkin's Disease with cyclophosphamide, vinblastine, procarbazine and prednisone
LYCVPPABO I
procarbazine capsule Lymphoma lymphoma palliative chemotherapy LYPALL I
procarbazine (cont'd) capsuleNot Otherwise Specified
Other tumour site code followed by ‘NOS’ (e.g. CNNOS)
I
quinagolide tablet Neuro-Oncology therapy for pituitary adenaomas using quinagolide CNQUIN I
* denotes change
BC Cancer Benefit Drug ListJuly 2018
Page 60 of 70
DRUGDOSAGE
FORMTUMOUR
SITEAPPROVED INDICATIONS
PROTOCOL CODES
CLASS NOTES
radium-223radio-
pharmaceuticalGenitourinary
therapy for metastatic castration resistant prostate cancer using radium-223
UGUPRAD R
raltitrexed injectable Gastrointestinalunresectable or metastatic colorectal adenocarcinoma for patients with previous fluorouracil toxicity
GIRALT I
raltitrexed (cont'd) injectable Gastrointestinaladjuvant combination chemotherapy for node-positive colon cancer using oxaliplatin and raltitrexed in patients intolerant to fluorouracil or capecitabine
UGIAJRALOX R
ramucirumab injectable Gastrointestinalsecond-line therapy for metastatic or locally advanced gastric or gastroesophageal junction cancer using weekly paclitaxel and ramucirumab
UGIGAVRAMT R
regorafenib tablet Sarcomathird line treatment of advanced gastrointestinal stromal cell tumours (GIST's) using regorafenib
USAAVGR R
rituximab IV injectable BMTpre-emptive rituximab therapy of Epstein-Barr virus related post-transplant lymphoproliferative disease
BMTLPDRIT IIV formulation only; Rituximab®
SC not funded
rituximabIV / SC
injectableLymphoma treatment of Non-Hodgkin Lymphoma with bendamustine and rituximab ULYBENDR R
rituximabIV / SC
injectableLymphoma
treatment of indolent B-cell lymphoma and chronic lymphocytic leukemia with chlorambucil and rituximab
LYCHLRR I
rituximab (cont'd)IV / SC
injectableLymphoma
in combination with CHOP (cyclophosphamide, doxorubicin, prednisone, vincristine), in all stages of newly diagnosed diffuse large B-cell lymphoma and mantle cell lymphoma, advanced stage at diagnosis
LYCHOPR I
rituximabIV / SC
injectableLymphoma
central nervous system prophylaxis with high dose methotrexate, CHOP and rituximab in diffuse large B-cell lymphoma
LYCHOPRMTX I
IV injectabletreatment of previously untreated chronic lymphocytic leukemia (CLL) with bendamustine and rituximab
ULYCLLFBR RIV formulation only; Rituximab®
SC not funded
rituximabIV / SC
injectableLymphoma
treatment of Burkitt’s lymphoma and leukemia with cyclophosphamide, vincristine, doxorubicin, methotrexate, leucovorin and rituximab
LYCODOXMR I
rituximab (cont'd)IV / SC
injectableLymphoma
combination with CVP for advanced stage indolent lymphoma at diagnosis
LYCVPR I
rituximab (cont'd) IV injectable Lymphomatreatment of lymphoma with dose-adjusted etoposide, doxorubicin, vincristine, cyclophosphamide, prednisone and rituximab with intrathecal methotrexate
LYEPOCHR IIV formulation only; Rituximab®
SC not funded
rituximab (cont'd)IV / SC
injectableLymphoma
treatment of chronic lymphocytic leukemia (CLL) or prolymphocytic leukemia with fludarabine, cyclophosphamide and rituximab
LYFCR I
rituximabIV / SC
injectableLymphoma
in combination with fludarabine for treatment of chronic lymphocytic leukemia or prolymphocytic leukemia and relapsed indolent lymphoma
LYFLUDR I
rituximab (cont'd)IV / SC
injectableLymphoma
in combination with gemcitabine, dexamethasone and cisplatin for lymphoma
LYGDPR I
* denotes change
BC Cancer Benefit Drug ListJuly 2018
Page 61 of 70
DRUGDOSAGE
FORMTUMOUR
SITEAPPROVED INDICATIONS
PROTOCOL CODES
CLASS NOTES
rituximabIV / SC
injectableLymphoma
treatment of primary intracerebral lymphoma with high dose methotrexate and rituximab
LYHDMRP I
* denotes change
BC Cancer Benefit Drug ListJuly 2018
Page 62 of 70
DRUGDOSAGE
FORMTUMOUR
SITEAPPROVED INDICATIONS
PROTOCOL CODES
CLASS NOTES
rituximab (cont'd) IV injectable Lymphomatreatment of relapsed/refractory chronic lymphocytic leukemia or small lymphocytic lymphoma using idelalisib and rituximab
ULYIDELAR RIV formulation only; Rituximab®
SC not funded
rituximab (cont'd)IV / SC
injectableLymphoma
treatment of Burkitt’s lymphoma and leukemia with ifosfamide, mesna, etoposide, cytarabine and rituximab
LYIVACR I
rituximab (cont'd)IV / SC
injectableLymphoma
treatment of advanced stage large B-cell non-Hodgkin’s lymphoma with ifosfamide, carboplatin, etoposide and rituximab
ULYRICE R
rituximab (cont'd)IV / SC
injectableLymphoma
follicular lymphoma progressive despite alkylating agents and purine analogues (fludarabine or cladribine), post-transplant lymphoproliferative disease, or newly diagnosed (within 6 months) asymptomatic advanced follicular lymphoma
LYRITUX I
rituximab (cont'd) IV injectable Lymphomapalliative therapy for lymphoma using radioimmunotherapy: rituximab-priming for ibritumomab 90Y (ZEVALIN®) ULYRITZ R
IV formulation only; Rituximab® SC not funded
rituximab (cont'd)IV / SC
injectableLymphoma maintenance treatment of indolent lymphoma LYRMTN I
rituximab (cont'd) IV injectable Pediatric
pediatric patients treated on the COG protocols ANHL0221 for CD20 positive post-transplant lymphoproliferative disease following solid organ transplantation and ANHL01P1 for newly diagnosed advanced B-cell leukemia/lymphoma
IIV formulation only; Rituximab®
SC not funded
romidepsin injectable Lymphomatreatment of relapsed or refractory Peripheral T-Cell lymphoma (PTCL) with romidepsin
ULYROMI R
ruxolitinib tablet Leukemia treatment of symptomatic myelofibrosis with ruxolitinib ULKMFRUX Rruxolitinib tablet Leukemia treatment of polycythemia vera with ruxolitinib ULKPCVRUX R
sargramostim injectable Pediatricpediatric patients with neuroblastoma treated on the COG ANBL0032 protocol
I
sargramostim injectable Pediatricpediatric patients with relapsed neuroblastoma treated on the COG ANBL1021 protocol
I
siltuximab injectable Lymphomatreatment of Multicentric Castleman’s Disease (MCD) negative for Human Immunodeficiency Virus (HIV) and Human Herpes Virus-8 (HHV-8) Using siltuximab
ULYSILTUX R
sorafenib tablet Gastrointestinal sorafenib therapy for advanced hepatocellular carcinoma UGISORAF R
sorafenib tablet Genitourinary palliative therapy for renal cell carcinoma in patients after cytokine failure UGUSORAF R
sorafenib tablet Leukemia therapy of acute myeloid leukemia using azacitidine and sorafenib ULKAMLAS R
streptozocin injectable Gastrointestinalpalliative therapy for pancreatic endocrine tumours using streptozocin and doxorubicin
GIENDO2 I
streptozocin injectableNot Otherwise Specified
Other tumour site code followed by ‘NOS’ (e.g. GINOS)
I
Approval from Health Canada Special Access Programme is
required for each patient
* denotes change
BC Cancer Benefit Drug ListJuly 2018
Page 63 of 70
DRUGDOSAGE
FORMTUMOUR
SITEAPPROVED INDICATIONS
PROTOCOL CODES
CLASS NOTES
sunitinib capsule Gastrointestinal as palliative treatment of advance pancreatic neuroendocrine tumours UGIPNSUNI R
sunitinib capsule Genitourinarypalliative therapy for renal cell carcinoma in patients who are not suitable candidates for interferon
UGUSUNI R
sunitinib (cont'd) capsule Sarcomasecond line treatment of advanced c-kit positive gastrointestinal stromal cell tumours (GIST's) after imatinib
SAAVGS I
tamoxifen tablet Breastneoadjuvant or adjuvant therapy for breast cancer using a LHRH agonist and tamoxifen
BRAJLHRHT I
tamoxifen tablet Breast neoadjuvant or adjuvant therapy for breast cancer using tamoxifen BRAJTAM I
tamoxifen (cont'd) tablet Breast palliative therapy for breast cancer using a LHRH agonist and tamoxifen BRAVLHRHT I
tamoxifen tablet Breast palliative therapy for breast cancer BRAVTAM I
tamoxifen tablet Gynecologyendometrial cancernon-aromatase inhibitor hormonal treatment of endometrial cancer
GOENDH I
tamoxifen tablet Gynecology therapy for advanced ovarian cancer using tamoxifen GOOVTAM Itamoxifen (cont'd) tablet Head and Neck treatment of recurrent/metastatic salivary gland cancers HNSAVTAM Itamoxifen tablet Sarcoma recurrent desmoid tumors/aggressive fibromatosis SATAM Itamoxifen tablet Skin & Melanoma recurrent or metastatic melanoma SMTAM I
temozolomide capsule Neuro-Oncologyconcomitant (dual modality) and 12 cycles of adjuvant temozolomide for newly diagnosed astrocytomas and oligodendrogliomas with radiation
CNAJ12TZRT I
temozolomide capsule Neuro-Oncologyconcomitant and adjuvant temozolomide for newly diagnosed malignant gliomas with radiation
CNAJTZRT I
temozolomide capsule Neuro-Oncologytreatment of elderly newly diagnosed glioma patient with concurrent and adjuvant temozolomide and radiation therapy
CNELTZRT I
temozolomide capsule Neuro-Oncologytherapy for newly diagnosed malignant brain tumours with MGMT methylation in elderly patients using temozolomide
CNTEM60 I
temozolomide capsule Neuro-Oncology therapy for malignant brain tumours CNTEMOZ I
temozolomide capsule Neuro-Oncologytherapy for malignant brain tumours using metronomic dosing of temozolomide
CNTEMOZMD I
temozolomide capsule Neuro-Oncologytherapy for recurrent malignant brain tumours using temozolomide and etoposide
CNTMZETO I
temozolomide (cont'd) capsule Gastrointestinalpalliative therapy of metastatic neuroendocrine cancer using temozolomide and capecitabine
GIAVTZCAP I
temozolomide capsule Pediatric pediatric patients with brain tumours I
temozolomide capsule Pediatricpediatric patients treated on the COG protocol ANBL0421 for recurrent neuroblastoma
I
temozolomide (cont'd) capsule Pediatricpediatric patients with rhabdomyosarcoma treated on the COG ARST08P1 protocol
I
temozolomide (cont'd) capsule Sarcomatherapy for advanced solitary fibrous tumours and hemangiopericytoma using temozolomide and bevacizumab
USATEMBEV R
temozolomide (cont'd) capsule Skin & Melanoma palliative therapy for malignant melanoma with brain metastases SMAVTMZ Itemsirolimus injectable Genitourinary therapy for advanced renal cancer using temsirolimus UGUTEM R
* denotes change
BC Cancer Benefit Drug ListJuly 2018
Page 64 of 70
DRUGDOSAGE
FORMTUMOUR
SITEAPPROVED INDICATIONS
PROTOCOL CODES
CLASS NOTES
teniposide injectableNot Otherwise Specified
Tumour site code followed by ‘NOS’ (e.g. GUNOS)
I
testosterone injectable Breast palliative therapy for metastatic breast cancer BRAVTEST INot reimbursed for symptom
management or appetite stimulation
thioguanine tabletNot Otherwise Specified
Tumour site code followed by ‘NOS’ (e.g. LYNOS)
I
thiotepa injectable Miscellaneous Originstherapy for solid tumours using intrathecal methotrexate and/or thiotepa and/or cytarabine
MOIT I
thiotepa (cont'd) injectableNot Otherwise Specified
Other tumour site code followed by ‘NOS’ (e.g. GUNOS)
I
thyrotropin alfa injectable Head and Neck radioiodine imaging in patients with thyroid cancer and treatment HNOTTSH I
topotecan injectable Gynecologytreatment of relapsed/progressive epithelial ovarian, fallopian tube or primary peritoneal cancer using topotecan
GOOVTOP I
topotecan injectable Lung second line treatment of recurrent small cell lung cancer LUSCTOP Itopotecan (cont'd) injectable Pediatric pediatric sarcoma I
topotecan injectable Pediatricintermediate-risk (COG ANBL0532) and high risk (COG ANBL0531) pediatric neuroblastoma
I
topotecan injectable Sarcomasummary for treatment of recurrent/refractory neuroblastoma, ewing’s sarcoma, osteogenic sarcoma or rhabdomyosarcoma with topotecan/cyclophosphamide
SAAVTC I
trametinib tablet Skin & Melanomatreatment of BRAF V600 mutation-positive unresectable or metastatic melanoma using dabrafenib and trametinib
USMAVDT R
trametinib tablet Skin & Melanomatreatment of BRAF V600 mutation-positive unresectable or metastatic melanoma using trametinib
USMAVTRA R
trastuzumab (HERCEPTIN) injectable Breastadjuvant therapy for breast cancer using doxorubicin and cyclophosphamide followed by paclitaxel and trastuzumab (HERCEPTIN)
BRAJACTT I
trastuzumab (HERCEPTIN) Injectable Breastadjuvant treatment of HER-2 positive breast cancer using carboplatin, docetaxel and trastuzumab (HERCEPTIN)
BRAJDCARBT I
trastuzumab (HERCEPTIN) Injectable Breastcombination with docetaxel after FEC regimen as adjuvant therapy for breast cancer
BRAJFECDT I
trastuzumab (HERCEPTIN) cont'd
Injectable Breastdocetaxel, cyclophosphamide and concurrent trastuzumab (HERCEPTIN) as adjuvant treatment of HER-2 postive breast cancer
BRAJTDC I
trastuzumab (HERCEPTIN) Injectable Breastadjuvant therapy for breast cancer using trastuzumab (HERCEPTIN) following the completion of chemotherapy (sequential)
BRAJTR I
Approval from Health Canada Special Access Programme is
required for each patient
* denotes change
BC Cancer Benefit Drug ListJuly 2018
Page 65 of 70
DRUGDOSAGE
FORMTUMOUR
SITEAPPROVED INDICATIONS
PROTOCOL CODES
CLASS NOTES
trastuzumab (HERCEPTIN) (cont'd)
injectable Breast adjuvant therapy for breast cancer using weekly paclitaxel and trastuzumab (HERCEPTIN)
BRAJTTW I
trastuzumab (HERCEPTIN) (cont'd)
injectable Breastpalliative therapy for metastatic breast cancer using pertuzumab, trastuzumab (HERCEPTIN) and docetaxel as first-line treatment for advanced breast cancer
BRAVPTRAD I
trastuzumab (HERCEPTIN) (cont'd)
injectable Breastpalliative therapy for metastatic breast cancer using pertuzumab, trastuzumab (HERCEPTIN), and paclitaxel as first-line treatment for advanced breast cancer
BRAVPTRAT I
trastuzumab (HERCEPTIN) (cont'd)
injectable Breastcombination with capecitabine as second-line treatment of HER-2 positive metastatic breast cancer after prior treatment with trastuzumab (HERCEPTIN)
UBRAVTCAP R
trastuzumab (HERCEPTIN) (cont'd)
injectable Breastcombination with paclitaxel and carboplatin as palliative therapy for metastatic breast cancer as first-line treatment for recurrent breast cancer refractory to anthracycline chemotherapy
BRAVTPCARB I
trastuzumab (HERCEPTIN) (cont'd)
injectable Breast
single agent therapy for metastatic breast cancer progressing after 1 prior regimens (e.g., taxane) and responding to trastuzumab (HERCEPTIN) in combination with paclitaxel, with paclitaxel and carboplatin, or with vinorelbine
BRAVTR I
trastuzumab (HERCEPTIN) (cont'd)
Injectable Breastwith docetaxel as first-line treatment for advanced breast cancer refractory to anthracycline adjuvant chemotherapy
BRAVTRAD I
trastuzumab (HERCEPTIN) (cont'd)
Injectable Breastwith paclitaxel as first-line treatment for advanced breast cancer refractory to anthracycline adjuvant chemotherapy
BRAVTRAP I
trastuzumab (HERCEPTIN) (cont'd)
Injectable Breastcombination with 3-weekly vinorelbine as palliative therapy for metastatic breast cancer
BRAVTRVIN I
trastuzumab (HERCEPTIN) (cont'd)
Injectable Breastadjuvant therapy for breast cancer using dose dense therapy: doxorubicin and cyclophosphamide followed by paclitaxel and trastuzumab (HERCEPTIN)
BRAJACTTG I
trastuzumab (HERCEPTIN) (cont'd)
Injectable Breasttreatment of locally advanced breast cancer using doxorubicin and cyclophosphamide followed by docetaxel and trastuzumab (HERCEPTIN)
BRLAACDT I
trastuzumab (HERCEPTIN) (cont'd)
Injectable Gastrointestinalpalliative treatment of metastatic or locally advanced gastric, gastroesophageal junction, or esophageal adenocarcinoma using cisplatin, capecitabine and trastuzumab (HERCEPTIN)
GIGAVCCT I
trastuzumab (HERCEPTIN) (cont'd)
Injectable Gastrointestinalpalliative treatment of metastatic or inoperable, locally advanced gastric or gastroesophageal junction adenocarcinoma using cisplatin, infusional fluorouracil and trastuzumab (HERCEPTIN)
GIGAVCFT I
trastuzumab (HERCEPTIN) (cont'd)
injectable Gastrointestinalcontinuation of palliative treatment of metastatic or inoperable, locally advanced gastric or gastroesophageal junction adenocarcinoma using trastuzumab (HERCEPTIN)
GIGAVTR I
* denotes change
BC Cancer Benefit Drug ListJuly 2018
Page 66 of 70
DRUGDOSAGE
FORMTUMOUR
SITEAPPROVED INDICATIONS
PROTOCOL CODES
CLASS NOTES
trastuzumab emtansine (KADCYLA)
injectable Breastpalliative therapy for metastatic breast cancer using trastuzumab emtansine (KADCYLA)
UBRAVKAD R
tretinoin (VESANOID®) capsule Leukemia acute promyelocytic leukemia LKNOS I
tretinoin (VESANOID®) (cont'd)
capsule Leukemiafirst-line induction and consolidation therapy of acute promyelocytic leukemia using arsenic trioxide and tretinoin
LKATOATRA I
tretinoin (VESANOID®) capsule Leukemiafirst-line induction and consolidation therapy of acute promyelocytic leukemia using arsenic trioxide, tretinoin and daunorubicin
LKATOP I
vemurafenib tablet Skin & Melanomatreatment of BRAF V600 mutation-positive unresectable or metastatic melanoma using vemurafenib
USMAVVEM R
vemurafenib tablet Skin & Melanomatreatment of BRAF V600 mutation-positive unresectable or metastatic melanoma using vemurafenib and cobimetinib
USMAVVC R
vinblastine injectable Genitourinary therapy for transitional cell cancers using carboplatin-vinblastine GUBCV I
vinblastine injectable Genitourinarytherapy for transitional cell cancers of the urothelium using methotrexate, vinblastine, doxorubicin and cisplatin
GUMVAC I
vinblastine injectable Genitourinaryconsolidation/ salvage treatment for germ cell cancer using vinblastine, cisplatin, ifosfamide and mesna
GUVEIP I
vinblastine injectable Kaposi's Sarcoma therapy for Kaposi's Sarcoma using vinblastine-vincristine KSVB I
vinblastine injectable Lymphomatreatment of Hodgkin's disease with doxorubicin, bleomycin, vinblastine and dacarbazine
LYABVD I
vinblastine (cont'd) injectable Lymphoma lymphoma palliative chemotherapy LYPALL I
vinblastine (cont'd) injectable Sarcomapalliative therapy for aggressive fibromatosis using weekly or alternate week methotrexate and vinblastine intravenously
SAMV I
vinblastine injectableNot Otherwise Specified
Other tumour site code followed by ‘NOS’ (e.g. LYNOS)
I
vincristine injectable Neuro-Oncologyadjuvant lomustine, cisplatin and vincristine in adult high-risk medulloblastoma or other primitive neuroectodermal tumour
CNCCV I
vincristine (cont'd) injectable Neuro-Oncologymodified PCV chemotherapy of brain tumours using procarbazine, lomustine and vincristine
CNMODPCV I
vincristine (cont'd) injectable Gynecologytherapy for high-risk Gestational Trophoblastic Neoplasia (GTN) using etoposide, methotrexate, leucovorin (folinic acid), dactinomycin, cyclophosphamide and vincristine
GOTDEMACO I
vincristine (cont'd) injectable Kaposi's sarcoma therapy for Kaposi's Sarcoma using vinblastine-vincristine KSVB I
vincristine (cont'd) injectable Lungtreatment of thymoma/thymic carcinoma with cyclophosphamide, doxorubicin and vincristine
LUOTCAV I
vincristine (cont'd) injectable Lungtreatment of extensive small cell lung cancer with cyclophosphamide, doxorubicin and vincristine
LUSCCAV I
vincristine (cont'd) injectable Lymphomatreatment of Hodgkin's disease using cyclophosphamide, vincristine and prednisone
LYCCOP I
* denotes change
BC Cancer Benefit Drug ListJuly 2018
Page 67 of 70
DRUGDOSAGE
FORMTUMOUR
SITEAPPROVED INDICATIONS
PROTOCOL CODES
CLASS NOTES
vincristine (cont'd) injectable Lymphomatreatment of lymphoma with doxorubicin, cyclophosphamide, vincristine and prednisone
LYCHOP I
vincristine (cont'd) injectable Lymphomatreatment of lymphoma with doxorubicin, cyclophosphamide, vincristine, prednisone and rituximab
LYCHOPR I
* denotes change
BC Cancer Benefit Drug ListJuly 2018
Page 68 of 70
DRUGDOSAGE
FORMTUMOUR
SITEAPPROVED INDICATIONS
PROTOCOL CODES
CLASS NOTES
vincristine (cont'd) injectable Lymphomacentral nervous system prophylaxis with high dose methotrexate, CHOP and rituximab in diffuse large B-cell lymphoma
LYCHOPRMTX I
vincristine (cont'd) injectable Lymphomatreatment of Burkitt’s Lymphoma and Leukemia with cyclophosphamide, vincristine, doxorubicin, methotrexate, leucovorin and rituximab
LYCODOXMR I
vincristine (cont'd) injectable Lymphomaadvanced indolent lymphoma using cyclophosphamide, vincristine and prednisone
LYCVP I
vincristine (cont'd) injectable Lymphomatreatment of Hodgkin's Disease with cyclophosphamide, vinblastine, procarbazine and prednisone
LYCVPPABO I
vincristine (cont'd) injectable Lymphomatreatment of advanced indolent lymphoma using cyclophosphamide, vincristine, prednisone and rituximab
LYCVPR I
vincristine (cont'd) injectable Lymphomatreatment of lymphoma with dose-adjusted etoposide, doxorubicin, vincristine, cyclophosphamide, prednisone and rituximab with intrathecal methotrexate
LYEPOCHR I
vincristine (cont'd) injectable Lymphoma lymphoma palliative chemotherapy LYPALL I
vincristine (cont'd) injectable Sarcoma
SAIME alternating with SAVAC or SAVACM with filgrastim support at a TWO weekly interval for newly diagnosed Ewing's Sarcoma/Ewing’s Family of Tumours, Desmoplastic Intra-Abdominal Small Round Blue Cell Tumour or Rhabdomyosarcoma
SAALT2W I
vincristine (cont'd) injectable Sarcoma
SAIME alternating with SAVAC or SAVACM with filgrastim support at a THREE weekly interval for newly diagnosed Ewing's Sarcoma/Ewing’s Family of Tumours, Desmoplastic Intra-Abdominal Small Round Blue Cell Tumour or Rhabdomyosarcoma
SAALT3W I
vincristine (cont'd) injectable Sarcomatreatment of sarcomas with vincristine, doxorubicin and cyclophosphamide
SAVAC I
vincristine (cont'd) injectable Sarcomatreatment of sarcomas with pelvic primaries or chemotherapy induced hematuria using vincristine, doxorubicin, cyclophosphamide and mesna
SAVACM I
vincristine (cont'd) injectable Sarcomaadjuvant therapy for rhabdomyosarcoma using vincristine, dactinomycin and cyclophosphamide
SAVDC I
vincristine (cont'd) injectable Sarcomaadjuvant therapy for rhabdomyosarcoma using vincristine, dactinomycin, cyclophosphamide and mesna
SAVDCM I
vincristine (cont'd) injectableNot Otherwise Specified
Other tumour site code followed by ‘NOS’ (e.g. LYNOS)
I
* denotes change
BC Cancer Benefit Drug ListJuly 2018
Page 69 of 70
DRUGDOSAGE
FORMTUMOUR
SITEAPPROVED INDICATIONS
PROTOCOL CODES
CLASS NOTES
vinorelbine injectable Breast palliative therapy for metastatic breast cancer BRAVNAV I
vinorelbine injectable Breastcombination with 3-weekly trastuzumab (HERCEPTIN) as palliative therapy for metastatic breast cancer
BRAVTRVIN I
vinorelbine injectable Gynecologytreatment of platinum resistant epithelial ovarian cancer with bevacizumab and vinorelbine
UGOOVBEVV R
vinorelbine injectable Gynecologypalliative chemotherapy for re-treatment of ovarian, tubal, and peritoneal cancer
GOOVVIN I
vinorelbine injectable Head and Neckcombination with cisplatin as treatment of advanced salivary gland cancers with cisplatin and vinorelbine
HNSAVNP I
vinorelbine (cont'd) injectable Lungadjuvant cisplatin and vinorelbine following resection of stage I, II and IIIA non-small cell lung cancer
LUAJNP I
vinorelbine (cont'd) injectable Lungcombination with cisplatin as treatment for advanced non-small cell lung cancer
LUAVNP I
vinorelbine (cont'd) injectable Lung advanced non-small cell lung cancer in elderly patients LUAVVIN Ivinorelbine (cont'd) injectable Lung malignant mesothelioma LUMMVIN I
vinorelbine (cont'd) injectable Pediatricpediatric patients treated on the COG protocol AHOD0521 for refractory/recurrent Hodgkin’s disease
I
vismodegib capsule Skin & Melanoma treatment of metastatic or locally advanced basal cell carcinoma USMAVVIS R
yttrium-90 injectable Gastrointestinaltransarterial radioembolisation of hepatocellular carcinoma with portal venous invasion or T3 tumours, and metastatic neuroendocrine tumours
UGIYTT R
zoledronic acid injectable Breast adjuvant treatment of post-menopausal women using zoledronic acid BRAJZOL5* Iadjuvant treatment breast cancer in post-menopausal women using 3-monthly zoledronic acid BRAJZOL2* I
treatment of acute bone pain secondary to breast cancer metastases using IV zoledronic acid
BRAVZOL I
zoledronic acid injectable Breast treatment of multiple myeloma with zoledronic acid MYZOL* I
BMTBRGIGUGOHNKSLKLULYMOMYCN
Miscellaneous Origin
LeukemiaLung
MyelomaNeuro-Oncology
Lymphoma
Gastrointestinal
Head and NeckKaposi’s sarcoma
Protocol Code DefinitionsBone Marrow Transplantation
GenitourinaryGynecologic
Breast
* denotes change
BC Cancer Benefit Drug ListJuly 2018
Page 70 of 70
DRUGDOSAGE
FORMTUMOUR
SITEAPPROVED INDICATIONS
PROTOCOL CODES
CLASS NOTES
OCPUSASMSkin & Melanoma
OcularPrimary UnknownSarcoma
* denotes change