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Page 1 of 57 BC Cancer Benefit Drug List August 2019

DEFINITIONS Class I Reimbursed 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 Restricted Funding (R) provide the appropriate clinical information for each patient. NOTES 1. 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. 2. Not Otherwise Specified (NOS) code only applicable to Class I drugs where indicated. 3. Intrahepatic use of drugs is not reimbursable unless specified. 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]

DOSAGE TUMOUR PROTOCOL DRUG APPROVED INDICATIONS CLASS NOTES FORM SITE CODES 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 first-line treatment of epidermal growth factor receptor mutation-positive afatinib tablet Lung LUAVAFAT I advanced non-small cell lung cancer with afatinib pediatric patients with high risk neuroblastoma treated on the aldesleukin injectable Pediatric I ANBL0032 study treatment of ALK-positive advanced non-small cell lung cancer with alectinib capsule Lung ULUAVALE R alectinib treatment of -refractory B-chronic lymphocytic leukemia and alemtuzumab injectable Lymphoma LYALEM I T-prolymphocytic leukemia Only reimbursable when prescribed by physicians in the topical solution Skin & Melanoma topical therapy for skin cancer with PDT () SMPDT I Skin Tumour Group within the (LEVULAN® KERASTICK®) Skin PDT Program of the BC Cancer Agency injectable Leukemia LKNOS I patients with thrombocytosis related to a myeloproliferative disorder who capsule Leukemia have had an inadequate response to or are intolerant of hydroxyurea LKANAG I and/or interferon neoadjuvant or adjuvant therapy for breast cancer using anastrozole in anastrozole tablet Breast BRAJANAS I postmenopausal women neoadjuvant or adjuvant ovarian suppression and aromatase inhibitor in anastrozole tablet Breast BRAJLHRHAI I premenopausal women with high-risk early stage breast cancer first or second line hormonal treatment for advanced breast cancer in anastrozole tablet Breast BRAVANAS I postmenopausal women therapy for advanced breast cancer using a LHRH agonist and an anastrozole tablet Breast BRAVLHRHA I aromatase inhibitor therapy of advanced breast cancer using and aromatase anastrozole tablet Breast UBRAVPALAI I inhibitor with or without LHRH agonist hormonal treatment for advanced endometrial cancer in anastrozole (cont'd) tablet Gynecology postmenopausal women with contraindications to tamoxifen or intolerant GOENDAI I of tamoxifen anastrozole (cont'd) tablet Gynecology therapy for advanced ovarian cancer using an aromatase inhibitor GOOVAI I

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DOSAGE TUMOUR PROTOCOL DRUG APPROVED INDICATIONS CLASS NOTES FORM SITE CODES first-line induction and consolidation therapy of acute promyelocytic injectable Leukemia LKATOATRA I leukemia using arsenic trioxide and first-line induction and consolidation therapy of acute promyelocytic arsenic trioxide injectable Leukemia LKATOP I leukemia using arsenic trioxide, tretinoin and induction and consolidation therapy of relapsed acute promyelocytic arsenic trioxide injectable Leukemia LKATOR I leukemia using arsenic trioxide and tretinoin (All-Trans Retinoic Acid) injectable Leukemia LKNOS, LYNOS I (KIDROLASE®) asparaginase-erwinia injectable Leukemia patients allergic to KIDROLASE® LKNOS, LYNOS I (ERWINASE®) second-line treatment of recurrent or metastatic merkel cell carcinoma avelumab injectable Skin & Melanoma USMMCCAVE R using avelumab axitinib tablet Genitourinary therapy for metastatic renal cell carcinoma using axitinib UGUAXIT R injectable Leukemia therapy of acute myeloid leukemia using azacitidine and sorafenib ULKAMLAS R azacitidine injectable Leukemia therapy of myelodysplastic syndrome ULKMDSA R The three substrains of BCG bacillus calmette guerin available are considered injectable Genitourinary therapy for high risk superficial transitional cell bladder cancer GUBCG I (BCG) interchangeable by BC Cancer for the treatment of bladder cancer (i.e., Montreal [PACIS] 120 mg = TICE [OncoTICE] 1 to 8 x 108 bacillus calmette guerin palliative therapy for BCG-refractory superficial high-grade transitional injectable Genitourinary GUBCGIFN I CFU = Connaught [ImmuCyst] 81 (BCG) (cont'd) cell carcinoma bladder with BCG and Interferon mg) BUT only the current contract brand is reimbursed at the current injectable Lymphoma treatment of Non-Hodgkin Lymphoma with bendamustine LYBEND I bendamustine injectable Lymphoma treatment of Non-Hodgkin Lymphoma with bendamustine and rituximab LYBENDR I bendamustine injectable Lymphoma treatment of relapsed chronic lymphocytic leukemia with bendamustine LYCLLBEND I treatment of relapsed/refractory chronic lymphocytic leukemia or small bendamustine injectable Lymphoma LYCLLBENDR I lymphocytic lymphoma with bendamustine and rituximab treatment of previously untreated chronic lymphocytic leukemia (CLL) bendamustine injectable Lymphoma LYCLLFBR I with bendamustine and rituximab treatment of rituximab-refractory follicular lymphoma with obinutuzumab bendamustine injectable Lymphoma ULYOBBEND R in combination with bendamustine

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DOSAGE TUMOUR PROTOCOL DRUG APPROVED INDICATIONS CLASS NOTES FORM SITE CODES palliative therapy of metastatic colorectal cancer using and bevacizumab injectable Gastrointestinal GIAVCAPB I bevacizumab palliative combination chemotherapy for metastatic colorectal cancer bevacizumab injectable Gastrointestinal GICIRB I using , bevacizumab and capecitabine palliative combination chemotherapy for metastatic colorectal cancer bevacizumab injectable Gastrointestinal GICOXB I using , bevacizumab and capecitabine palliative combination chemotherapy for metastatic colorectal cancer bevacizumab (cont'd) injectable Gastrointestinal GIFFIRB I using irinotecan, , folinic acid (leucovorin) and bevacizumab palliative combination chemotherapy for metastatic colorectal cancer bevacizumab (cont'd) injectable Gastrointestinal GIFFOXB I using oxaliplatin, fluorouracil, leucovorin, and bevacizumab bevacizumab (cont'd) injectable Neuro-Oncology patients with relapsed malignant gliomas CNBEV I primary treatment of metastatic/recurrent cancer of the cervix with bevacizumab injectable Gynecology GOCXCATB I bevacizumab, and treatment of platinum resistant epithelial ovarian cancer with bevacizumab injectable Gynecology UGOOVBEVG R bevacizumab and treatment of platinum resistant epithelial ovarian cancer with bevacizumab injectable Gynecology UGOOVBEVLD R bevacizumab and pegylated liposomal (CAELYX) treatment of platinum resistant epithelial ovarian cancer with bevacizumab injectable Gynecology UGOOVBEVP R bevacizumab and paclitaxel treatment of platinum resistant epithelial ovarian cancer with bevacizumab injectable Gynecology UGOOVBEVV R bevacizumab and primary treatment of invasive epithelial ovarian, fallopian tube and bevacizumab injectable Gynecology primary peritoneal cancer with high risk of relapse using bevacizumab, UGOOVCATB* R carboplatin and paclitaxel therapy for advanced solitary fibrous tumours and hemangiopericytoma bevacizumab (cont'd) injectable Sarcoma USATEMBEV R using and bevacizumab Approval from Health Canada capsule Lymphoma patients with refractory cutaneous T-cell lymphoma ULYMFBEX R Special Access Programme is required for each patient. Not reimbursed for vasomotor bicalutamide tablet Genitourinary nonsteroidal treatment of prostate cancer, at 50 mg po daily GUPNSAA I symptoms (hot flashes) or high dose monotherapy therapy of non-dysgerminomatous ovarian germ cell cancer using injectable Gynecology GOBEP I bleomycin, , and curative therapy for germ cell cancer using with bleomycin, etoposide, bleomycin injectable Genitourinary GUBEP I cisplatin for germ cell cancers palliative therapy for kaposi’s sarcoma using alternating with bleomycin injectable Kaposi's Sarcoma KSVB I Not reimbursed for pleurodesis treatment of Hodgkin lymphoma with doxorubicin, bleomycin, bleomycin injectable Lymphoma LYABVD I vinblastine, and Other tumour site code Not Otherwise bleomycin injectable followed by ‘NOS’ (e.g. I Specified LYNOS) treatment of Philadelphia chromosome negative refractory or relapsed blinatumomab injectable Leukemia ULKBLIN R pre-B-cell acute lymphoblastic leukemia with blinatumomab

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DOSAGE TUMOUR PROTOCOL DRUG APPROVED INDICATIONS CLASS NOTES FORM SITE CODES maintenance therapy for multiple myeloma using for patients bortezomib injectable Myeloma MYBORMTN I with the high-risk chromosome abnormality treatment of multiple myeloma using bortezomib, dexamethasone with injectable Myeloma MYBORPRE I or without as induction pre-stem cell transplant treatment of relapsed multiple myeloma using bortezomib, bortezomib injectable Myeloma MYBORREL I dexamethasone with or without cyclophosphamide treatment of relapsed and refractory multiple myeloma with bortezomib injectable Myeloma daratumumab in combination with bortezomib and dexamethasone with UMYDARBD R or without cyclophosphamide treatment of multiple myeloma using , prednisone and weekly bortezomib (cont'd) injectable Myeloma bortezomib with the option of substituting cyclophosphamide for MYMPBOR I melphalan bosutinib tablet Leukemia treatment of chronic myeloid leukemia using bosutinib ULKCMLB R treatment of Hodgkin lymphoma and anaplastic large cell lymphoma brentuximab vedotin injectable Lymphoma ULYBRENTUX R with brentuximab vedotin adjuvant therapy post-autologous stem cell transplant (ASCT) for ULYAJBV R Hodgkin Lymphoma using brentuximab vedotin bromocriptine tablet, capsule Neuro-Oncology therapy for pituitary adenomas using bromocriptine CNB I injectable, long- neoadjuvant or adjuvant ovarian suppression and aromatase inhibitor in buserelin Breast BRAJLHRHAI I acting injectable premenopausal women with high-risk early stage breast cancer neoadjuvant or adjuvant therapy for breast cancer using a LHRH buserelin (cont'd) injectable Breast BRAJLHRHT I agonist and tamoxifen therapy for advanced breast cancer using a LHRH agonist and an buserelin injectable Breast BRAVLHRHA I aromatase inhibitor Not reimbursed for endometriosis combination therapy with tamoxifen as palliative therapy for metastatic buserelin injectable Breast BRAVLHRHT I breast cancer therapy of advanced breast cancer using palbociclib and aromatase buserelin injectable Breast UBRAVPALAI R inhibitor with or without LHRH agonist buserelin (cont'd) injectable Genitourinary therapy for prostate cancer using LHRH agonist GUPLHRH I Tumour site code Not Otherwise tablet followed by ‘NOS’ I Specified (e.g. LKNOS) myeloablative conditioning therapy prior to hematopoietic stem cell busulfan injectable BMT BMTIVBUCY I transplantation for myeloid malignancies busulfan injectable Pediatric pediatric patients who cannot swallow oral busulfan I palliative therapy for metastatic castration resistant prostate cancer injectable Genitourinary UGUPCABA R using cabazitaxel and prednisone cabergoline tablet Neuro-Oncology therapy for pituitary adenomas using cabergoline CNCAB I

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DOSAGE TUMOUR PROTOCOL DRUG APPROVED INDICATIONS CLASS NOTES FORM SITE CODES capecitabine tablet Breast therapy of adjuvant breast cancer using capecitabine BRAJCAP I metastatic breast cancer as first line treatment if and contraindicated, or where sidfect profile and/or treatment capecitabine tablet Breast delivery concerns favour initial use of BRAVCAP; second or third line BRAVCAP I treatment of metastatic breast cancer that has previously responded to an and capecitabine tablet Breast therapy for metastatic breast cancer using capecitabine and lapatinib UBRAVLCAP R combination with trastuzumab (HERCEPTIN) as second-line treatment capecitabine tablet Breast of HER-2 positive metastatic breast cancer after prior treatment with UBRAVTCAP R trastuzumab (HERCEPTIN) capecitabine tablet Gastrointestinal adjuvant therapy of colon cancer using capecitabine GIAJCAP I adjuvant combination chemotherapy for stage III and IIB colon cancer capecitabine tablet Gastrointestinal GIAJCAPOX I with oxaliplatin first line palliative therapy of metastatic or unresectable colorectal capecitabine (cont'd) tablet Gastrointestinal adenocarcinoma in a patient either not suitable for or refusing GIAVCAP I GIIRFUFA palliative therapy of metastatic colorectal cancer using capecitabine and capecitabine (cont'd) tablet Gastrointestinal GIAVCAPB I bevacizumab palliative therapy of metastatic neuroendocrine cancer using capecitabine tablet Gastrointestinal GIAVTZCAP I temozolomide and capecitabine palliative combination chemotherapy for metastatic colorectal cancer capecitabine (cont'd) tablet Gastrointestinal GICAPIRI I using irinotecan and capecitabine in patients unsuitable for GIFOLFIRI palliative combination chemotherapy for metastatic colorectal cancer capecitabine (cont'd) tablet Gastrointestinal GICAPOX I using oxaliplatin and capecitabine combination with mitomycin and radiation therapy as curative combined capecitabine (cont'd) tablet Gastrointestinal GICART I modality therapy for carcinoma of the anal canal palliative combination chemotherapy for metastatic colorectal cancer capecitabine (cont'd) tablet Gastrointestinal GICIRB I using irinotecan, bevacizumab and capecitabine palliative combination chemotherapy for metastatic colorectal cancer capecitabine (cont'd) tablet Gastrointestinal GICOXB I using oxaliplatin, bevacizumab and capecitabine curative-intent combined modality therapy for cancer of the anal canal, capecitabine (cont'd) tablet Gastrointestinal GICPART I using cisplatin, capecitabine and radiation therapy adjuvant chemotherapy of gastric cancer patients with D2 resection capecitabine (cont'd) tablet Gastrointestinal (node negative) or ineligible for adjuvant chemoradiation using GIGAJCOX I oxaliplatin and capecitabine

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DOSAGE TUMOUR PROTOCOL DRUG APPROVED INDICATIONS CLASS NOTES FORM SITE CODES adjuvant chemotherapy of gastric cancer patients with completely capecitabine (cont'd) tablet Gastrointestinal resected gastric cancer using cisplatin and capecitabine and radiation GIGAJCPRT I therapy palliative therapy of metastatic or locally advanced anal squamous cell capecitabine (cont'd) tablet Gastrointestinal GIGAVCC I carcinoma using cisplatin and capecitabine palliative treatment of metastatic or locally advanced gastric, capecitabine (cont'd) tablet Gastrointestinal gastroesophageal junction, or esophageal adenocarcinoma using GIGAVCCT I cisplatin, capecitabine and trastuzumab (HERCEPTIN) palliative treatment of metastatic or locally advanced gastric, capecitabine (cont'd) tablet Gastrointestinal gastroesophageal junction, or esophageal adenocarcinoma using GIGAVCOX I capecitabine and oxaliplatin palliative treatment of metastatic or locally advanced gastric, capecitabine (cont'd) tablet Gastrointestinal gastroesophageal junction, or esophageal adenocarcinoma using GIGAVCOXT I capecitabine, oxaliplatin and trastuzumab (HERCEPTIN) treatment of operable cancer of the stomach, stomach-esophagus capecitabine (cont'd) tablet Gastrointestinal junction or lower 1/3 esophagus, given before and after surgery, using GIGECC I , cisplatin and capecitabine palliative therapy for metastatic or locally advanced gastric or capecitabine (cont'd) tablet Gastrointestinal GIGAVEOCAP I esophagogastric cancer using epirubicin, oxaliplatin and capecitabine adjuvant chemotherapy for resected pancreatic adenocarcinoma using capecitabine (cont'd) tablet Gastrointestinal GIPAJGCAP I capecitabine and gemcitabine second line treatment of metastatic or unresectable pancreatic capecitabine (cont'd) tablet Gastrointestinal GIPAVCAP I adenocarcinoma using capecitabine adjuvant combination chemotherapy for stage III rectal cancer with capecitabine (cont'd) tablet Gastrointestinal GIRAJCOX I oxaliplatin adjuvant capecitabine therapy for stage II and III rectal cancer capecitabine (cont'd) tablet Gastrointestinal GIRCAP I previously treated with preoperative radiotherapy combined modality adjuvant therapy for high risk rectal carcinoma using capecitabine (cont'd) tablet Gastrointestinal GIRCRT I capecitabine and radiation therapy combined modality adjuvant therapy for high risk rectal carcinoma using capecitabine (cont'd) tablet Gastrointestinal GIRINFRT I capecitabine, infusional fluorouracil and radiation therapy treatment of recurrent or metastatic nasopharyngeal cancer with capecitabine (cont'd) tablet Head and Neck HNNAVCAP I capecitabine

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DOSAGE TUMOUR PROTOCOL DRUG APPROVED INDICATIONS CLASS NOTES FORM SITE CODES neoadjuvant or adjuvant therapy for breast cancer using carboplatin, carboplatin injectable Breast BRAJDCARBT I and trastuzumab (HERCEPTIN) palliative therapy for metastatic breast cancer using cisplatin and carboplatin (cont'd) injectable Breast BRAVGEMP I gemcitabine palliative therapy for metastatic breast cancer using trastuzumab carboplatin (cont'd) injectable Breast (HERCEPTIN), paclitaxel and carboplatin as first-line treatment for BRAVTPCARB I advanced breast cancer carboplatin injectable Neuro-Oncology carboplatin and etoposide in the treatment of recurrent ependymoma CNCARV I first-line palliative chemotherapy for advanced gallbladder cancer and carboplatin injectable Gastrointestinal GIAVPG I cholangiocarcinoma using gemcitabine and cisplatin neoadjuvant treatment of esophageal and gastroesophageal carboplatin injectable Gastrointestinal GIENACTRT I carcinomas using carboplatin, paclitaxel and radiation therapy primary adjuvant treatment of adenocarcinoma/adenosquamous cancer carboplatin (cont'd) injectable Gynecology of the cervix with carboplatin and paclitaxel preceding or following GOCXAJCAT I irradiation with or without cisplatin treatment of advanced/recurrent non-small cell cancer of the cervix with carboplatin (cont'd) injectable Gynecology GOCXCAD I carboplatin and docetaxel primary treatment of advanced/recurrent non-small cell cancer of the carboplatin (cont'd) injectable Gynecology GOCXCAT I cervix with carboplatin and paclitaxel primary treatment of metastatic/recurrent cancer of the cervix with carboplatin injectable Gynecology GOCXCATB I bevacizumab, carboplatin and paclitaxel treatment of primarily advanced or recurrent endometrial cancer using carboplatin injectable Gynecology GOENDCAD I carboplatin and docetaxel treatment of primary advanced or recurrent endometrial cancer using carboplatin (cont'd) injectable Gynecology GOENDCAT I carboplatin and paclitaxel primary treatment with visible or no visible residual tumour (moderate, high, or extreme risk) or treatment at relapse of invasive epithelial carboplatin injectable Gynecology GOOVCAD I ovarian, fallopian tube, and primary peritoneal cancer, using carboplatin and docetaxel carboplatin and gemcitabine for the treatment of recurrent platinum- carboplatin (cont'd) injectable Gynecology GOOVCAG I sensitive ovarian cancer first or second line therapy for invasive epithelial ovarian cancer using carboplatin (cont'd) injectable Gynecology GOOVCARB I single-agent carboplatin primary treatment of invasive epithelial ovarian, fallopian tube and carboplatin (cont'd) injectable Gynecology primary peritoneal cancer with high risk of relapse using bevacizumab, UGOOVCATB* R carboplatin and paclitaxel primary treatment of invasive epithelial ovarian, fallopian tube and carboplatin (cont'd) injectable Gynecology primary peritoneal cancer, with no visible residual tumour (moderate- GOOVCATM I high risk) using carboplatin and paclitaxel second line treatment using paclitaxel and carboplatin for epithelial carboplatin (cont'd) injectable Gynecology GOOVCATR I ovarian cancer relapsing after primary treatment primary treatment of visible residual (extreme risk) invasive epithelial carboplatin (cont'd) injectable Gynecology ovarian cancer in ambulatory care settings using paclitaxel and GOOVCATX I carboplatin

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DOSAGE TUMOUR PROTOCOL DRUG APPROVED INDICATIONS CLASS NOTES FORM SITE CODES primary treatment of advanced epithelial ovarian, primary peritoneal, or carboplatin (cont'd) injectable Gynecology GOOVDDCAT I fallopian tube carcinoma using carboplatin and weekly paclitaxel first line treatment of epithelial ovarian cancer using doxorubicin carboplatin (cont'd) injectable Gynecology GOOVFPLDC I pegylated liposomal (CAELYX™) and carboplatin 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 carboplatin (cont'd) injectable Gynecology GOOVIPPC I papillary serous ovarian cancer using intravenous and intraperitoneal paclitaxel and intraperitoneal carboplatin second line treatment for epithelial ovarian cancer relapsing after carboplatin (cont'd) injectable Gynecology primary treatment using pegylated liposomal doxorubicin (PLD) and GOOVPLDC I carboplatin treatment of small cell or neuroendocrine carcinoma of gynecologic carboplatin (cont'd) injectable Gynecology system origin using paclitaxel, cisplatin, etoposide and carboplatin with GOSMCCRT I radiation palliative therapy for urothelial carcinoma using cisplatin and carboplatin (cont'd) injectable Genitourinary GUAVPG I gemcitabine carboplatin (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 therapy of genitourinary small cell tumors with a platin and etoposide carboplatin (cont'd) injectable Genitourinary GUSCPERT I with radiation treatment of advanced squamous cell carcinoma of the head and neck carboplatin (cont'd) injectable Head and Neck HNAVFUP I cancer using fluorouracil and platinum treatment for unresectable, locoregionally recurrent or metastatic carboplatin (cont'd) injectable Head and Neck squamous cell carcinoma of the head and neck using paclitaxel and HNAVPC I cisplatin or carboplatin treatment of recurrent or metastatic squamous cell carcinoma of the carboplatin (cont'd) injectable Head and Neck HNAVPD I head and neck with platinum and docetaxel treatment of recurrent and metastatic squamous cell cancer with carboplatin (cont'd) injectable Head and Neck HNAVPE I platinum and etoposide combined chemotherapy (carboplatin and fluorouracil) and radiation carboplatin (cont'd) injectable Head and Neck treatment for locally advanced squamous cell carcinoma of the head HNLACAFRT I and neck treatment for advanced nasopharyngeal cancer of the head and neck carboplatin (cont'd) injectable Head and Neck HNNAVFUP I using platinum and fluorouracil treatment of recurrent and/or metastatic nasopharyngeal cancer with carboplatin (cont'd) injectable Head and Neck HNNAVPE I platinum and etoposide treatment of locoregionally recurrent and/or metastatic nasopharyngeal carboplatin (cont'd) injectable Head and Neck HNNAVPG I cancer with platinum and gemcitabine treatment of recurrent or metastatic nasopharyngeal carcinoma with carboplatin (cont'd) injectable Head and Neck HNNAVPC I carboplatin and paclitaxel adjuvant carboplatin and paclitaxel following resection of stage I, II and carboplatin (cont'd) injectable Lung LUAJPC I IIIA non-small cell lung cancer first-line treatment of advanced non-small cell lung cancer with carboplatin (cont'd) injectable Lung LUAVPC I carboplatin and paclitaxel treatment of advanced non-small cell lung cancer with platinum and carboplatin (cont'd) injectable Lung LUAVPG I gemcitabine first-line treatment of advanced non-small cell lung cancer with platinum carboplatin (cont'd) injectable Lung LUAVPP I and

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DOSAGE TUMOUR PROTOCOL DRUG APPROVED INDICATIONS CLASS NOTES FORM SITE CODES treatment of locally advanced non-small cell lung cancer using carboplatin (cont'd) injectable Lung LULACATRT I carboplatin and paclitaxel with radiation therapy treatment of locally advanced non-small cell lung cancer using cisplatin carboplatin (cont'd) injectable Lung LULAPERT I and etoposide with radiation therapy treatment of locally advanced non-small cell lung cancer using carboplatin (cont'd) injectable Lung LULAPE2RT I alternative dosing of cisplatin and etoposide with radiation therapy carboplatin (cont'd) injectable Lung treatment of thymoma with cisplatin and etoposide LUOTPE I treatment of thymoma using cisplatin and etoposide with radiation carboplatin (cont'd) injectable Lung LUOTPERT I therapy therapy of extensive stage small cell lung cancer with cisplatin and carboplatin (cont'd) injectable Lung LUSCPE I etoposide therapy of limited stage small cell lung cancer using cisplatin and carboplatin (cont'd) injectable Lung LUSCPERT I etoposide with radiation second line treatment of extensive stage small cell lung cancer (SCLC) carboplatin (cont'd) injectable Lung LUSCPI I with irinotecan with or without platinum treatment of avanced stage large B-cell non-Hodgkin’s lymphoma with carboplatin (cont'd) injectable Lymphoma ULYRICE R , carboplatin, etoposide and rituximab primary treatment of cancer of unknown primary origin using carboplatin carboplatin (cont'd) injectable Primary Unknown PUCAT I and paclitaxel treatment of recurrent or metastatic Merkel cell carcinoma with cisplatin carboplatin (cont'd) injectable Skin & Melanoma SMMCCPE I and etoposide Other tumour site Not Otherwise carboplatin (cont'd) injectable code followed by I Specified ‘NOS’ (e.g. HNNOS) therapy of multiple myeloma using and dexamethasone with carfilzomib injectable Myeloma UMYCARDEX R or without cyclophosphamide therapy of multiple myeloma using carfilzomib, lenalidomide with carfilzomib injectable Myeloma UMYCARLD R dexamethasone injectable Lymphoma topical therapy in cutaneous T-cell lymphoma LYCARTOP I Other tumour site Not Otherwise carmustine injectable code followed by I Specified ‘NOS’ (e.g. LKNOS) treatment of ALK-positive advanced non-small cell lung cancer (NSCLC) ceritinib capsule Lung ULUAVCER R with ceritinib palliative third line treatment of metastatic colorectal cancer with wild- cetuximab injectable Gastrointestinal GIAVCETIR I type KRAS using cetuximab and irinotecan combined cetuximab and radiation treatment for locally advanced cetuximab (cont'd) injectable Head and Neck HNLACETRT I squamous cell carcinoma of the head and neck

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DOSAGE TUMOUR PROTOCOL DRUG APPROVED INDICATIONS CLASS NOTES FORM SITE CODES tablet Lymphoma low grade lymphoma and chronic lymphocytic leukemia LYCHLOR I chlorambucil tablet Lymphoma treatment of indolent B-cell lymphoma with chlorambucil and rituximab LYCHLRR I treatment of chronic lymphocytic leukemia with chlorambucil and chlorambucil tablet Lymphoma LYCLLCHLR I rituximab chlorambucil tablet Lymphoma lymphoma palliative chemotherapy LYPALL I treatment of previously untreated chronic lymphocytic leukemia using chlorambucil (cont'd) tablet Lymphoma ULYOBCHLOR R obinutuzumab in combination with chlorambucil Other tumour site Not Otherwise code followed by chlorambucil (cont'd) tablet I Specified ‘NOS’ (e.g. LKNOS, LYNOS) palliative therapy for metastatic breast cancer using cisplatin and cisplatin injectable Breast BRAVGEMP I gemcitabine adjuvant , cisplatin and vincristine in adult high-risk cisplatin Neuro-Oncology CNCCV I injectable medulloblastoma or other primitive neuroectodermal tumour first-line palliative chemotherapy for advanced gallbladder cancer and cisplatin Gastrointestinal GIAVPG I injectable cholangiocarcinoma using gemcitabine and cisplatin curative-intent combined modality therapy for cancer of the anal canal, cisplatin GICPART I injectable Gastrointestinal using cisplatin, capecitabine and radiation therapy Note: cisplatin solution and cisplatin powder (SAP) only hepatic trans-arterial chemoembolization for primary liver cancer or liver cisplatin (cont'd) injectable Gastrointestinal GIEMBOL I funded when prescribed by metastasis specialists at BC Cancer VC and Royal Jubilee Hospital palliative chemotherapy for upper gastrointestinal tract cancer (gastric, cisplatin (cont'd) injectable Gastrointestinal esophageal, gall bladder carcinoma and cholangiocarcinoma) and GIFUC I metastatic anal cancer using infusional fluorouracil and cisplatin combined modality curative therapy for carcinoma of the anal canal cisplatin (cont'd) injectable Gastrointestinal GIFUPART I using cisplatin, infusional fluorouracil and radiation therapy adjuvant chemotherapy of gastric cancer patients with completely cisplatin (cont'd) injectable Gastrointestinal resected gastric cancer using cisplatin and capecitabine and radiation GIGAJCPRT I therapy

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DOSAGE TUMOUR PROTOCOL DRUG APPROVED INDICATIONS CLASS NOTES FORM SITE CODES palliative therapy of metastatic or locally advanced anal squamous cell cisplatin (cont'd) injectable Gastrointestinal GIGAVCC I carcinoma using cisplatin and capecitabine palliative treatment of metastatic or locally advanced gastric, cisplatin (cont'd) injectable Gastrointestinal gastroesophageal junction, or esophageal adenocarcinoma using GIGAVCCT I cisplatin, capecitabine and trastuzumab (HERCEPTIN) palliative treatment of metastatic or inoperable, locally advanced gastric cisplatin (cont'd) or gastroesophageal junction adenocarcinoma using cisplatin, infusional GIGAVCFT I injectable Gastrointestinal fluorouracil and trastuzumab (HERCEPTIN) treatment of operable cancer of the stomach, stomach-esophagus cisplatin (cont'd) injectable Gastrointestinal junction or lower 1/3 esophagus, given before and after surgery, using GIGECC I epirubicin, cisplatin and capecitabine palliative therapy of neuroendocrine tumours using cisplatin and cisplatin (cont'd) injectable Gastrointestinal GIPE I etoposide hyperthermic intraperitoneal chemotherapy (HIPEC) for patients with cisplatin (cont'd) Gastrointestinal GIPMHIPEC I injectable peritoneal using doxorubicin, cisplatin and paclitaxel therapy of non-dysgerminomatous ovarian germ cell cancer using cisplatin (cont'd) injectable Gynecology GOBEP I bleomycin, etoposide and cisplatin alternative treatment of gynecological malignancies using cisplatin and cisplatin (cont'd) injectable Gynecology GOCISP I paclitaxel treatment of high risk squamous carcinoma, adenocarcinoma, or cisplatin (cont'd) injectable Gynecology adenosquamous carcinoma of the cervix with concurrent cisplatin and GOCXCRT I radiation therapy of dysgerminomatous ovarian germ cell cancer using cisplatin cisplatin (cont'd) injectable Gynecology GOEP I and etoposide cisplatin (cont'd) injectable Gynecology invasive epithelial ovarian cancer GOOVCIS I treatment of small cell or neuroendocrine carcinoma of gynecologic cisplatin (cont'd) injectable Gynecology system origin using paclitaxel, cisplatin, etoposide and carboplatin with GOSMCCRT I radiation adjuvant therapy for urothelial carcinoma using cisplatin and cisplatin (cont'd) injectable Genitourinary GUAJPG I gemcitabine palliative therapy for urothelial carcinoma using cisplatin and cisplatin (cont'd) injectable Genitourinary GUAVPG I gemcitabine curative therapy for germ cell cancer using bleomycin, etoposide and cisplatin (cont'd) injectable Genitourinary GUBEP I cisplatin treatment of locally advanced bladder cancer with weekly cisplatin and cisplatin (cont'd) injectable Genitourinary GUBPWRT I concurrent radiation treatment of metastatic adrenalcortical cancer with doxorubicin, cisplatin (cont'd) injectable Genitourinary GUEDPM I etoposide, cisplatin and cisplatin (cont'd) injectable Genitourinary therapy for nonseminoma germ cell cancer using etoposide-cisplatin GUEP I

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DOSAGE TUMOUR PROTOCOL DRUG APPROVED INDICATIONS CLASS NOTES FORM SITE CODES combined modality therapy for squamous cell cancer of the cisplatin (cont'd) injectable Genitourinary GUFUPRT I genitourinary system using fluorouracil and cisplatin with radiation therapy for transitional cell cancers of the urothelium using cisplatin (cont'd) injectable Genitourinary GUMVAC I , vinblastine, doxorubicin and cisplatin neo-adjuvant therapy for urothelial carcinoma using cisplatin and cisplatin (cont'd) injectable Genitourinary GUNAJPG I gemcitabine cisplatin (cont'd) injectable Genitourinary therapy of genitourinary small cell tumors with a platin and etoposide GUSCPE I therapy of genitourinary small cell tumors with a platin and etoposide cisplatin (cont'd) injectable Genitourinary GUSCPERT I with radiation therapy for relapsed testicular germ cell cancer using paclitaxel, cisplatin (cont'd) injectable Genitourinary UGUTIP R ifosfamide and cisplatin consolidation/ salvage treatment for germ cell cancer using vinblastine, cisplatin (cont'd) injectable Genitourinary GUVEIP I cisplatin, ifosfamide and mesna nonseminoma consolidation/salvage protocol using etoposide, cisplatin, cisplatin (cont'd) injectable Genitourinary GUVIP2 I ifosfamide, mesna treatment of advanced squamous cell carcinoma of the head and neck cisplatin (cont'd) injectable Head and Neck HNAVFUP I cancer using fluorouracil and platinum palliative chemotherapy for advanced head and neck squamous cell cisplatin (cont'd) injectable Head and Neck HNAVP I carcinoma with weekly cisplatin treatment for unresectable, locoregionally recurrent or metastatic cisplatin (cont'd) injectable Head and Neck squamous cell carcinoma of the head and neck using paclitaxel and HNAVPC I cisplatin or carboplatin treatment of recurrent or metastatic squamous cell carcinoma of the cisplatin (cont'd) injectable Head and Neck HNAVPD I head and neck with platinum and docetaxel treatment of recurrent and metastatic squamous cell cancer with cisplatin (cont'd) injectable Head and Neck HNAVPE I platinum and etoposide treatment of locally advanced (alternate) head and neck cancer using cisplatin (cont'd) injectable Head and Neck HNLAALTPRT I cisplatin during radiation therapy treatment of locally advanced squamous cell carcinoma of the head and cisplatin (cont'd) injectable Head and Neck UHNLADCF R neck with docetaxel, cisplatin and infusional fluorouracil combined chemotherapy (cisplatin) and radiation treatment for locally cisplatin (cont'd) injectable Head and Neck HNLAPRT I advanced squamous cell carcinoma of the head and neck treatment for advanced nasopharyngeal cancer of the head and neck cisplatin (cont'd) injectable Head and Neck HNNAVFUP I using platinum and fluorouracil palliative chemotherapy for advanced head and neck nasopharyngeal cisplatin (cont'd) injectable Head and Neck HNNAVP I carcinoma with weekly cisplatin treatment of recurrent and/or metastatic nasopharyngeal cancer with cisplatin (cont'd) injectable Head and Neck HNNAVPE I platinum and etoposide treatment of locoregionally recurrent and/or metastatic nasopharyngeal cisplatin (cont'd) injectable Head and Neck HNNAVPG I cancer with platinum and gemcitabine

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DOSAGE TUMOUR PROTOCOL DRUG APPROVED INDICATIONS CLASS NOTES FORM SITE CODES induction treatment of locally advanced nasopharyngeal cancer with cisplatin (cont'd) injectable Head and Neck HNNLAPG I cisplatin and gemcitabine treatment of locally advanced nasopharyngeal cancer with concurrent cisplatin (cont'd) injectable Head and Neck HNNLAPRT I cisplatin and radiation treatment of advanced head and neck cancer using cisplatin and cisplatin (cont'd) injectable Head and Neck HNSAVFUP I fluorouracil treatment of advanced salivary gland cancers with cisplatin and cisplatin (cont'd) injectable Head and Neck HNSAVNP I vinorelbine treatment of advanced salivary gland cancers with platinum, doxorubicin cisplatin (cont'd) injectable Head and Neck HNSAVPAC I and cyclophospahmide adjuvant cisplatin and vinorelbine following resection of non-small cell cisplatin (cont'd) injectable Lung LUAJNP I lung cancer first-line treatment of advanced non-small cell lung cancer with cisplatin cisplatin (cont'd) injectable Lung LUAVDC I and docetaxel treatment for advanced non-small cell lung cancer with cisplatin and cisplatin (cont'd) injectable Lung LUAVNP I vinorelbine treatment of advanced non-small cell lung cancer with platinum and cisplatin (cont'd) injectable Lung LUAVPG I gemcitabine first-line treatment of advanced non-small cell lung cancer with platinum cisplatin (cont'd) injectable Lung LUAVPP I and pemetrexed treatment of locally advanced non-small cell lung cancer using cisplatin cisplatin (cont'd) injectable Lung LULAPERT I and etoposide with radiation therapy treatment of locally advanced non-small cell lung cancer using cisplatin (cont'd) injectable Lung LULAPE2RT I alternative dosing of cisplatin and etoposide with radiation therapy 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 treatment of thymoma using cisplatin and etoposide with radiation cisplatin (cont'd) injectable Lung LUOTPERT I therapy treatment of cancer of unknown primary involving the thorax with cisplatin (cont'd) injectable Lung LUPUPE I cisplatin and etoposide therapy of extensive stage small cell lung cancer with cisplatin and cisplatin (cont'd) injectable Lung LUSCPE I etoposide therapy of limited stage small cell lung cancer using cisplatin and cisplatin (cont'd) injectable Lung LUSCPERT I etoposide with radiation second line treatment of extensive stage small cell lung cancer (SCLC) cisplatin (cont'd) injectable Lung LUSCPI I with irinotecan with or without platinum cisplatin (cont'd) injectable Lymphoma treatment of lymphoma with gemcitabine, dexamethasone and cisplatin LYGDP I

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DOSAGE TUMOUR PROTOCOL DRUG APPROVED INDICATIONS CLASS NOTES FORM SITE CODES treatment of lymphoma with gemcitabine, dexamethasone and cisplatin cisplatin (cont'd) injectable Lymphoma LYGDPR I with rituximab Treatment of newly diagnosed nasal, extranodal natural killer (NK) or T- cell lymphoma, stage IE to IIE using concurrent radiation and weekly cisplatin (cont'd) injectable Lymphoma LYVIPDRT I cisplatin followed by etoposide, ifosfamide, cisplatin and dexamethasone 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 hyperthermic intraperitoneal chemotherapy (HIPEC) for patients with cisplatin (cont'd) injectable Sarcoma peritoneal desmoplastic small round cell tumour (DSRCT) using SAHIPEC I CISplatin treatment of recurrent or metastatic Merkel cell carcinoma with cisplatin cisplatin (cont'd) injectable Skin & Melanoma SMMCCPE I and etoposide Other tumour site Not Otherwise cisplatin (cont'd) injectable code followed by I Specified ‘NOS’ (e.g. HNNOS) injectable Lymphoma hairy cell leukemia LYCDA I bony metastases associated with breast cancer or acute bone pain clodronate capsule Breast BRAVCLOD I Not reimbursed for hypercalcemia secondary to metastatic breast cancer treatment of BRAF V600 mutation-positive unresectable or metastatic cobimetinib tablet Skin & Melanoma USMAVVC R melanoma using vemurafenib and cobimetinib treatment of metastatic adrenalcortical cancer with doxorubicin, cortisone tablet Genitourinary GUEDPM I etoposide, cisplatin and mitotane cortisone tablet Genitourinary treatment of adrenal cortical cancer using mitotane GUMITO I Other tumour site Not Otherwise cortisone tablet code followed by I Specified ‘NOS’ (e.g. GUNOS) second-line treatment of ALK-positive advanced non-small cell lung crizotinib tablet Lung LUAVCRIZ I cancer (NSCLC) with crizotinib first-line treatment of ALK-positive advanced non-small cell lung cancer crizotinib (cont'd) tablet Lung LUAVCRIZF I (NSCLC) with crizotinib myeloablative conditioning therapy prior to autologous and allogeneic cyclophosphamide tablet, injectable BMT hematopoietic stem cell transplantation for myeloid malignancies using BMTIVBUCY I IV busulfan and cyclophosphamide adjuvant therapy for breast cancer using doxorubicin and cyclophosphamide tablet, injectable Breast BRAJAC I cyclophosphamide neoadjuvant or adjuvant therapy for breast cancer using doxorubicin cyclophosphamide (cont'd) tablet, injectable Breast BRAJACT I and cyclophosphamide followed by paclitaxel neoadjuvant or adjuvant therapy for breast cancer using dose dense cyclophosphamide (cont'd) tablet, injectable Breast BRAJACTG I therapy: doxorubicin and cyclophosphamide followed by paclitaxel

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DOSAGE TUMOUR PROTOCOL DRUG APPROVED INDICATIONS CLASS NOTES FORM SITE CODES neoadjuvant or adjuvant therapy for breast cancer using doxorubicin cyclophosphamide (cont'd) tablet, injectable Breast and cyclophosphamide followed by paclitaxel and trastuzumab BRAJACTT I (HERCEPTIN) neoadjuvant or adjuvant therapy for breast cancer using dose dense cyclophosphamide tablet, injectable Breast therapy: doxorubicin and cyclophosphamide followed by paclitaxel and BRAJACTTG I trastuzumab (HERCEPTIN) neoadjuvant or adjuvant therapy for early breast cancer using cyclophosphamide tablet, injectable Breast BRAJACTW I doxorubicin and cyclophosphamide followed by weekly paclitaxel adjuvant therapy for high-risk breast cancer using cyclophosphamide cyclophosphamide (cont'd) tablet, injectable BRAJCMFPO I Breast (oral), methotrexate and fluorouracil neoadjuvant or adjuvant therapy for breast cancer using cyclophosphamide (cont'd) tablet, injectable UBRAJDAC R Breast cyclophosphamide, doxorubicin and docetaxel neoadjuvant or adjuvant therapy for breast cancer using docetaxel and cyclophosphamide (cont'd) tablet, injectable Breast BRAJDC I cyclophosphamide adjuvant therapy for breast cancer using fluorouracil, epirubicin and cyclophosphamide (cont'd) tablet, injectable Breast BRAJFEC I cyclophosphamide neoadjuvant or adjuvant therapy for breast cancer using fluorouracil, cyclophosphamide (cont'd) tablet, injectable Breast BRAJFECD I epirubicin and cyclophosphamide and docetaxel neoadjuvant or adjuvant therapy for breast cancer using fluorouracil, cyclophosphamide (cont'd) tablet, injectable epirubicin and cyclophosphamide followed by docetaxel and BRAJFECDT I Breast trastuzumab (HERCEPTIN) neoadjuvant or adjuvant therapy for breast cancer using trastuzumab cyclophosphamide (cont'd) tablet, injectable Breast BRAJTDC I (HERCEPTIN), docetaxel and cyclophosphamide palliative therapy for metastatic breast cancer using doxorubicin and cyclophosphamide (cont'd) tablet, injectable Breast BRAVAC I cyclophosphamide palliative therapy for advanced breast cancer using cyclophosphamide, cyclophosphamide (cont'd) tablet, injectable BRAVCMF I Breast methotrexate and fluorouracil palliative therapy for metastatic breast cancer using metronomic low- cyclophosphamide (cont'd) tablet, injectable BRAVCMPO I Breast dose oral cyclophosphamide and methotrexate treatment of locally advanced breast cancer using doxorubicin and cyclophosphamide (cont'd) tablet, injectable Breast BRLAACD I cyclophosphamide followed by docetaxel treatment of locally advanced breast cancer using doxorubicin and cyclophosphamide (cont'd) tablet, injectable Breast cyclophosphamide followed by docetaxel and trastuzumab BRLAACDT I (HERCEPTIN) neoadjuvant therapy for breast cancer using dose dense therapy: cyclophosphamide (cont'd) injectable Breast BRLATACG I paclitaxel followed by doxorubicin and cyclophosphamide treatment of locally advanced breast cancer using doxorubicin and cyclophosphamide (cont'd) injectable Breast BRLATWAC I cyclophosphamide followed by weekly paclitaxel palliative therapy for relapsed/progressing epithelial ovarian, primary cyclophosphamide (cont'd) tablet, injectable Gynecology peritoneal, or fallopian tube carcinoma using metronomic low-dose oral GOOVCYCPO I cyclophosphamide

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DOSAGE TUMOUR PROTOCOL DRUG APPROVED INDICATIONS CLASS NOTES FORM SITE CODES therapy for high-risk Gestational Trophoblastic Neoplasia (GTN) using cyclophosphamide (cont'd) tablet, injectable Gynecology etoposide, methotrexate, leucovorin (folinic acid), , GOTDEMACO I cyclophosphamide and vincristine palliative therapy for advanced salivary gland cancers using cyclophosphamide (cont'd) tablet, injectable Head and Neck HNSAVFAC I cyclophosphamide, doxorubicin and fluorouracil treatment of advanced salivary gland cancers with platinum, doxorubicin cyclophosphamide (cont'd) tablet, injectable Head and Neck HNSAVPAC I and cyclophospahmide treatment of thymoma/thymic carcinoma with cyclophosphamide, cyclophosphamide (cont'd) tablet, injectable Lung LUOTCAV I doxorubicin and vincristine cyclophosphamide (cont'd) tablet, injectable Lung treatment of thymoma with platinum, doxorubicin and cyclophosphamide LUOTPAC I

treatment of extensive small cell lung cancer with cyclophosphamide, cyclophosphamide (cont'd) tablet, injectable Lung LUSCCAV I doxorubicin and vincristine treatment of lymphoma with doxorubicin, cyclophosphamide, vincristine cyclophosphamide (cont'd) tablet, injectable Lymphoma LYCHOP I and prednisone treatment of lymphoma with doxorubicin, cyclophosphamide, vincristine, cyclophosphamide (cont'd) tablet, injectable Lymphoma LYCHOPR I prednisone and rituximab treatment of relapsed chronic lymphocytic leukemia using cyclophosphamide (cont'd) tablet, injectable Lymphoma LYCLLCVPR I cyclophosphamide, vincristine, prednisone and rituximab treatment of Burkitt’s Lymphoma and Leukemia with cyclophosphamide, cyclophosphamide (cont'd) tablet, injectable Lymphoma LYCODOXMR I vincristine, doxorubicin, methotrexate, leucovorin and rituximab advanced indolent lymphoma using cyclophosphamide, vincristine and cyclophosphamide (cont'd) tablet, injectable Lymphoma LYCVP I prednisone treatment of Hodgkin's disease with cyclophosphamide, vinblastine, cyclophosphamide (cont'd) tablet, injectable Lymphoma LYCVPPABO I and prednisone treatment of advanced indolent lymphoma using cyclophosphamide, cyclophosphamide (cont'd) tablet, injectable Lymphoma LYCVPR I vincristine, prednisone and rituximab therapy of lymphoma, Hodgkin's disease, chronic lymphocytic leukemia cyclophosphamide (cont'd) tablet, injectable Lymphoma LYCYCLO I or multiple myeloma using cyclophosphamide treatment of lymphoma with dose-adjusted etoposide, doxorubicin, cyclophosphamide (cont'd) tablet, injectable Lymphoma vincristine, cyclophosphamide, prednisone and rituximab with LYEPOCHR I intrathecal methotrexate treatment of chronic lymphocytic leukemia (CLL) or prolymphocytic cyclophosphamide (cont'd) tablet, injectable Lymphoma LYFCR I leukemia with fludarabine, cyclophosphamide and rituximab

cyclophosphamide (cont'd) tablet, injectable Lymphoma lymphoma palliative chemotherapy LYPALL I

treatment of multiple myeloma using bortezomib, dexamethasone with cyclophosphamide (cont'd) tablet, injectable Myeloma MYBORPRE I or without cyclophosphamide as induction pre-stem cell transplant treatment of relapsed multiple myeloma using bortezomib, cyclophosphamide (cont'd) tablet, injectable Myeloma MYBORREL I dexamethasone with or without cyclophosphamide

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DOSAGE TUMOUR PROTOCOL DRUG APPROVED INDICATIONS CLASS NOTES FORM SITE CODES therapy of multiple myeloma using carfilzomib and dexamethasone with cyclophosphamide (cont'd) tablet, injectable Myeloma UMYCARDEX R or without cyclophosphamide treatment of relapsed and refractory multiple myeloma with cyclophosphamide (cont'd) tablet, injectable Myeloma daratumumab in combination with bortezomib and dexamethasone with UMYDARBD R or without cyclophosphamide treatment of multiple myeloma using melphalan, prednisone and weekly cyclophosphamide (cont'd) tablet, injectable Myeloma bortezomib with the option of substituting cyclophosphamide for MYMPBOR I melphalan single dose cyclophosphamide priming therapy for multiple myeloma cyclophosphamide (cont'd) tablet, injectable Myeloma MYHDC I prior to autologous stem cell transplant SAIME alternating with SAVAC or SAVACM with filgrastim support at a TWO weekly interval for newly diagnosed Ewing's Sarcoma/Ewing’s cyclophosphamide (cont'd) tablet, injectable Sarcoma SAALT2W I Family of Tumours, Desmoplastic Intra-Abdominal Small Round Blue Cell Tumour or Rhabdomyosarcoma SAIME alternating with SAVAC or SAVACM with filgrastim support at a THREE weekly interval for newly diagnosed Ewing's Sarcoma/Ewing’s cyclophosphamide (cont'd) tablet, injectable Sarcoma SAALT3W I Family of Tumours, Desmoplastic Intra-Abdominal Small Round Blue Cell Tumour or Rhabdomyosarcoma summary for treatment of recurrent/refractory neuroblastoma, ewing’s cyclophosphamide (cont'd) tablet, injectable Sarcoma sarcoma, osteogenic sarcoma or rhabdomyosarcoma with SAAVTC I /cyclophosphamide treatment of sarcomas with vincristine, doxorubicin and cyclophosphamide (cont'd) tablet, injectable Sarcoma SAVAC I cyclophosphamide treatment of sarcomas with pelvic primaries or chemotherapy induced cyclophosphamide (cont'd) tablet, injectable Sarcoma SAVACM I hematuria using vincristine, doxorubicin, cyclophosphamide and mesna adjuvant therapy for rhabdomyosarcoma using vincristine, dactinomycin cyclophosphamide (cont'd) tablet, injectable Sarcoma SAVDC I and cyclophosphamide adjuvant therapy for rhabdomyosarcoma using vincristine, dactinomycin, cyclophosphamide (cont'd) tablet, injectable Sarcoma SAVDCM I cyclophosphamide and mesna treatment of recurrent/refractory rhabdomysarcoma in pediatric patients cyclophosphamide (cont'd) tablet, injectable Pediatric with cyclophosphamide, vinorelbine and temsirolimus on the COG I ARST0921 protocol* Other tumour site Not Otherwise cyclophosphamide (cont'd) tablet, injectable code followed by I Specified ‘NOS’ (e.g. BRNOS) cytopenias associated with lymphoproliferative disorder of large cyclosporine capsule Lymphoma LYCSPA I granular lymphocytes treatment of hemophagocytic lymphohistiocytosis with etoposide, cyclosporine capsule Lymphoma HLHETCSPA I dexamethasone and cyclosporine

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DOSAGE TUMOUR PROTOCOL DRUG APPROVED INDICATIONS CLASS NOTES FORM SITE CODES injectable Leukemia therapy of acute myeloid leukemia using low dose cytarabine LKAMLCYT I treatment of Burkitt’s lymphoma and leukemia with cyclophosphamide, cytarabine injectable Lymphoma LYCODOXMR I vincristine, doxorubicin, methotrexate, leucovorin and rituximab cytarabine injectable Lymphoma treatment of lymphoma using intrathecal methotrexate and cytarabine LYIT I treatment of Burkitt’s lymphoma and leukemia with ifosfamide, mesna, cytarabine injectable Lymphoma LYIVACR I etoposide, cytarabine and rituximab therapy for solid tumours using intrathecal methotrexate and/or cytarabine (cont'd) injectable Miscellaneous Origins MOIT I and/or cytarabine Other tumour site Not Otherwise cytarabine (cont'd) injectable code followed by I Specified ‘NOS’ (e.g. LYNOS) treatment of BRAF V600 mutation-positive unresectable or metastatic dabrafenib capsule Skin & Melanoma USMAVDAB R melanoma using dabrafenib treatment of BRAF V600 mutation-positive unresectable or metastatic dabrafenib capsule Skin & Melanoma USMAVDT R melanoma using dabrafenib and trametinib treatment of Hodgkin's disease with doxorubicin, bleomycin, vinblastine dacarbazine injectable Lymphoma LYABVD I and dacarbazine adjuvant treatment of patients with soft tissue sarcoma using dacarbazine (cont'd) injectable Sarcoma SAAJADIC I doxorubicin and dacarbazine treatment of patients with soft tissue sarcoma using doxorubicin and dacarbazine injectable Sarcoma SAAVADIC I dacarbazine dacarbazine injectable Sarcoma high dose single agent dacarbazine for metastatic soft tissue sarcoma SADTIC I therapy for metastatic malignant melanoma using high dose single dacarbazine injectable Skin & Melanoma SMDTIC I agent dacarbazine Other tumour site Not Otherwise dacarbazine (cont'd) injectable code followed by I Specified ‘NOS’ (e.g. SMNOS)

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DOSAGE TUMOUR PROTOCOL DRUG APPROVED INDICATIONS CLASS NOTES FORM SITE CODES therapy for high-risk Gestational Trophoblastic Neoplasia (GTN) using dactinomycin injectable Gynecology etoposide, methotrexate, leucovorin (folinic acid), dactinomycin, GOTDEMACO I cyclophosphamide and vincristine therapy for low risk gestational trophoblastic neoplasia using dactinomycin injectable Gynecology GOTDLR I methotrexate, leucovorin and actinomycin-D adjuvant therapy for rhabdomyosarcoma using vincristine, dactinomycin dactinomycin injectable Sarcoma SAVDC I and cyclophosphamide adjuvant therapy for rhabdomyosarcoma using vincristine, dactinomycin, dactinomycin (cont'd) injectable Sarcoma SAVDCM I cyclophosphamide and mesna Other tumour site Not Otherwise dactinomycin injectable code followed by I Specified ‘NOS’ (e.g. SANOS) treatment of relapsed and refractory multiple myeloma with daratumumab injectable Myeloma daratumumab in combination with bortezomib and dexamethasone with UMYDARBD R or without cyclophosphamide treatment of relapsed and refractory multiple myeloma with daratumumab injectable Myeloma UMYDARLD R daratumumab in combination with lenalidomide and dexamethasone dasatinib tablet Leukemia chronic myeloid leukemia and Ph+ acute lymphoblastic leukemia ULKCMLD R first-line induction and consolidation therapy of acute promyelocytic daunorubicin injectable Leukemia LKATOP I leukemia using arsenic trioxide, tretinoin and daunorubicin Other tumour site Not Otherwise daunorubicin injectable code followed by I Specified ‘NOS’ (e.g. KSNOS) degarelix injectable Genitourinary therapy for prostate cancer using LHRH antagonist GUPLHRHA I neoadjuvant use in patients with non-metastatic operable giant cell denosumab (XGEVA®) injectable Sarcoma USANADENO R tumour of the bone

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DOSAGE TUMOUR PROTOCOL DRUG APPROVED INDICATIONS CLASS NOTES FORM SITE CODES palliative therapy for metastatic castration resistant prostate cancer dexamethasone tablet Genitourinary UGUPABI R using abiraterone and prednisone after failure of docetaxel therapy palliative therapy for metastatic hormone refractory prostate cancer GUPDOC I

treatment of hemophagocytic lymphohistiocytosis with etoposide, dexamethasone tablet Lymphoma HLHETCSPA I dexamethasone and cycloSPORINE treatment of refractory or relapsing extranodal natural killer or T-Cell dexamethasone tablet Lymphoma LYASPMEDEX I lymphoma using , methotrexate and dexamethasone dexamethasone tablet Lymphoma treatment of lymphoma with gemcitabine, dexamethasone and cisplatin LYGDP I treatment of lymphoma with gemcitabine, dexamethasone and cisplatin dexamethasone Lymphoma LYGDPR I tablet with rituximab dexamethasone tablet Lymphoma lymphoma palliative chemotherapy LYPALL I treatment of natural killer or T-Cell Lymphoma using dexamethasone, dexamethasone Lymphoma LYSMILE I tablet methotrexate, ifosfamide, pegaspargase and etoposide treatment of newly diagnosed nasal, extranodal natural killer (NK) or T- cell lymphoma, stage IE to IIE using concurrent radiation and weekly dexamethasone (cont'd) tablet Lymphoma LYVIPDRT I cisplatin followed by etoposide, ifosfamide, cisplatin and dexamethasone treatment of multiple myeloma using bortezomib, dexamethasone with dexamethasone (cont'd) tablet Myeloma MYBORPRE I or without cyclophosphamide as induction pre-stem cell transplant Not reimbursed for: treatment of relapsed multiple myeloma using bortezomib, dexamethasone MYBORREL I anti-emetic treatment, steroid tablet Myeloma dexamethasone with or without cyclophosphamide replacement therapy, pre-taxane therapy of multiple myeloma using carfilzomib and dexamethasone with dexamethasone UMYCARDEX R use, or appetite stimulation tablet Myeloma or without cyclophosphamide therapy of multiple myeloma using carfilzomib, lenalidomide with dexamethasone UMYCARLD R tablet Myeloma dexamethasone treatment of relapsed and refractory multiple myeloma with dexamethasone daratumumab in combination with bortezomib and dexamethasone with UMYDARBD R tablet Myeloma or without cyclophosphamide treatment of relapsed and refractory multiple myeloma with dexamethasone UMYDARLD R tablet Myeloma daratumumab in combination with lenalidomide and dexamethasone treatment of previously untreated multiple myeloma and not eligible for dexamethasone UMYLDF R tablet Myeloma stem cell transplant using lenalidomide with low-dose dexamethasone therapy of relapsed multiple myeloma using lenalidomide with dexamethasone (cont'd) UMYLDREL R tablet Myeloma dexamethasone treatment of multiple myeloma using melphalan, prednisone and weekly dexamethasone (cont'd) bortezomib with the option of substituting cyclophosphamide for MYMPBOR I tablet Myeloma melphalan dexamethasone tablet Myeloma therapy of multiple myeloma using pomalidomide with dexamethasone UMYPOMDEX R patients with primary or metastatic disease exhibiting cerebral edema or dexamethasone (cont'd) tablet Miscellaneous Origins CNS swelling; management of malignant brain tumours; management of MODEXA I CNS lymphoma

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DOSAGE TUMOUR PROTOCOL DRUG APPROVED INDICATIONS CLASS NOTES FORM SITE CODES Other tumour site Not Otherwise code followed by dexamethasone (cont'd) tablet I Not reimbursed for: anti-emetic Specified ‘NOS’ (for e.g. treatment, steroid replacement CNNOS) therapy, pre-taxane use, or Other tumour site Not Otherwise appetite stimulation dexamethasone (cont'd) injectable code followed by I Specified ‘NOS’ (e.g. BRNOS) pediatric patients with neuroblastoma treated on the CCG AEWS1031 dexrazoxane injectable Pediatric I protocol pediatric patients with rhabdomyosarcoma treated on the COG dexrazoxane (cont'd) injectable Pediatric I ARST08P1 protocol neoadjuvant or adjuvant therapy for breast cancer using docetaxel injectable Breast UBRAJDAC R cyclophosphamide, doxorubicin and docetaxel neoadjuvant or adjuvant therapy for breast cancer using docetaxel and docetaxel (cont'd) injectable Breast BRAJDC I cyclophosphamide neoadjuvant or adjuvant therapy for breast cancer using carboplatin, docetaxel (cont'd) injectable Breast BRAJDCARBT I docetaxel and trastuzumab (HERCEPTIN) neoadjuvant or adjuvant therapy for breast cancer using fluorouracil, docetaxel (cont'd) injectable Breast BRAJFECD I epirubicin and cyclophosphamide and docetaxel neoadjuvant or adjuvant therapy for breast cancer using fluorouracil, docetaxel (cont'd) injectable Breast epirubicin and cyclophosphamide followed by docetaxel and BRAJFECDT I trastuzumab (HERCEPTIN) neoadjuvant or adjuvant therapy for breast cancer using trastuzumab docetaxel (cont'd) injectable Breast BRAJTDC I (HERCEPTIN), docetaxel and cyclophosphamide combination with doxorubicin and cyclophosphamide as treatment of docetaxel (cont'd) injectable Breast BRLAACD I locally advanced breast cancer treatment of locally advanced breast cancer using doxorubicin and docetaxel (cont'd) injectable Breast cyclophosphamide followed by docetaxel and trastuzumab BRLAACDT I (HERCEPTIN) first, second, or third line treatment of metastatic breast cancer patients docetaxel (cont'd) injectable Breast with ECOG performance status 0, 1, or 2, and greater than 3 month life BRAVDOC I expectancy weekly docetaxel regimen for metastatic breast cancer patients with docetaxel (cont'd) injectable Breast poor tolerance to 3-weekly docetaxel regimen (BRAVDOC) or high BRAVDOC7 I doses of dexamethasone used in BRAVDOC palliative therapy for metastatic breast cancer using gemcitabine and docetaxel (cont'd) injectable Breast BRAVGEMD I docetaxel palliative therapy for metastatic breast cancer using pertuzumab, docetaxel (cont'd) injectable Breast trastuzumab (HERCEPTIN) and docetaxel as first-line treatment for BRAVPTRAD I advanced breast cancer with trastuzumab (HERCEPTIN) as first-line treatment for advanced docetaxel (cont'd) injectable Breast BRAVTRAD I breast cancer refractory to anthracycline adjuvant chemotherapy palliative treatment of metastatic esophagogastric adenocarcinoma with docetaxel (cont'd) injectable Gastrointestinal GIAVDOC I docetaxel perioperative treatment of resectable adenocarcinoma of the stomach, docetaxel (cont'd) injectable Gastrointestinal gastroesophageal junction or lower 1/3 esophagus using docetaxel, GIGFLODOC I oxaliplatin, infusional fluorouracil, and leucovorin

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DOSAGE TUMOUR PROTOCOL DRUG APPROVED INDICATIONS CLASS NOTES FORM SITE CODES combination with carboplatin as primary treatment of docetaxel (cont'd) injectable Gynecology advanced/recurrent non-small cell cancer of the cervix in ambulatory GOCXCAD I care settings treatment of primarily advanced or recurrent endometrial cancer using docetaxel (cont'd) injectable Gynecology GOENDCAD I carboplatin and docetaxel primary treatment with visible or no visible residual tumour (moderate, high, or extreme risk) or treatment at relapse of invasive epithelial docetaxel (cont'd) injectable Gynecology GOOVCAD I ovarian, fallopian tube, and primary peritoneal cancer, using carboplatin and docetaxel treatment of progressive, platinum-refractory epithelial ovarian docetaxel (cont'd) injectable Gynecology GOOVDOC I carcinoma, primary peritoneal combination with gemcitabine for advanced or recurrent uterine docetaxel (cont'd) injectable Gynecology GOSADG I sarcoma cancer intravesical use for bladder cancer if BCG and not docetaxel (cont'd) injectable Genitourinary GUNOS I available docetaxel (cont'd) injectable Genitourinary palliative therapy for metastatic hormone refractory prostate cancer GUPDOC I first-line treatment of castration sensitive, metastatic prostate cancer docetaxel (cont'd) injectable Genitourinary using docetaxel and androgen deprivation therapy with LHRH agonist or GUPDOCADT I LHRH antagonist with or without antiandrogen, or surgical castration treatment of recurrent or metastatic squamous cell carcinoma of the docetaxel (cont'd) injectable Head and Neck HNAVDOC I head and neck with docetaxel treatment of recurrent or metastatic squamous cell carcinoma of the docetaxel (cont'd) injectable Head and Neck HNAVPD I head and neck with platinum and docetaxel treatment of locally advanced squamous cell carcinoma of the head and docetaxel (cont'd) injectable Head and Neck UHNLADCF R neck with docetaxel, cisplatin and infusional fluorouracil combination with cisplatin as first line treatment of advanced non-small docetaxel (cont'd) injectable Lung LUAVDC I lung cancer docetaxel (cont'd) injectable Lung second-line treatment of non-small cell lung cancer LUAVDOC I combination with gemcitabine as second or third line therapy for soft docetaxel (cont'd) injectable Sarcoma SAAVGEMD I tissue sarcomas

* denotes change Page 23 of 57 BC Cancer Benefit Drug List August 2019

DOSAGE TUMOUR PROTOCOL DRUG APPROVED INDICATIONS CLASS NOTES FORM SITE CODES adjuvant therapy for breast cancer using doxorubicin and doxorubicin injectable Breast BRAJAC I cyclophosphamide neoadjuvant or adjuvant therapy for breast cancer using doxorubicin doxorubicin injectable Breast BRAJACT I and cyclophosphamide followed by paclitaxel neoadjuvant or adjuvant therapy for breast cancer using dose dense doxorubicin (cont'd) injectable Breast BRAJACTG I therapy: doxorubicin and cyclophosphamide followed by paclitaxel neoadjuvant or adjuvant therapy for breast cancer using doxorubicin doxorubicin injectable Breast and cyclophosphamide followed by paclitaxel and trastuzumab BRAJACTT I (HERCEPTIN) neoadjuvant or adjuvant therapy for breast cancer using dose dense doxorubicin (cont'd) injectable Breast therapy: doxorubicin and cyclophosphamide followed by paclitaxel and BRAJACTTG I trastuzumab (HERCEPTIN) neoadjuvant or adjuvant therapy for early breast cancer using doxorubicin injectable Breast BRAJACTW I doxorubicin and cyclophosphamide followed by weekly paclitaxel neoadjuvant or adjuvant therapy for breast cancer using doxorubicin (cont'd) injectable Breast UBRAJDAC R cyclophosphamide, doxorubicin and docetaxel doxorubicin injectable Breast palliative therapy for metastatic breast cancer using weekly doxorubicin BRAVA7 I

palliative therapy for metastatic breast cancer using doxorubicin and doxorubicin (cont'd) injectable Breast BRAVAC I cyclophosphamide treatment of locally advanced breast cancer using doxorubicin and doxorubicin (cont'd) injectable Breast BRLAACD I cyclophosphamide followed by docetaxel treatment of locally advanced breast cancer using doxorubicin and doxorubicin (cont'd) injectable Breast cyclophosphamide followed by docetaxel and trastuzumab BRLAACDT I (HERCEPTIN) neoadjuvant therapy for breast cancer using dose dense therapy: doxorubicin (cont'd) injectable Breast BRLATACG I paclitaxel followed by doxorubicin and cyclophosphamide treatment of locally advanced breast cancer using doxorubicin and doxorubicin (cont'd) injectable Breast BRLATWAC I cyclophosphamide followed by weekly paclitaxel doxorubicin (cont'd) injectable Gastrointestinal palliative therapy for hepatoma using doxorubicin GIA I transarterial chemoembolization (TACE) of hepatocellular carcinoma doxorubicin (cont'd) injectable Gastrointestinal UGIDEBTACE R using drug-eluting bead (DEB) loaded with doxorubicin Note: only funded when hepatic trans-arterial chemoembolization for primary liver cancer or liver prescribed by specialists at BC doxorubicin (cont'd) injectable Gastrointestinal GIEMBOL I metastasis Cancer VC & Royal Jubilee Hospital palliative therapy for pancreatic endocrine tumours using streptozocin doxorubicin (cont'd) injectable Gastrointestinal GIENDO2 I and doxorubicin hyperthermic intraperitoneal chemotherapy (HIPEC) for patients with doxorubicin (cont'd) injectable Gastrointestinal GIPMHIPEC I peritoneal mesothelioma using doxorubicin, cisplatin and paclitaxel doxorubicin (cont'd) injectable Genitourinary palliative therapy for advanced adrenal cortical cancer using doxorubicin GUAVD I Not reimbursed for bladder treatment of metastatic adrenalcortical cancer with doxorubicin, instillations doxorubicin (cont'd) injectable Genitourinary GUEDPM I etoposide, cisplatin and mitotane

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DOSAGE TUMOUR PROTOCOL DRUG APPROVED INDICATIONS CLASS NOTES FORM SITE CODES therapy for transitional cell cancers of the urothelium using Not reimbursed for bladder doxorubicin (cont'd) injectable Genitourinary GUMVAC I methotrexate, vinblastine, doxorubicin and cisplatin instillations doxorubicin (cont'd) injectable Gynecology for use in patients with advanced endometrial cancer GOENDD I doxorubicin (cont'd) injectable Gynecology for use in patients with advanced uterine sarcoma GOSAD I doxorubicin (cont'd) injectable Head and Neck palliative therapy for advanced thyroid cancers using doxorubicin HNOTAVD I palliative therapy for advanced salivary gland cancers using doxorubicin (cont'd) injectable Head and Neck HNSAVFAC I cyclophosphamide, doxorubicin and fluorouracil treatment of advanced salivary gland cancers with platinum, doxorubicin doxorubicin (cont'd) injectable Head and Neck HNSAVPAC I and cyclophospahmide treatment of thymoma/thymic carcinoma with cyclophosphamide, doxorubicin (cont'd) injectable Lung LUOTCAV I doxorubicin and vincristine treatment of thymoma with platinum, doxorubicin, and doxorubicin (cont'd) injectable Lung LUOTPAC I cyclophosphamide treatment of extensive small cell lung cancer with cyclophosphamide, doxorubicin (cont'd) injectable Lung LUSCCAV I doxorubicin and vincristine treatment of Hodgkin's disease with doxorubicin, bleomycin, vinblastine doxorubicin (cont'd) injectable Lymphoma LYABVD I and dacarbazine treatment of lymphoma with doxorubicin, cyclophosphamide, vincristine doxorubicin (cont'd) injectable Lymphoma LYCHOP I and prednisone treatment of lymphoma with doxorubicin, cyclophosphamide, vincristine, doxorubicin (cont'd) injectable Lymphoma LYCHOPR I prednisone and rituximab central nervous system prophylaxis with high dose methotrexate, CHOP doxorubicin (cont'd) injectable Lymphoma LYCHOPRMTX I and rituximab in diffuse large B-cell lymphoma treatment of burkitt’s lymphoma and leukemia with cyclophosphamide, doxorubicin (cont'd) injectable Lymphoma LYCODOXMR I vincristine, doxorubicin, methotrexate, leucovorin and rituximab treatment of lymphoma with dose-adjusted etoposide, doxorubicin, doxorubicin (cont'd) injectable Lymphoma vincristine, cyclophosphamide, prednisone and rituximab with LYEPOCHR I intrathecal methotrexate doxorubicin (cont'd) injectable Lymphoma lymphoma palliative chemotherapy LYPALL I therapy for advanced soft tissue sarcoma using doxorubicin, ifosfamide- doxorubicin (cont'd) injectable Sarcoma SAAI I mesna doxorubicin for adjuvant use for patients with non-metastatic operable doxorubicin (cont'd) injectable Sarcoma SAAJA I large high grade soft tissue sarcoma adjuvant treatment of patients with soft tissue sarcoma using doxorubicin (cont'd) injectable Sarcoma SAAJADIC I doxorubicin and dacarbazine doxorubicin (cont'd) injectable Sarcoma adjuvant therapy for osteosarcoma using doxorubicin and cisplatin SAAJAP I SAIME alternating with SAVAC or SAVACM with filgrastim support at a TWO weekly interval for newly diagnosed Ewing's Sarcoma/Ewing’s doxorubicin (cont'd) injectable Sarcoma SAALT2W I Family of Tumours, Desmoplastic Intra-Abdominal Small Round Blue Cell Tumour or Rhabdomyosarcoma

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DOSAGE TUMOUR PROTOCOL DRUG APPROVED INDICATIONS CLASS NOTES FORM SITE CODES SAIME alternating with SAVAC or SAVACM with filgrastim support at a THREE weekly interval for newly diagnosed Ewing's Sarcoma/Ewing’s doxorubicin (cont'd) tablet, injectable Sarcoma SAALT3W I Family of Tumours, Desmoplastic Intra-Abdominal Small Round Blue Cell Tumour or Rhabdomyosarcoma doxorubicin (cont'd) injectable Sarcoma therapy for advanced soft tissue sarcoma using doxorubicin SAAVA I treatment of patients with soft tissue sarcoma using doxorubicin and doxorubicin (cont'd) injectable Sarcoma SAAVADIC I dacarbazine doxorubicin (cont'd) injectable Sarcoma therapy of advanced osteosarcoma using doxorubicin and cisplatin SAAVAP I treatment of sarcomas with vincristine, doxorubicin and doxorubicin (cont'd) injectable Sarcoma SAVAC I cyclophosphamide treatment of sarcomas with pelvic primaries or chemotherapy induced doxorubicin (cont'd) injectable Sarcoma SAVACM I hematuria using vincristine, doxorubicin, cyclophosphamide and mesna Other tumour site Not Otherwise Not reimbursed for bladder doxorubicin (cont'd) injectable code followed by I Specified instillations ‘NOS’ (e.g. BRNOS) doxorubicin – pegylated treatment of platinum resistant epithelial ovarian cancer with injectable Gynecology UGOOVBEVLD R liposomaL (CAELYX®) bevacizumab and pegylated liposomal doxorubicin (CAELYX) doxorubicin – pegylated first line treatment of epithelial ovarian cancer using doxorubicin injectable Gynecology GOOVFPLDC I liposomaL (CAELYX®) pegylated liposomal (CAELYX™) and carboplatin doxorubicin – pegylated treatment of epithelial ovarian cancer relapsing after primary treatment injectable Gynecology GOOVLDOX I liposomaL (CAELYX®) using pegylated liposomal doxorubicin (CAELYX) doxorubicin – pegylated treatment of epithelial ovarian cancer relapsing after primary treatment injectable Gynecology GOOVPLDC I liposomaL (CAELYX®) using pegylated liposomal doxorubicin (CAELYX) and carboplatin doxorubicin – pegylated injectable Kaposi's Sarcoma Kaposi’s sarcoma KSLDO I liposomaL (CAELYX®) drug-eluting bead (DEB) transarterial chemoembolization (TACE) of hepatocellular carcinoma loaded with doxorubicin (DC other Gastrointestinal UGIDEBTACE R using drug-eluting bead (DEB) loaded with doxorubicin Bead® or HepaSphere™) palliative therapy for metastatic castration resistant prostate cancer enzalutamide tablet Genitourinary UGUPENZ R using enzalutamide adjuvant therapy for breast cancer using fluorouracil, epirubicin and epirubicin injectable Breast BRAJFEC I cyclophosphamide neoadjuvant or adjuvant therapy for breast cancer using fluorouracil, epirubicin injectable Breast BRAJFECD I epirubicin and cyclophosphamide and docetaxel neoadjuvant or adjuvant therapy for breast cancer using fluorouracil, epirubicin (cont'd) injectable Breast epirubicin and cyclophosphamide followed by docetaxel and BRAJFECDT I trastuzumab (HERCEPTIN) palliative therapy for metastatic or locally advanced gastric or epirubicin (cont'd) injectable Gastrointestinal GIGAVEOCAP I esophagogastric cancer using epirubicin, oxaliplatin and capecitabine

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DOSAGE TUMOUR PROTOCOL DRUG APPROVED INDICATIONS CLASS NOTES FORM SITE CODES palliative therapy for metastatic or locally advanced gastric or epirubicin (cont'd) injectable Gastrointestinal esophagogastric cancer using epirubicin, oxaliplatin and infusional GIGAVEOF I fluorouracil treatment of operable cancer of the stomach, stomach-esophagus epirubicin (cont'd) injectable Gastrointestinal junction or lower 1/3 esophagus, given before and after surgery, using GIGECC I epirubicin, cisplatin and capecitabine intravesical use for bladder cancer if BCG and mitomycin C not epirubicin (cont'd) injectable Genitourinary GUNOS I available Other tumour site Not Otherwise epirubicin (cont'd) injectable code followed by I Specified ‘NOS’ (e.g. BRNOS) 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 maintenance therapy of advanced non-small cell lung cancer after first- erlotinib tablet Lung LUAVMTNE I line chemotherapy capsule/ etoposide Neuro-Oncology carboplatin and etoposide in the treatment of recurrent ependymoma CNCARV I injectable capsule/ palliative treatment of patients with recurrent malignant gliomas and etoposide Neuro-Oncology CNETO I injectable ependymoma using low dose etoposide capsule/ therapy for recurrent malignant brain tumours using temozolomide and etoposide Neuro-Oncology CNTMZETO I injectable etoposide capsule/ palliative therapy of neuroendocrine tumours using cisplatin and etoposide Gastrointestinal GIPE I injectable etoposide capsule/ therapy of non-dysgerminomatous ovarian germ cell cancer using etoposide Gynecology GOBEP I injectable bleomycin, etoposide and cisplatin capsule/ therapy of dysgerminomatous ovarian germ cell cancer using cisplatin etoposide Gynecology GOEP I injectable and etoposide capsule/ treatment of relapsed/progressing epithelial ovarian, primary peritoneal, etoposide Gynecology GOOVETO I injectable or fallopian tube carcinoma using etoposide treatment of small cell or neuroendocrine carcinoma of gynecologic capsule/ etoposide Gynecology system origin using paclitaxel, cisplatin, etoposide and carboplatin with GOSMCCRT I injectable radiation therapy for high-risk Gestational Trophoblastic Neoplasia (GTN) using capsule/ etoposide (cont'd) Gynecology etoposide, methotrexate, leucovorin (folinic acid), dactinomycin, GOTDEMACO I injectable cyclophosphamide and vincristine capsule/ curative therapy for germ cell cancer using bleomycin, etoposide and etoposide (cont'd) Genitourinary GUBEP I injectable cisplatin capsule/ treatment of metastatic adrenalcortical cancer with doxorubicin, etoposide (cont'd) Genitourinary GUEDPM I injectable etoposide, cisplatin and mitotane

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DOSAGE TUMOUR PROTOCOL DRUG APPROVED INDICATIONS CLASS NOTES FORM SITE CODES capsule/ etoposide (cont'd) Genitourinary therapy for nonseminoma germ cell cancer using etoposide-cisplatin GUEP I injectable capsule/ etoposide (cont'd) Genitourinary therapy of genitourinary small cell tumours with a platin and etoposide GUSCPE I injectable capsule/ therapy of genitourinary small cell tumors with a platin and etoposide etoposide (cont'd) Genitourinary GUSCPERT I injectable with radiation capsule/ nonseminoma consolidation/salvage protocol using etoposide, cisplatin, etoposide Genitourinary GUVIP2 I injectable ifosfamide, mesna capsule/ treatment of recurrent and metastatic squamous cell cancer with etoposide (cont'd) Head and Neck HNAVPE I injectable platinum and etoposide capsule/ treatment of recurrent and/or metastatic nasopharyngeal cancer with etoposide (cont'd) Head and Neck HNNAVPE I injectable platinum and etoposide capsule/ treatment of locally advanced non-small cell lung cancer using cisplatin etoposide (cont'd) Lung LULAPERT I injectable and etoposide with radiation capsule/ treatment of locally advanced non-small cell lung cancer using etoposide (cont'd) Lung LULAPE2RT I injectable alternative dosing of cisplatin and etoposide with radiation therapy capsule/ etoposide (cont'd) Lung treatment of thymoma with cisplatin and etoposide LUOTPE I injectable capsule/ treatment of thymoma using cisplatin and etoposide with radiation etoposide (cont'd) Lung LUOTPERT I injectable therapy capsule/ treatment of cancer of unknown primary involving the thorax with etoposide (cont'd) Lung LUPUPE I injectable cisplatin and etoposide capsule/ therapy of extensive stage small cell lung cancer with cisplatin and etoposide (cont'd) Lung LUSCPE I injectable etoposide capsule/ therapy of limited stage small cell lung cancer using cisplatin and etoposide (cont'd) Lung LUSCPERT I injectable etoposide with radiation capsule/ palliative therapy of extensive stage small cell lung cancer with oral etoposide (cont'd) Lung LUSCPOE I injectable etoposide capsule/ treatment of hemophagocytic lymphohistiocytosis with etoposide, etoposide (cont'd) Lymphoma HLHETCSPA I injectable dexamethasone and cycloSPORINE treatment of lymphoma with dose-adjusted etoposide, doxorubicin, capsule/ etoposide (cont'd) Lymphoma vincristine, cyclophosphamide, prednisone and rituximab with LYEPOCHR I injectable intrathecal methotrexate capsule/ treatment of burkitt’s lymphoma and leukemia with ifosfamide, mesna, etoposide (cont'd) Lymphoma LYIVACR I injectable etoposide, cytarabine and rituximab capsule/ etoposide (cont'd) Lymphoma lymphoma palliative chemotherapy LYPALL I injectable capsule/ treatment of advanced stage Large B-Cell Non-Hodgkin’s Lymphoma etoposide (cont'd) Lymphoma ULYRICE R injectable with ifosfamide, carboplatin, etoposide and rituximab capsule/ treatment of natural killer or T-Cell Lymphoma using dexamethasone, etoposide (cont'd) Lymphoma LYSMILE I injectable methotrexate, ifosfamide, pegaspargase and etoposide

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DOSAGE TUMOUR PROTOCOL DRUG APPROVED INDICATIONS CLASS NOTES FORM SITE CODES treatment of newly diagnosed nasal, extranodal natural killer (NK) or T- capsule/ cell lymphoma, stage IE to IIE using concurrent radiation and weekly etoposide (cont'd) Lymphoma LYVIPDRT I injectable cisplatin followed by etoposide, ifosfamide, cisplatin and dexamethasone SAIME alternating with SAVAC or SAVACM with filgrastim support at a capsule/ TWO weekly interval for newly diagnosed Ewing's Sarcoma/Ewing’s etoposide (cont'd) Sarcoma SAALT2W I injectable Family of Tumours, Desmoplastic Intra-Abdominal Small Round Blue Cell Tumour or Rhabdomyosarcoma SAIME alternating with SAVAC or SAVACM with filgrastim support at a capsule/ THREE weekly interval for newly diagnosed Ewing's Sarcoma/Ewing’s etoposide (cont'd) SAALT3W I injectable Family of Tumours, Desmoplastic Intra-Abdominal Small Round Blue Cell Tumour or Rhabdomyosarcoma capsule/ 3-Day etoposide & ifosfamide-mesna for patients with advanced soft etoposide (cont'd) Sarcoma SAAVIME3 I injectable tissue or bony sarcomas capsule/ etoposide (cont'd) Sarcoma etoposide, ifosfamide-mesna (SAIME) for use in sarcomas SAIME I injectable capsule/ treatment of recurrent or metastatic Merkel cell carcinoma with cisplatin etoposide (cont'd) Skin & Melanoma SMMCCPE I injectable and etoposide Other tumour site capsule/ Not Otherwise etoposide (cont'd) code followed by I injectable Specified ‘NOS’ (e.g. HNNOS)

everolimus tablet Breast therapy for advanced breast cancer using everolimus and exemestane BRAVEVEX I

treatment of advanced neuroendocrine tumours of gastrointestinal origin everolimus tablet Gastrointestinal UGINETEV R TM (non-functional) using everolimus Note: AFINITOR® DISPERZ everolimus tablet Gastrointestinal palliative treatment of advanced pancreatic neuroendocrine tumours UGIPNEVER R formulation not funded everolimus tablet Genitourinary therapy for advanced renal cancer using everolimus GUEVER I treatment of advanced neuroendocrine tumours of lung origin (non- everolimus tablet Lung ULUNETEV R functional) using everolimus neoadjuvant or adjuvant therapy for breast cancer using exemestane in exemestane tablet Breast BRAJEXE I postmenopausal women neoadjuvant or adjuvant ovarian suppression and aromatase inhibitor in exemestane tablet Breast BRAJLHRHAI I premenopausal women with high-risk early stage breast cancer exemestane tablet Breast therapy for advanced breast cancer using everolimus and exemestane BRAVEVEX I first or second line hormonal treatment for advanced breast cancer in exemestane tablet Breast BRAVEXE I postmenopausal women therapy for advanced breast cancer using a LHRH agonist and an exemestane (cont'd) tablet Breast BRAVLHRHA I aromatase inhibitor hormonal treatment for advanced endometrial cancer in exemestane (cont'd) tablet Gynecology GOENDAI I postmenopausal women Note: NEUPOGEN® brand will for inpatient administration only - see BC PharmaCare Special Authority filgrastim (GRASTOFIL®) injectable FILGRASTIM only be reimbursed for pediatric Form for indications covered inpatient administration

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DOSAGE TUMOUR PROTOCOL DRUG APPROVED INDICATIONS CLASS NOTES FORM SITE CODES treatment of chronic lymphocytic leukemia or prolymphocytic leukemia fludarabine injectable/ tablet Lymphoma LYCLLFLUDR I with fludarabine and rituximab treatment of chronic lymphocytic leukemia (CLL) or prolymphocytic fludarabine injectable/ tablet Lymphoma LYFCR I leukemia with fludarabine, cyclophosphamide and rituximab fludarabine injectable/ tablet Lymphoma chronic lymphocytic leukemia or low grade lymphoma LYFLU I fludarabine injectable/ tablet Lymphoma treatment of relapsed indolent lymphoma with fludarabine and rituximab LYFLUDR I fludarabine injectable/ tablet Pediatric pediatric patients with AML treated on the CCG-2961 study I treatment of metastatic adrenalcortical cancer with doxorubicin, fludrocortisone tablet Genitourinary GUEDPM I etoposide, cisplatin and mitotane fludrocortisone (cont'd) tablet Genitourinary mineralocorticoid deficiency associated with mitotane use GUMITO I adjuvant therapy for high-risk breast cancer using cyclophosphamide fluorouracil injectable Breast BRAJCMFPO I (oral), methotrexate and fluorouracil adjuvant therapy for breast cancer using fluorouracil, epirubicin and fluorouracil (cont'd) injectable Breast BRAJFEC I cyclophosphamide neoadjuvant or adjuvant therapy for breast cancer using fluorouracil, fluorouracil injectable Breast BRAJFECD I epirubicin and cyclophosphamide and docetaxel neoadjuvant or adjuvant therapy for breast cancer using fluorouracil, fluorouracil (cont'd) injectable Breast epirubicin and cyclophosphamide followed by docetaxel and BRAJFECDT I trastuzumab (HERCEPTIN) palliative therapy for advanced breast cancer using cyclophosphamide, fluorouracil (cont'd) injectable Breast BRAVCMF I methotrexate and fluorouracil adjuvant combination chemotherapy for stage III and stage IIB colon fluorouracil (cont'd) injectable Gastrointestinal GIAJFFOX I cancer using oxaliplatin, fluorouracil and folinic acid (leucovorin) adjuvant therapy of colon cancer using fluorouracil injection and infusion fluorouracil (cont'd) injectable Gastrointestinal GIAJFL I and leucovorin infusion palliative combination chemotherapy for metastatic colorectal cancer fluorouracil (cont'd) injectable Gastrointestinal using fluorouracil injection and infusion and folinic acid (leucovorin) GIAVFL I infusion combined modality therapy for locally advanced esophageal cancer fluorouracil (cont'd) injectable Gastrointestinal GIEFFOXRT I using oxaliplatin, fluorouracil, leucovorin, and radiation therapy Note: only funded when hepatic trans-arterial chemoembolization for primary liver cancer or liver prescribed by specialists at BC fluorouracil (cont'd) injectable Gastrointestinal GIEMBOL I metastasis Cancer VC & Royal Jubilee Hospital palliative therapy for pancreatic endocrine tumours using streptozocin fluorouracil (cont'd) injectable Gastrointestinal GIENDO2 I and doxorubicin

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DOSAGE TUMOUR PROTOCOL DRUG APPROVED INDICATIONS CLASS NOTES FORM SITE CODES palliative combination chemotherapy for metastatic colorectal cancer fluorouracil (cont'd) injectable Gastrointestinal GIFFIRB I using irinotecan, fluorouracil, folinic acid (leucovorin) and bevacizumab palliative combination chemotherapy for metastatic colorectal cancer fluorouracil (cont'd) injectable Gastrointestinal UGIFFIRPAN R using irinotecan, fluorouracil, leucovorin, and panitumumab palliative combination chemotherapy for metastatic colorectal cancer fluorouracil (cont'd) injectable Gastrointestinal GIFFOXB I using oxaliplatin, fluorouracil, leucovorin, and bevacizumab palliative combination chemotherapy for metastatic colorectal cancer fluorouracil (cont'd) injectable Gastrointestinal UGIFFOXPAN R using oxaliplatin, fluorouracil, leucovorin, and panitumumab palliative combination chemotherapy for advanced pancreatic fluorouracil (cont'd) injectable Gastrointestinal adenocarcinoma using irinotecan, oxaliplatin, fluorouracil and folinic GIFIRINOX I acid (leucovorin) palliative combination chemotherapy for metastatic colorectal cancer fluorouracil (cont'd) injectable Gastrointestinal GIFOLFIRI I using irinotecan, fluorouracil and folinic acid (leucovorin) palliative combination chemotherapy for metastatic colorectal cancer fluorouracil (cont'd) injectable Gastrointestinal GIFOLFOX I using oxaliplatin, fluorouracil and folinic acid (leucovorin) combined modality curative therapy for carcinoma of the anal canal fluorouracil (cont'd) injectable Gastrointestinal GIFUART I using mitomycin, fluorouracil and radiation therapy palliative chemotherapy for upper gastrointestinal tract cancer (gastric, fluorouracil (cont'd) injectable Gastrointestinal esophageal, gall bladder carcinoma and cholangiocarcinoma) and GIFUC I metastatic anal cancer using infusional fluorouracil and cisplatin combined modality curative therapy for carcinoma of the anal canal fluorouracil (cont'd) injectable Gastrointestinal GIFUPART I using cisplatin, infusional fluorouracil and radiation therapy adjuvant chemotherapy of gastric cancer patients with D2 resection fluorouracil (cont'd) injectable Gastrointestinal (node negative) or ineligible for adjuvant chemoradiation using GIGAJFFOX I oxaliplatin, fluorouracil, and leucovorin palliative treatment of metastatic or inoperable, locally advanced gastric fluorouracil (cont'd) injectable Gastrointestinal or gastroesophageal junction adenocarcinoma using cisplatin, infusional GIGAVCFT I fluorouracil and trastuzumab (HERCEPTIN) palliative therapy for metastatic or locally advanced gastric or fluorouracil (cont'd) injectable Gastrointestinal esophagogastric cancer using epirubicin, oxaliplatin and infusional GIGAVEOF I fluorouracil palliative treatment of metastatic or locally advanced gastric, fluorouracil (cont'd) injectable Gastrointestinal gastroesophageal junction, or esophageal adenocarcinoma using GIGAVFFOX I oxaliplatin, fluorouracil and leucovorin palliative treatment of metastatic or locally advanced HER-2 positive fluorouracil (cont'd) injectable Gastrointestinal gastric, gastroesophageal junction, or esophageal adenocarcinoma GIGAVFFOXT I using oxaliplatin, fluorouracil, leucovorin, and trastuzumab perioperative treatment of resectable adenocarcinoma of the stomach, fluorouracil (cont'd) injectable Gastrointestinal gastroesophageal junction or lower 1/3 esophagus using docetaxel, GIGFLODOC I oxaliplatin, infusional fluorouracil, and leucovorin palliative combination chemotherapy for metastatic gastric or fluorouracil (cont'd) injectable Gastrointestinal esophageal adenocarcinoma using irinotecan, fluorouracil and folinic GIGFOLFIRI I acid (leucovorin) hyperthermic intraperitoneal chemotherapy (HIPEC) for patients with fluorouracil (cont'd) injectable Gastrointestinal peritoneal carcinomatosis from limited advanced colorectal and GIHIPEC I appendiceal carcinomas using oxaliplatin and fluorouracil adjuvant chemotherapy for resected pancreatic adenocarcinoma using fluorouracil (cont'd) injectable Gastrointestinal GIPAJFIROX* I irinotecan, oxaliplatin, fluorouracil and leucovorin

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DOSAGE TUMOUR PROTOCOL DRUG APPROVED INDICATIONS CLASS NOTES FORM SITE CODES adjuvant combination chemotherapy for stage III rectal cancer using fluorouracil (cont'd) injectable Gastrointestinal GIRAJFFOX I oxaliplatin, fluorouracil and folinic acid (leucovorin) combined modality adjuvant therapy for high risk rectal carcinoma using fluorouracil (cont'd) injectable Gastrointestinal GIRINFRT I capecitabine, infusional fluorouracil and radiation therapy combined modality therapy for squamous cell cancer of the fluorouracil (cont'd) injectable Genitourinary GUFUPRT I genitourinary system using fluorouracil and cisplatin with radiation fluorouracil and leucovorin for recurrent head and neck cancer fluorouracil (cont'd) injectable Head and Neck HNAVFUFA I (squamous cell carcinoma) treatment of advanced squamous cell carcinoma of the head and neck fluorouracil (cont'd) injectable Head and Neck HNAVFUP I cancer using fluorouracil and platinum combined chemotherapy (carboplatin and fluorouracil) and radiation fluorouracil (cont'd) injectable Head and Neck treatment for locally advanced squamous cell carcinoma of the head HNLACAFRT I and neck treatment of locally advanced squamous cell carcinoma of the head and fluorouracil (cont'd) injectable Head and Neck UHNLADCF R neck with docetaxel, cisplatin and infusional fluorouracil fluorouracil and leucovorin for recurrent head and neck cancer fluorouracil (cont'd) injectable Head and Neck HNNAVFUFA I (nasopharyngeal) treatment for advanced nasopharyngeal cancer of the head and neck fluorouracil (cont'd) injectable Head and Neck HNNAVFUP I using platinum and fluorouracil palliative therapy for advanced salivary gland cancers using fluorouracil (cont'd) injectable Head and Neck HNSAVFAC I cyclophosphamide, doxorubicin and fluorouracil treatment of advanced head and neck cancer using cisplatin and fluorouracil (cont'd) injectable Head and Neck HNSAVFUP I fluorouracil Other tumour site Not Otherwise fluorouracil (cont'd) injectable code followed by I Specified ‘NOS’ (e.g. HNNOS) fluorouracil topical cream Skin & Melanoma skin cancer SMNOS I Not reimbursed for vasomotor flutamide tablet Genitourinary nonsteroidal treatment of prostate cancer GUPNSAA I symptoms (hot flashes) first-line treatment of epidermal growth factor receptor mutation-positive gefitinib tablet Lung LUAVGEFF I advanced NSCLC gemcitabine injectable Breast palliative therapy for metastatic breast cancer using gemcitabine BRAVGEM I palliative therapy for metastatic breast cancer using gemcitabine and gemcitabine injectable Breast BRAVGEMD I docetaxel as palliative therapy for metastatic breast cancer using cisplatin and gemcitabine (cont'd) injectable Breast BRAVGEMP I gemcitabine gemcitabine injectable Breast treatment of metastatic breast cancer using gemcitabine and paclitaxel BRAVGEMT I first-line palliative chemotherapy for advanced gallbladder cancer and gemcitabine (cont'd) injectable Gastrointestinal GIAVPG I cholangiocarcinoma using gemcitabine and cisplatin adjuvant chemotherapy for resected pancreatic adenocarcinoma using gemcitabine (cont'd) injectable Gastrointestinal GIPAJGCAP I capecitabine and gemcitabine

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DOSAGE TUMOUR PROTOCOL DRUG APPROVED INDICATIONS CLASS NOTES FORM SITE CODES adjuvant chemotherapy for pancreatic adenocarcinoma using gemcitabine (cont'd) injectable Gastrointestinal GIPAJGEM I gemcitabine palliative chemotherapy for pancreatic adenocarcinoma, gallbladder gemcitabine injectable Gastrointestinal GIPGEM I cancer, and cholangiocarcinoma using gemcitabine first line treatment of locally advanced and metastatic pancreatic cancer gemcitabine (cont'd) injectable Gastrointestinal GIPGEMABR I with paclitaxel-nab (ABRAXANE®) and gemcitabine treatment of platinum resistant epithelial ovarian cancer with gemcitabine injectable Gynecology UGOOVBEVG R bevacizumab and gemcitabine carboplatin and gemcitabine for the treatment of recurrent platinum- gemcitabine injectable Gynecology GOOVCAG I sensitive ovarian cancer palliative chemotherapy for re-treatment of ovarian, tubal, and peritoneal gemcitabine injectable Gynecology GOOVGEM I cancer using gemcitabine combination with docetaxel for advanced or recurrent uterine sarcoma gemcitabine (cont'd) injectable Gynecology GOSADG I cancer adjuvant therapy for urothelial carcinoma using cisplatin and gemcitabine (cont'd) injectable Genitourinary GUAJPG I gemcitabine combination with cisplatin for advanced transitional cell carcinoma of the gemcitabine (cont'd) injectable Genitourinary GUAVPG I bladder intravesical therapy for non-muscle invasive bladder cancer using gemcitabine (cont'd) injectable Genitourinary GUBGEM I gemcitabine combination with cisplatin as neoadjuvant therapy for urothelial gemcitabine (cont'd) injectable Genitourinary GUNAJPG I carcinoma combination palliative therapy with paclitaxel in patients with relapsed, gemcitabine (cont'd) injectable Genitourinary cisplatin-refractory germ cell cancers not amenable to cure with surgery UGUTAXGEM R or chemotherapy (patients relapsed after BMT are potentially eligible) treatment of loco-regionally recurrent and/or metastatic nasopharyngeal gemcitabine (cont'd) injectable Head and Neck HNNAVGEM I cancer with gemcitabine treatment of local-regionally recurrent and/or metastatic nasopharyngeal gemcitabine (cont'd) injectable Head and Neck HNNAVPG I cancer with platinum and gemcitabine as induction treatment of locally advanced nasopharyngeal cancer with gemcitabine (cont'd) injectable Head and Neck HNNLAPG I cisplatin and gemcitabine combination with cisplatin or carboplatin as treatment of advanced non- gemcitabine (cont'd) injectable Lung LUAVPG I small cell lung cancer 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 in combination with dexamethasone, cisplatin and rituximab for gemcitabine (cont'd) injectable Lymphoma LYGDPR I lymphoma gemcitabine (cont'd) injectable Lymphoma palliative chemotherapy of lymphomas LYPALL I combination with docetaxel as second or third line therapy for soft tissue gemcitabine (cont'd) injectable Sarcoma SAAVGEMD I sarcomas

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DOSAGE TUMOUR PROTOCOL DRUG APPROVED INDICATIONS CLASS NOTES FORM SITE CODES injectable/ long neoadjuvant or adjuvant ovarian suppression and aromatase inhibitor in goserelin Breast BRAJLHRHAI I acting injectable premenopausal women with high-risk early stage breast cancer injectable/ long neoadjuvant or adjuvant therapy for breast cancer using a LHRH goserelin Breast BRAJLHRHT I acting injectable agonist and tamoxifen injectable/ long therapy for advanced breast cancer using a LHRH agonist and an goserelin (cont'd) Breast BRAVLHRHA I acting injectable aromatase inhibitor Not reimbursed for endometriosis injectable/ long combination therapy with tamoxifen palliative therapy for metastatic goserelin (cont'd) Breast BRAVLHRHT I acting injectable breast cancer injectable/ long therapy of advanced breast cancer using palbociclib and aromatase goserelin (cont'd) Breast UBRAVPALAI R acting injectable inhibitor with or without LHRH agonist injectable/ long goserelin (cont'd) Genitourinary therapy for prostate cancer using LHRH agonist GUPLHRH I acting injectable treatment of hemophagocytic lymphohistiocytosis with etoposide, hydrocortisone tablet, injectable Lymphoma HLHETCSPA I dexamethasone and cycloSPORINE Not reimbursed for supportive Other tumour site Not Otherwise care hydrocortisone (cont'd) tablet, injectable code followed by I Specified ‘NOS’ (e.g. LYNOS) Myeloid neoplasms, including but not limited to: Acute myeloid leukemia, Myelodysplastic syndromes (e.g. Refractory anemia), hydroxyurea capsule Leukemia LKNOS I Myeloproliferative disease (e.g. Chronic myeloid leukemia, Polycythemia, Essential thrombocythemia) Lymphoid neoplasms, including but not limited to: Lymphoproliferative hydroxyurea capsule Lymphoma LYNOS I disease, Myeloma ibritumomab 90Y Palliative therapy for lymphoma using radioimmunotherapy: rituximab- injectable Lymphoma 90 ULYRITZ R (ZEVALIN®) priming for ibritumomab Y (ZEVALIN®) treatment of previously untreated chronic lymphocytic leukemia or small ibrutinib capsule Lymphoma ULYFIBRU R lymphocytic lymphoma using ibrutinib treatment of relapsed or refractory chronic lymphocytic leukemia or ibrutinib capsule Lymphoma ULYIBRU R small lymphocytic lymphoma using ibrutinib ibrutinib capsule Lymphoma treatment of relapsed/refractory mantle-cell lymphoma using ibrutinib ULYMIBRU R Tumour site code Not Otherwise injectable followed by ‘NOS’ I Specified (e.g. BRNOS) treatment of relapsed/refractory chronic lymphocytic leukemia or small tablet Lymphoma ULYIDELAR R lymphocytic lymphoma using idelalisib and rituximab therapy for relapsed testicular germ cell cancer using paclitaxel, ifosfamide injectable Genitourinary UGUTIP R lfosfamide and cisplatin consolidation/ salvage treatment for germ cell cancer using vinblastine, ifosfamide injectable Genitourinary GUVEIP I cisplatin, ifosfamide and mesna nonseminoma consolidation/salvage protocol using etoposide, cisplatin, ifosfamide (cont'd) injectable Genitourinary GUVIP2 I ifosfamide, mesna

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DOSAGE TUMOUR PROTOCOL DRUG APPROVED INDICATIONS CLASS NOTES FORM SITE CODES treatment of burkitt’s lymphoma and leukemia with ifosfamide, mesna, ifosfamide (cont'd) injectable Lymphoma LYIVACR I etoposide, cytarabine and rituximab treatment of advanced stage Large B-Cell Non-Hodgkin’s Lymphoma ifosfamide (cont'd) injectable Lymphoma ULYRICE R with ifosfamide, carboplatin, etoposide and rituximab treatment of natural killer or T-Cell Lymphoma using dexamethasone, ifosfamide (cont'd) injectable Lymphoma LYSMILE I methotrexate, ifosfamide, pegaspargase and etoposide treatment of newly diagnosed nasal, extranodal natural killer (NK) or T- cell lymphoma, stage IE to IIE using concurrent radiation and weekly ifosfamide (cont'd) injectable Lymphoma LYVIPDRT I cisplatin followed by etoposide, ifosfamide, cisplatin and dexamethasone therapy for advanced soft tissue sarcoma using doxorubicin, ifosfamide- ifosfamide injectable Sarcoma SAAI I mesna SAIME alternating with SAVAC or SAVACM with filgrastim support at a TWO weekly interval for newly diagnosed Ewing's Sarcoma/Ewing’s ifosfamide (cont'd) injectable Sarcoma SAALT2W I Family of Tumours, Desmoplastic Intra-Abdominal Small Round Blue Cell Tumour or Rhabdomyosarcoma SAIME alternating with SAVAC or SAVACM with filgrastim support at a THREE weekly interval for newly diagnosed Ewing's Sarcoma/Ewing’s ifosfamide (cont'd) injectable Sarcoma SAALT3W I Family of Tumours, Desmoplastic Intra-Abdominal Small Round Blue Cell Tumour or Rhabdomyosarcoma ifosfamide injectable Sarcoma therapy for advanced soft tissue sarcoma using ifosfamide SAAVI I ifosfamide injectable Sarcoma 3-day ifosfamide for use in patients with advanced soft tissue sarcoma SAAVI3 I 3-Day etoposide & ifosfamide-mesna for patients with advanced soft ifosfamide injectable Sarcoma SAAVIME3 I tissue or bony sarcomas ifosfamide injectable Sarcoma etoposide, ifosfamide-mesna (SAIME) for use in sarcomas SAIME I Other tumour site Not Otherwise ifosfamide (cont'd) injectable code followed by I Specified ‘NOS’ (e.g. LYNOS) therapy for chronic myeloid leukemia and Ph+ acute lymphoblastic imatinib capsule/tablet Leukemia LKCMLI I leukemia pediatric patients with Philadelphia chromosome positive acute imatinib capsule/tablet Pediatric I lymphoblastic leukemia adjuvant therapy of C-Kit positive high risk gastrointestinal stromal cell imatinib capsule/tablet Sarcoma SAAJGI I tumours advanced c-kit positive and c-kit negative gastrointestinal stromal cell imatinib (cont'd) capsule/tablet Sarcoma SAAVGI I tumours advanced c-kit positive gastrointestinal stromal cell tumors using 800 imatinib capsule/tablet Sarcoma SAAVGIDD I mg dosing of imatinib imatinib capsule/tablet Skin & Melanoma treatment of advanced c-kit melanoma using imatinib USMAVI R topical immunotherapy for in-transit melanoma metastases, cutaneous imiquimod topical cream Skin & Melanoma SMIMI I lymphoma, basal cell carcinoma using imiquimod treatment of relapsed or refractory pre-B-cell acute lymphoblastic inotuzumab ozogamicin injectable Leukemia ULKINOZ R leukemia with inotuzumab ozogamicin palliative therapy for BCG-refractory superficial high-grade transitional interferon alfa injectable Genitourinary GUBCGIFN I cell carcinoma bladder with BCG and interferon bladder cancer Not reimbursed for hepatitis, interferon alfa injectable Leukemia LKNOS I Kaposi’s Sarcoma interferon alfa injectable Lymphoma lymphoma palliative therapy LYPALL I interferon alfa (cont'd) injectable Lymphoma LYNOS I

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DOSAGE TUMOUR PROTOCOL DRUG APPROVED INDICATIONS CLASS NOTES FORM SITE CODES interferon alfa injectable Myeloma MYNOS I adjuvant therapy of melanoma patients with palpable lymph nodes or interferon alfa (cont'd) injectable Skin & Melanoma SMAJIFN I Not reimbursed for hepatitis, fully resected recurrent disease in lymph nodes Kaposi’s Sarcoma interferon alfa injectable Skin & Melanoma basal cell carcinoma SMNOS I interferon alfa eyedrops Ocular topical therapy for ocular malignancies OCIFN I treatment of metastatic or advanced renal cell carcinoma using ipilimumab injectable Genitourinary UGUAVIPNI R ipilimumab and nivolumab first-line treatment of unresectable or metastatic melanoma using injectable Skin & Melanoma USMAVFIPI R ipilimumab treatment of advanced and metastatic melanoma after prior systemic ipilimumab injectable Skin & Melanoma USMAVIPI R therapy treatment of unresectable or metastatic melanoma using ipilimumab and ipilimumab injectable Skin & Melanoma USMAVIPNI R nivolumab palliative third line treatment of metastatic colorectal cancer with wild- irinotecan injectable Gastrointestinal GIAVCETIR I type KRAS using cetuximab and irinotecan palliative combination chemotherapy for metastatic colorectal cancer irinotecan (cont'd) injectable Gastrointestinal GICAPIRI I using irinotecan and capecitabine in patients unsuitable for GIFOLFIRI palliative combination chemotherapy for metastatic colorectal cancer irinotecan injectable Gastrointestinal GICIRB I using irinotecan, bevacizumab and capecitabine palliative combination chemotherapy for metastatic colorectal cancer irinotecan injectable Gastrointestinal GIFFIRB I using irinotecan, fluorouracil, folinic acid (leucovorin) and bevacizumab palliative combination chemotherapy for metastatic colorectal cancer irinotecan injectable Gastrointestinal UGIFFIRPAN R using irinotecan, fluorouracil, leucovorin, and panitumumab palliative combination chemotherapy for advanced pancreatic irinotecan (cont'd) injectable Gastrointestinal adenocarcinoma using irinotecan, oxaliplatin, fluorouracil and folinic GIFIRINOX I acid (leucovorin) palliative combination chemotherapy for metastatic colorectal cancer irinotecan (cont'd) injectable Gastrointestinal GIFOLFIRI I using irinotecan, fluorouracil and folinic acid (leucovorin) second line palliative combination chemotherapy for metastatic gastric irinotecan (cont'd) injectable Gastrointestinal or esophageal adenocarcinoma using irinotecan, fluorouracil and folinic GIGFOLFIRI I acid (leucovorin) irinotecan injectable Gastrointestinal palliative chemotherapy for metastatic colorectal cancer using irinotecan GIIR I

palliative therapy for metastatic colorectal cancer in patients who may irinotecan injectable Gastrointestinal GIIRINALT I not tolerate the 3-weekly irinotecan schedule of GIIR adjuvant chemotherapy for resected pancreatic adenocarcinoma using irinotecan injectable Gastrointestinal GIPAJFIROX* I irinotecan, oxaliplatin, fluorouracil and leucovorin second line treatment of extensive stage small cell lung cancer (SCLC) irinotecan injectable Lung LUSCPI I with irinotecan with or without platinum pediatric patients treated on the COG protocol ARST0531 for irinotecan (cont'd) injectable Pediatric I intermediate-risk rhabdomyosarcoma pediatric patients with recurrent pediatric neuroblastoma treated on the irinotecan (cont'd) injectable Pediatric I COG protocol ANBL0421 pediatric patients with high risk renal tumors treated on the COG irinotecan (cont'd) injectable Pediatric I protocol AREN0321 pediatric patients with high risk rhabdomyosarcoma treated on the COG irinotecan (cont'd) injectable Pediatric I protocol ARSTO431

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DOSAGE TUMOUR PROTOCOL DRUG APPROVED INDICATIONS CLASS NOTES FORM SITE CODES pediatric patients with rhabdomyosarcoma treated on the COG irinotecan (cont'd) injectable Pediatric I ARST08P1 protocol pediatric patients with recurrent/refractory medulloblastomas/CNS PNET irinotecan (cont'd) injectable Pediatric I of childhood treated on the COG ACNS0821 protocol isotretinoin (ACCUTANE) capsule Pediatric pediatric patients with high risk neuroblastoma I pediatric patients treated on the COG protocol ACNS0332 for above isotretinoin (ACCUTANE™) capsule Pediatric I average risk medulloblastoma/PNE treatment of growth hormone secreting pituitary adenoma using lanreotide injectable Neuro-Oncology CNLAN I lanreotide symptomatic management of functional carcinoid and neuroendocrine lanreotide (cont'd) injectable Gastrointestinal UGILAN R tumours of the GI Tract using lanreotide lapatinib tablet Breast therapy for metastatic breast cancer using capecitabine and lapatinib UBRAVLCAP R lenalidomide capsule Leukemia therapy of myelodysplastic syndrome using lenalidomide ULKMDSL R therapy of multiple myeloma using carfilzomib, lenalidomide with lenalidomide capsule Myeloma UMYCARLD R dexamethasone treatment of relapsed and refractory multiple myeloma with lenalidomide capsule Myeloma UMYDARLD R daratumumab in combination with lenalidomide and dexamethasone treatment of previously untreated multiple myeloma and not eligible for lenalidomide capsule Myeloma UMYLDF R stem cell transplant using lenalidomide with low-dose dexamethasone therapy of relapsed multiple myeloma using lenalidomide with lenalidomide (cont'd) capsule Myeloma UMYLDREL R dexamethasone lenalidomide capsule Myeloma maintenance therapy of multiple myeloma using lenalidomide UMYLENMTN R therapy for locally recurrent or metastatic, RAI-refractory differentiated lenvatinib capsule Head and Neck UHNOTLEN R thyroid cancer using lenvatinib neoadjuvant or adjuvant therapy for breast cancer using letrozole in letrozole tablet Breast BRAJLET I postmenopausal women neoadjuvant or adjuvant ovarian suppression and aromatase inhibitor in letrozole (cont'd) tablet Breast BRAJLHRHAI I premenopausal women with high-risk early stage breast cancer first or second line hormonal treatment for advanced breast cancer in letrozole tablet Breast BRAVLET I postmenopausal women therapy for advanced breast cancer using a LHRH agonist and an letrozole (cont'd) tablet Breast BRAVLHRHA I aromatase inhibitor therapy of advanced breast cancer using palbociclib and aromatase letrozole tablet Breast UBRAVPALAI R inhibitor with or without LHRH agonist hormonal treatment for advanced endometrial cancer in letrozole tablet Gynecology postmenopausal women with contraindications to tamoxifen or intolerant GOENDAI I of tamoxifen hormonal treatment for advanced ovarian cancer in postmenopausal letrozole (cont'd) tablet Gynecology GOOVAI I women

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DOSAGE TUMOUR PROTOCOL DRUG APPROVED INDICATIONS CLASS NOTES FORM SITE CODES adjuvant combination chemotherapy for Stage III and Stage IIB colon leucovorin calcium tablet, injectable Gastrointestinal GIAJFFOX I cancer using oxaliplatin, fluorouracil and folinic acid (Leucovorin) adjuvant therapy of colon cancer using fluorouracil injection and infusion leucovorin calcium tablet, injectable Gastrointestinal GIAJFL I and leucovorin infusion palliative combination chemotherapy for metastatic colorectal cancer leucovorin calcium (cont'd) tablet, injectable Gastrointestinal using fluorouracil injection and infusion and folinic acid (leucovorin) GIAVFL I infusion combined modality therapy for locally advanced esophageal cancer leucovorin calcium (cont'd) tablet, injectable Gastrointestinal GIEFFOXRT I using oxaliplatin, fluorouracil, leucovorin, and radiation therapy palliative combination chemotherapy for metastatic colorectal cancer leucovorin calcium (cont'd) tablet, injectable Gastrointestinal GIFFIRB I using irinotecan, fluorouracil, folinic acid (leucovorin) and bevacizumab palliative combination chemotherapy for metastatic colorectal cancer leucovorin calcium (cont'd) injectable Gastrointestinal UGIFFIRPAN R using irinotecan, fluorouracil, leucovorin, and panitumumab palliative combination chemotherapy for metastatic colorectal cancer leucovorin calcium (cont'd) tablet, injectable Gastrointestinal GIFFOXB I using oxaliplatin, fluorouracil, leucovorin, and bevacizumab palliative combination chemotherapy for metastatic colorectal cancer leucovorin calcium (cont'd) tablet, injectable Gastrointestinal UGIFFOXPAN R using oxaliplatin, fluorouracil, leucovorin, and panitumumab palliative combination chemotherapy for advanced pancreatic leucovorin calcium (cont'd) tablet, injectable Gastrointestinal adenocarcinoma using irinotecan, oxaliplatin, fluorouracil and folinic GIFIRINOX I acid (leucovorin) palliative combination chemotherapy for metastatic colorectal cancer leucovorin calcium tablet, injectable Gastrointestinal GIFOLFIRI I using irinotecan, fluorouracil and folinic acid (leucovorin) palliative combination chemotherapy for metastatic colorectal cancer leucovorin calcium (cont'd) tablet, injectable Gastrointestinal GIFOLFOX I using oxaliplatin, fluorouracil and folinic acid (leucovorin) adjuvant chemotherapy of gastric cancer patients with D2 resection leucovorin calcium (cont'd) tablet, injectable Gastrointestinal (node negative) or ineligible for adjuvant chemoradiation using GIGAJFFOX I oxaliplatin, fluorouracil, and leucovorin palliative treatment of metastatic or locally advanced gastric, leucovorin calcium (cont'd) tablet, injectable Gastrointestinal gastroesophageal junction, or esophageal adenocarcinoma using GIGAVFFOX I oxaliplatin, fluorouracil and leucovorin palliative treatment of metastatic or locally advanced HER-2 positive gastric, gastroesophageal junction, or esophageal adenocarcinoma GIGAVFFOXT I using oxaliplatin, fluorouracil, leucovorin, and trastuzumab perioperative treatment of resectable adenocarcinoma of the stomach, leucovorin calcium (cont'd) tablet, injectable Gastrointestinal gastroesophageal junction or lower 1/3 esophagus using docetaxel, GIGFLODOC I oxaliplatin, infusional fluorouracil, and leucovorin palliative combination chemotherapy for metastatic gastric or leucovorin calcium (cont'd) tablet, injectable Gastrointestinal esophageal adenocarcinoma using irinotecan, fluorouracil and folinic GIGFOLFIRI I acid (leucovorin) adjuvant chemotherapy for resected pancreatic adenocarcinoma using leucovorin calcium (cont'd) injectable Gastrointestinal GIPAJFIROX* I irinotecan, oxaliplatin, fluorouracil and leucovorin adjuvant combination chemotherapy for stage III rectal cancer using leucovorin calcium (cont'd) tablet, injectable Gastrointestinal GIRAJFFOX I oxaliplatin, fluorouracil and folinic acid (leucovorin) therapy for high-risk Gestational Trophoblastic Neoplasia (GTN) using leucovorin calcium (cont'd) tablet, injectable Gynecology etoposide, methotrexate, leucovorin (folinic acid), dactinomycin, GOTDEMACO I cyclophosphamide and vincristine therapy for low risk gestational trophoblastic neoplasia using leucovorin calcium (cont'd) tablet, injectable Gynecology GOTDLR I methotrexate, leucovorin and actinomycin-D

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DOSAGE TUMOUR PROTOCOL DRUG APPROVED INDICATIONS CLASS NOTES FORM SITE CODES fluorouracil and leucovorin for recurrent head and neck cancer leucovorin calcium (cont'd) tablet, injectable Head and Neck HNAVFUFA I (squamous cell carcinoma) fluorouracil and leucovorin for recurrent head and neck cancer leucovorin calcium (cont'd) tablet, injectable Head and Neck HNNAVFUFA I (nasopharyngeal) treatment of refractory or relapsing extranodal natural killer or T-Cell leucovorin calcium (cont'd) tablet, injectable Lymphoma LYASPMEDEX I lymphoma using pegaspargase, methotrexate and dexamethasone central nervous system prophylaxis with high dose methotrexate, CHOP leucovorin calcium (cont'd) tablet, injectable Lymphoma LYCHOPRMTX I and rituximab in diffuse large B-cell lymphoma treatment of Burkitt’s Lymphoma and Leukemia with cyclophosphamide, leucovorin calcium (cont'd) tablet, injectable Lymphoma LYCODOXMR I vincristine, doxorubicin, methotrexate, leucovorin and rituximab treatment of Primary Intracerebral Lymphoma with high dose leucovorin calcium (cont'd) tablet, injectable Lymphoma LYHDMRP I methotrexate and rituximab treatment of Primary Intracerebral Lymphoma with high dose leucovorin calcium (cont'd) tablet, injectable Lymphoma LYHDMTXP I methotrexate treatment of Leptomeningeal Lymphoma or recurrent Intracerebral leucovorin calcium (cont'd) tablet, injectable Lymphoma LYHDMTXR I Lymphoma with high dose methotrexate treatment of natural killer or T-Cell lymphoma using dexamethasone, leucovorin calcium (cont'd) tablet, injectable Lymphoma LYSMILE I methotrexate, ifosfamide, pegaspargase and etoposide treatment of osteosarcoma using high dose methotrexate with leucovorin calcium (cont'd) tablet, injectable Sarcoma SAHDMTX I leucovorin rescue Other tumour site Not Otherwise leucovorin calcium (cont'd) tablet, injectable code followed by I Specified ‘NOS’ (e.g. LYNOS)

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DOSAGE TUMOUR PROTOCOL DRUG APPROVED INDICATIONS CLASS NOTES FORM SITE CODES injectable, long neoadjuvant or adjuvant ovarian suppression and aromatase inhibitor in leuprolide Breast BRAJLHRHAI I acting injectable premenopausal women with high-risk early stage breast cancer injectable, long neoadjuvant or adjuvant therapy for breast cancer using a LHRH leuprolide Breast BRAJLHRHT I Leuprolide acetate IM acting injectable agonist and tamoxifen injectable, long therapy for advanced breast cancer using a LHRH agonist and an (LUPRON®) and SC (ELIGARD®) leuprolide (cont'd) Breast BRAVLHRHA I acting injectable aromatase inhibitor injectables are both reimbursable injectable, long combination therapy with tamoxifen palliative therapy for metastatic for prostate cancer indications leuprolide Breast BRAVLHRHT I acting injectable breast cancer (GUPLHRH). Not reimbursed for injectable, long therapy of advanced breast cancer using palbociclib and aromatase leuprolide Breast UBRAVPALAI R endometriosis. acting injectable inhibitor with or without LHRH agonist injectable, long leuprolide Genitourinary therapy for prostate cancer using LHRH agonist GUPLHRH I acting injectable lomustine capsule Neuro-Oncology lomustine for treatment of recurrent malignant brain tumors CNCCNU I adjuvant lomustine, cisplatin and vincristine in adult high-risk lomustine capsule Neuro-Oncology CNCCV I medulloblastoma or other primitive neuroectodermal tumour modified PCV chemotherapy of brain tumours using procarbazine, lomustine (cont'd) capsule Neuro-Oncology CNMODPCV I lomustine and vincristine lomustine (cont'd) capsule Lymphoma lymphoma palliative chemotherapy LYPALL I Other tumour site Not Otherwise lomustine (cont'd) capsule code followed by I Specified ‘NOS’ (e.g. CNNOS) Approval from Health Canada mechlorethamine topical gel Lymphoma topical mechlorethamine in cutaneous T-Cell lymphoma LYMECHLOR I Special Access Programme is () (SAP) required for each patient Not reimbursed for appetite medroxyprogesterone tablet Gynecology non-aromatase inhibitor hormonal treatment of endometrial cancer GOENDH I stimulation or replacement therapy. megestrol tablet Breast breast cancer BRAVMEG I Not reimbursed for appetite stimulation or symptom megestrol tablet Gynecology non-aromatase inhibitor hormonal treatment of endometrial cancer GOENDH I management conditioning therapy for autologous stem cell transplant using high dose melphalan tablet, injectable BMT BMTMM0301 I melphalan in the treatment of multiple myeloma melphalan tablet, injectable Myeloma treatment of multiple myeloma using melphalan and prednisone MYMP I treatment of multiple myeloma using melphalan, prednisone and weekly melphalan tablet, injectable Myeloma bortezomib with the option of substituting cyclophosphamide for MYMPBOR I melphalan Other tumour site Not Otherwise melphalan tablet, injectable code followed by I Specified ‘NOS’ (e.g. LKNOS) Tumour site code Not Otherwise 6- tablet followed by ‘NOS’ I Specified (e.g. LKNOS)

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DOSAGE TUMOUR PROTOCOL DRUG APPROVED INDICATIONS CLASS NOTES FORM SITE CODES consolidation/ salvage treatment for germ cell cancer using vinblastine, mesna injectable Genitourinary GUVEIP I cisplatin, ifosfamide and mesna nonseminoma consolidation/salvage protocol using etoposide, cisplatin, mesna injectable GUVIP2 I Genitourinary ifosfamide, mesna Treatment of Burkitt’s lymphoma and leukemia with ifosfamide, mesna, mesna (cont'd) injectable Lymphoma LYIVACR I etoposide, cytarabine and rituximab therapy for advanced soft tissue sarcoma using doxorubicin, ifosfamide- mesna injectable Sarcoma SAAI I mesna SAIME alternating with SAVAC or SAVACM with filgrastim support at a TWO weekly interval for newly diagnosed Ewing's Sarcoma/Ewing’s mesna (cont'd) injectable Sarcoma SAALT2W I Family of Tumours, Desmoplastic Intra-Abdominal Small Round Blue Cell Tumour or Rhabdomyosarcoma SAIME alternating with SAVAC or SAVACM with filgrastim support at a THREE weekly interval for newly diagnosed Ewing's Sarcoma/Ewing’s mesna (cont'd) injectable Sarcoma SAALT3W I Approved for use ONLY as an uro- Family of Tumours, Desmoplastic Intra-Abdominal Small Round Blue protector for ifosfamide or high Cell Tumour or Rhabdomyosarcoma dose cyclophosphamide mesna (cont'd) injectable Sarcoma therapy for advanced soft tissue sarcoma using ifosfamide SAAVI I mesna injectable Sarcoma 3-day ifosfamide for use in patients with advanced soft tissue sarcoma SAAVI3 I 3-day etoposide & ifosfamide-mesna for patients with advanced soft mesna injectable SAAVIME3 I Sarcoma tissue or bony sarcomas mesna (cont'd) injectable Sarcoma etoposide, ifosfamide-mesna (SAIME) for use in sarcomas SAIME I treatment of sarcomas with pelvic primaries or chemotherapy induced mesna (cont'd) injectable Sarcoma SAVACM I hematuria using vincristine, doxorubicin, cyclophosphamide and mesna adjuvant therapy for rhabdomyosarcoma using vincristine, dactinomycin, mesna (cont'd) injectable Sarcoma SAVDCM I cyclophosphamide and mesna mesna dosage modification for hematuria secondary to mesna (cont'd) injectable Supportive Care SCMESNA I oxazaphosphorines Other tumour site Not Otherwise mesna (cont'd) injectable code followed by I Specified ‘NOS’ (e.g. SANOS) adjuvant therapy for high-risk breast cancer using cyclophosphamide methotrexate tablet, injectable Breast BRAJCMFPO I (oral), methotrexate and fluorouracil palliative therapy for advanced breast cancer using cyclophosphamide, methotrexate (cont'd) tablet, injectable Breast BRAVCMF I Not reimbursed for rheumatoid methotrexate and fluorouracil arthritis, psoriasis. therapy for high-risk Gestational Trophoblastic Neoplasia (GTN) using methotrexate tablet, injectable Gynecology etoposide, methotrexate, leucovorin (folinic acid), dactinomycin, GOTDEMACO I cyclophosphamide and vincristine

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DOSAGE TUMOUR PROTOCOL DRUG APPROVED INDICATIONS CLASS NOTES FORM SITE CODES therapy for low risk gestational trophoblastic neoplasia using methotrexate (cont'd) tablet, injectable Gynecology GOTDLR I methotrexate, leucovorin and actinomycin-D therapy for transitional cell cancers of the urothelium using methotrexate tablet, injectable Genitourinary GUMVAC I methotrexate, vinblastine, doxorubicin and cisplatin treatment of head and neck cancer using methotrexate as standard methotrexate tablet, injectable Head and Neck HNAVM I therapy methotrexate (cont'd) tablet, injectable Kaposi's Sarcoma therapy for Kaposi's Sarcoma using vinblastine-vincristine KSVB I treatment of hemophagocytic lymphohistiocytosis with etoposide, methotrexate (cont'd) tablet, injectable Lymphoma HLHETCSPA I dexamethasone and cycloSPORINE treatment of refractory or relapsing extranodal natural killer or T-Cell methotrexate (cont'd) tablet, injectable Lymphoma LYASPMEDEX I lymphoma using pegaspargase, methotrexate and dexamethasone central nervous system prophylaxis with high dose methotrexate, CHOP methotrexate (cont'd) tablet, injectable Lymphoma LYCHOPRMTX I and rituximab in diffuse large B-cell lymphoma treatment of burkitt’s lymphoma and leukemia with cyclophosphamide, methotrexate (cont'd) tablet, injectable Lymphoma LYCODOXMR I vincristine, doxorubicin, methotrexate, leucovorin and rituximab treatment of lymphoma with dose-adjusted etoposide, doxorubicin, methotrexate (cont'd) tablet, injectable Lymphoma vincristine, cyclophosphamide, prednisone and rituximab with LYEPOCHR I intrathecal methotrexate treatment of primary intracerebral lymphoma with high dose methotrexate (cont'd) tablet, injectable Lymphoma LYHDMRP I Not reimbursed for rheumatoid methotrexate and rituximab arthritis, psoriasis. treatment of primary intracerebral lymphoma with high dose methotrexate (cont'd) tablet, injectable Lymphoma LYHDMTXP I methotrexate treatment of leptomeningeal lymphoma or recurrent intracerebral methotrexate (cont'd) tablet, injectable Lymphoma LYHDMTXR I lymphoma with high dose methotrexate methotrexate (cont'd) tablet, injectable Lymphoma treatment of lymphoma using intrathecal methotrexate and cytarabine LYIT I treatment of Burkitt’s Lymphoma and Leukemia with ifosfamide, mesna, methotrexate (cont'd) tablet, injectable Lymphoma LYIVACR I etoposide, cytarabine and rituximab methotrexate (cont'd) tablet, injectable Lymphoma lymphoma palliative chemotherapy LYPALL I treatment of natural killer or T-Cell Lymphoma using dexamethasone, methotrexate (cont'd) tablet, injectable Lymphoma LYSMILE I methotrexate, ifosfamide, pegaspargase and etoposide therapy for solid tumours using intrathecal methotrexate and/or thiotepa methotrexate (cont'd) tablet, injectable Miscellaneous Origins MOIT I and/or cytarabine treatment of osteosarcoma using high dose methotrexate with methotrexate (cont'd) tablet, injectable Sarcoma SAHDMTX I leucovorin rescue palliative therapy for aggressive fibromatosis using weekly or alternate methotrexate (cont'd) tablet, injectable Sarcoma SAMV I week methotrexate and vinblastine intravenously Other tumour site Not Otherwise methotrexate (cont'd) tablet, injectable code followed by I Specified ‘NOS’ (e.g. MYNOS) treatment of Cutaneous T-cell Lymphoma (Sézary syndrome) with methoxypsoralen injectable Lymphoma ULYMFECP R extracorporeal photopheresis Only reimbursable when prescribed by physicians in the topical cream Skin & Melanoma topical therapy for skin cancer with PDT (Photodynamic Therapy) SMPDT I Skin Tumour Group within the (METVIX®) Skin PDT Program of the BC Cancer Agency therapy of FLT3+ acute myeloid leukemia using midostaurin in midostaurin capsule Leukemia ULKAMLMIDO R combination with induction and consolidation chemotherapy

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DOSAGE TUMOUR PROTOCOL DRUG APPROVED INDICATIONS CLASS NOTES FORM SITE CODES combined modality therapy for carcinoma of the anal canal using mitomycin injectable Gastrointestinal GICART I mitomycin, capecitabine and radiation therapy Only funded when prescribed by hepatic trans-arterial chemoembolization for primary liver cancer or liver mitomycin injectable Gastrointestinal GIEMBOL I specialists at BC Cancer VC & metastasis Royal Jubilee Hospital combined modality curative therapy for carcinoma of the anal canal mitomycin (cont'd) injectable Gastrointestinal GIFUART I using mitomycin, fluorouracil and radiation therapy chemotherapy of pseudomyxoma peritonei using intraperitoneal mitomycin (cont'd) injectable Gastrointestinal GIFUIP I mitomycin and fluorouracil hyperthermic intraperitoneal chemotherapy (HIPEC) for patients with mitomycin (cont'd) injectable Gastrointestinal peritoneal carcinomatosis from limited advanced colorectal and GIHIPEC I appendiceal carcinomas using oxaliplatin and fluorouracil combined modality therapy for squamous cell cancer of the mitomycin (cont'd) injectable Genitourinary GUFUPRT I genitourinary system using fluorouracil and cisplatin with radiation intravesical therapy for non-muscle invasive cell bladder cancer using GUBMITO mitomycin injectable Genitourinary I mitomycin mitomycin eye drops Ocular eye drops as topical therapy for ocular malignancies OCMITO I Other tumour site Not Otherwise mitomycin (cont'd) injectable code followed by I Specified ‘NOS’ (e.g. GUNOS) mitotane tablet Genitourinary treatment of advanced adrenal cortical cancer GUMITO I treatment of metastatic adrenalcortical cancer with doxorubicin, mitotane tablet Genitourinary GUEDPM I etoposide, cisplatin and mitotane palliative therapy for hormone-refractory prostate cancer using injectable Genitourinary GUPMX I mitoxantrone and prednisone Other tumour site Not Otherwise mitoxantrone injectable code followed by I Specified ‘NOS’ (e.g. BRNOS) nilotinib tablet Leukemia treatment of chronic myeloid leukemia using nilotinib ULKCMLN R prostate carcinoma patients who are intolerant to bicalutamide or Not reimbursed for vasomotor nilutamide tablet Genitourinary GUPNSAA I flutamide, at 150 mg po daily symptoms (hot flashes)

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DOSAGE TUMOUR PROTOCOL DRUG APPROVED INDICATIONS CLASS NOTES FORM SITE CODES treatment of metastatic or advanced renal cell carcinoma using nivolumab injectable Genitourinary UGUAVIPNI R ipilimumab and nivolumab treatment of metastatic or advanced renal cell carcinoma using UGUAVNIV R nivolumab treatment of metastatic or advanced renal cell carcinoma using 4-weekly nivolumab injectable Genitourinary UGUAVNIV4 R nivolumab palliative therapy for unresectable, platinum-refractory, recurrent or nivolumab injectable Head and Neck UHNAVNIV R metastatic squamous cell cancer of the head and neck using nivolumab palliative therapy for unresectable, platinum-refractory, recurrent or nivolumab injectable Head and Neck metastatic squamous cell cancer of the head and neck using 4-weekly UHNAVNIV4 R nivolumab nivolumab injectable Lung treatment of advanced non-small cell lung cancer using nivolumab ULUAVNIV R treatment of advanced non-small cell lung cancer using 4-weekly nivolumab injectable Lung ULUAVNIV4 R nivolumab treatment of unresectable or metastatic melanoma using ipilimumab and nivolumab injectable Skin & Melanoma USMAVIPNI R nivolumab nivolumab injectable Skin & Melanoma treatment of unresectable or metastatic melanoma using nivolumab USMAVNIV R treatment of unresectable or metastatic melanoma using 4-weekly nivolumab injectable Skin & Melanoma USMAVNIV4 R nivolumab treatment of previously untreated chronic lymphocytic leukemia using obinutuzumab injectable Lymphoma ULYOBCHLOR R obinutuzumab in combination with chlorambucil treatment of rituximab-refractory follicular lymphoma with obinutuzumab obinutuzumab injectable Lymphoma ULYOBBEND R in combination with bendamustine octreotide injectable Neuro-Oncology treatment of growth hormone secreting pituitary adenoma CNOCTLAR I

neuroendocrine tumours of the mid-gut or pancreas (including carcinoid octreotide injectable Gastrointestinal GINOS I tumours and VIPoma) with symptoms due to ectopic hormone secretion long acting octreotide Neuro-Oncology treatment of growth hormone secreting pituitary adenoma CNOCTLAR I injectable long acting neuroendocrine tumours of the mid-gut or pancreas (including carcinoid octreotide Gastrointestinal UGIOCTLAR R injectable tumours and VIPoma) with symptoms due to ectopic hormone secretion maintenance treatment of relapsed, BRCA-mutated, platinum sensitive Note: capsule formulation not tablet Gynecology UGOOVOLAPM R and responsive epithelial ovarian cancer using olaparib funded treatment of EGFR T790M mutation-positive advanced non-small cell osimertinib tablet Lung ULUAVOSI R lung cancer with osimertinib adjuvant combination chemotherapy for stage III and IIB colon cancer oxaliplatin injectable Gastrointestinal GIAJCAPOX I with capecitabine adjuvant combination chemotherapy for stage III and IIB colon cancer oxaliplatin (cont'd) injectable Gastrointestinal GIAJFFOX I with fluorouracil and folinic acid adjuvant combination chemotherapy for node-positive colon cancer oxaliplatin injectable Gastrointestinal using oxaliplatin and raltitrexed in patients intolerant to fluorouracil or UGIAJRALOX R capecitabine palliative combination chemotherapy for metastatic colorectal cancer oxaliplatin injectable Gastrointestinal GICAPOX I using oxaliplatin and capecitabine

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DOSAGE TUMOUR PROTOCOL DRUG APPROVED INDICATIONS CLASS NOTES FORM SITE CODES palliative combination chemotherapy for metastatic colorectal cancer oxaliplatin (cont'd) injectable Gastrointestinal GICOXB I using oxaliplatin, bevacizumab and capecitabine combined modality therapy for locally advanced esophageal cancer oxaliplatin (cont'd) injectable Gastrointestinal GIEFFOXRT I using oxaliplatin, fluorouracil, leucovorin, and radiation therapy palliative combination chemotherapy for metastatic colorectal cancer oxaliplatin injectable Gastrointestinal GIFFOXB I using oxaliplatin, fluorouracil, leucovorin, and bevacizumab palliative combination chemotherapy for metastatic colorectal cancer oxaliplatin injectable Gastrointestinal UGIFFOXPAN R using oxaliplatin, fluorouracil, leucovorin, and panitumumab palliative combination chemotherapy for advanced pancreatic oxaliplatin (cont'd) injectable Gastrointestinal adenocarcinoma using irinotecan, oxaliplatin, fluorouracil and folinic GIFIRINOX I acid (leucovorin) palliative combination chemotherapy for metastatic colorectal cancer oxaliplatin injectable Gastrointestinal GIFOLFOX I with fluorouracil and folinic acid adjuvant chemotherapy of gastric cancer patients with D2 resection oxaliplatin (cont'd) injectable Gastrointestinal (node negative) or ineligible for adjuvant chemoradiation using GIGAJCOX I oxaliplatin and capecitabine adjuvant chemotherapy of gastric cancer patients with D2 resection oxaliplatin injectable Gastrointestinal (node negative) or ineligible for adjuvant chemoradiation using GIGAJFFOX I oxaliplatin, fluorouracil, and leucovorin palliative treatment of metastatic or locally advanced gastric, oxaliplatin injectable Gastrointestinal gastroesophageal junction, or esophageal adenocarcinoma using GIGAVCOX I capecitabine and oxaliplatin palliative treatment of metastatic or locally advanced gastric, oxaliplatin injectable Gastrointestinal gastroesophageal junction, or esophageal adenocarcinoma using GIGAVCOXT I capecitabine, oxaliplatin and trastuzumab (HERCEPTIN) palliative therapy for metastatic or locally advanced gastric or oxaliplatin (cont'd) injectable Gastrointestinal GIGAVEOCAP I esophagogastric cancer using epirubicin, oxaliplatin and capecitabine palliative therapy for metastatic or locally advanced gastric or oxaliplatin injectable Gastrointestinal esophagogastric cancer using epirubicin, oxaliplatin and infusional GIGAVEOF I fluorouracil palliative treatment of metastatic or locally advanced gastric, oxaliplatin injectable Gastrointestinal gastroesophageal junction, or esophageal adenocarcinoma using GIGAVFFOX I oxaliplatin, fluorouracil and leucovorin palliative treatment of metastatic or locally advanced HER-2 positive oxaliplatin injectable Gastrointestinal gastric, gastroesophageal junction, or esophageal adenocarcinoma GIGAVFFOXT I using oxaliplatin, fluorouracil, leucovorin, and trastuzumab perioperative treatment of resectable adenocarcinoma of the stomach, oxaliplatin injectable Gastrointestinal gastroesophageal junction or lower 1/3 esophagus using docetaxel, GIGFLODOC I oxaliplatin, infusional fluorouracil, and leucovorin hyperthermic intraperitoneal chemotherapy (HIPEC) for patients with oxaliplatin (cont'd) injectable Gastrointestinal peritoneal carcinomatosis from limited advanced colorectal and GIHIPEC I appendiceal carcinomas using oxaliplatin and fluorouracil adjuvant chemotherapy for resected pancreatic adenocarcinoma using oxaliplatin (cont'd) injectable Gastrointestinal GIPAJFIROX* I irinotecan, oxaliplatin, fluorouracil and leucovorin adjuvant combination chemotherapy for stage III rectal cancer with oxaliplatin injectable Gastrointestinal GIRAJCOX I capecitabine adjuvant combination chemotherapy for stage III rectal cancer with oxaliplatin injectable Gastrointestinal GIRAJFFOX I fluorouracil and folinic acid

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DOSAGE TUMOUR PROTOCOL DRUG APPROVED INDICATIONS CLASS NOTES FORM SITE CODES neoadjuvant or adjuvant therapy for breast cancer using doxorubicin paclitaxel injectable Breast BRAJACT I and cyclophosphamide followed by paclitaxel neoadjuvant or adjuvant therapy for breast cancer using dose dense paclitaxel injectable Breast BRAJACTG I therapy: doxorubicin and cyclophosphamide followed by paclitaxel neoadjuvant or adjuvant therapy for breast cancer using doxorubicin paclitaxel (cont'd) injectable Breast and cyclophosphamide followed by paclitaxel and trastuzumab BRAJACTT I (HERCEPTIN) neoadjuvant or adjuvant therapy for breast cancer using dose dense paclitaxel (cont'd) injectable Breast therapy: doxorubicin and cyclophosphamide followed by paclitaxel and BRAJACTTG I trastuzumab (HERCEPTIN) neoadjuvant or adjuvant therapy for early breast cancer using paclitaxel (cont'd) injectable Breast BRAJACTW I doxorubicin and cyclophosphamide followed by weekly paclitaxel adjuvant therapy for breast cancer using weekly paclitaxel and paclitaxel injectable Breast BRAJTTW I trastuzumab (HERCEPTIN) paclitaxel injectable Breast treatment of metastatic breast cancer using gemcitabine and paclitaxel BRAVGEMT I palliative therapy for metastatic breast cancer using pertuzumab, paclitaxel (cont'd) injectable Breast trastuzumab (HERCEPTIN), and paclitaxel as first-line treatment for BRAVPTRAT I advanced breast cancer paclitaxel (cont'd) injectable Breast palliative therapy for metastatic breast cancer using paclitaxel BRAVTAX I combination with paclitaxel and carboplatin as palliative therapy for paclitaxel (cont'd) injectable Breast metastatic breast cancer as first-line treatment for recurrent breast BRAVTPCARB I cancer refractory to anthracycline chemotherapy with paclitaxel as first-line treatment for advanced breast cancer paclitaxel (cont'd) injectable Breast BRAVTRAP I refractory to anthracycline adjuvant chemotherapy palliative therapy for metastatic breast cancer using weekly paclitaxel paclitaxel injectable Breast BRAVTW I (given weekly for 3 weeks out of 4 weeks) (replaces BRAVT7) neoadjuvant therapy for breast cancer using dose dense therapy: paclitaxel (cont'd) injectable Breast BRLATACG I paclitaxel followed by doxorubicin and cyclophosphamide treatment of locally advanced breast cancer using doxorubicin and paclitaxel injectable Breast BRLATWAC I cyclophosphamide followed by weekly paclitaxel neoadjuvant treatment of esophageal and gastroesophageal paclitaxel (cont'd) injectable Gastrointestinal GIENACTRT I carcinomas using carboplatin, paclitaxel and radiation therapy second-line therapy for metastatic or locally advanced gastric or paclitaxel (cont'd) injectable Gastrointestinal gastroesophageal junction cancer using weekly paclitaxel and GIGAVRAMT I ramucirumab hyperthermic intraperitoneal chemotherapy (HIPEC) for patients with paclitaxel (cont'd) injectable Gastrointestinal GIPMHIPEC I peritoneal mesothelioma using doxorubicin, cisplatin and paclitaxel alternative treatment of gynecological malignancies using cisplatin and paclitaxel (cont'd) injectable Gynecology GOCISP I paclitaxel primary adjuvant treatment of adenocarcinoma/adenosquamous cancer paclitaxel (cont'd) injectable Gynecology of the cervix with carboplatin and paclitaxel preceding or following GOCXAJCAT I irradiation with or without cisplatin combination with carboplatin as primary treatment of paclitaxel (cont'd) injectable Gynecology advanced/recurrent non-small cell cancer of the cervix in ambulatory GOCXCAT I care settings

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DOSAGE TUMOUR PROTOCOL DRUG APPROVED INDICATIONS CLASS NOTES FORM SITE CODES paclitaxel (cont'd) injectable Gynecology primarily advanced or recurrent endometrial cancer GOENDCAT I primary treatment of invasive epithelial ovarian, fallopian tube and paclitaxel (cont'd) injectable Gynecology primary peritoneal cancer with high risk of relapse using bevacizumab, UGOOVCATB* R carboplatin and paclitaxel primary treatment of invasive epithelial ovarian, fallopian tube and paclitaxel (cont'd) injectable Gynecology primary peritoneal cancer, with no visible residual tumour (moderate- GOOVCATM I high risk) ovarian cancer relapsing after complete remission of at least 4 months’ paclitaxel (cont'd) injectable Gynecology GOOVCATR I duration in response to primary treatment with carboplatin and paclitaxel primary treatment of visible residual (extreme risk) invasive epithelial paclitaxel (cont'd) injectable Gynecology GOOVCATX I ovarian cancer primary treatment of metastatic/recurrent cancer of the cervix with paclitaxel (cont'd) injectable Gynecology GOCXCATB I bevacizumab, carboplatin and paclitaxel treatment of platinum resistant epithelial ovarian cancer with paclitaxel (cont'd) injectable Gynecology UGOOVBEVP R bevacizumab and paclitaxel primary treatment of advanced epithelial ovarian, primary peritoneal, or paclitaxel (cont'd) injectable Gynecology GOOVDDCAT I fallopian tube carcinoma using carboplatin and weekly paclitaxel primary treatment of stage III less than or equal to 1 cm visible residual paclitaxel (cont'd) injectable Gynecology invasive epithelial ovarian cancer using intravenous and intraperitoneal GOOVIPPC I paclitaxel and intraperitoneal carboplatin progressive, platinum-refractory ovarian carcinoma, primary peritoneal paclitaxel (cont'd) injectable Gynecology GOOVTAX3 I carcinoma or fallopian tube carcinoma primary management of any gynecologic small cell cancer as part of a paclitaxel (cont'd) injectable Gynecology GOSMCCRT I combined modality regimen combination palliative therapy with gemcitabine in patients with relapsed, cisplatin-refractory germ cell cancers not amenable to cure paclitaxel (cont'd) injectable Genitourinary UGUTAXGEM R with surgery or chemotherapy (patients relapsed after BMT are potentially eligible therapy for relapsed testicular germ cell cancer using paclitaxel, paclitaxel (cont'd) injectable Genitourinary UGUTIP R lfosfamide and cisplatin treatment for unresectable, locoregionally recurrent or metastatic paclitaxel (cont'd) injectable Head and Neck squamous cell carcinoma of the head and neck using paclitaxel and HNAVPC I cisplatin or carboplatin treatment of recurrent or metastatic nasopharyngeal carcinoma with paclitaxel (cont'd) injectable Head and Neck HNNAVPC I carboplatin and paclitaxel adjuvant carboplatin and paclitaxel following resection of stage I, II and paclitaxel (cont'd) injectable Lung LUAJPC I IIIA non-small cell lung cancer combination with carboplatin as first line treatment of advanced non- paclitaxel (cont'd) injectable Lung LUAVPC I small cell lung cancer treatment of locally advanced non-small cell lung cancer using paclitaxel (cont'd) injectable Lung LULACATRT I carboplatin and paclitaxel with radiation therapy primary treatment of cancer of unknown primary origin using carboplatin paclitaxel (cont'd) injectable Primary Unknown PUCAT I and paclitaxel treatment of recurrent or resistant pediatric malignant germ cell tumors paclitaxel (cont'd) injectable Pediatric I with paclitaxel, ifosfamide and carboplatin (COG protocol AGCT0521)

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DOSAGE TUMOUR PROTOCOL DRUG APPROVED INDICATIONS CLASS NOTES FORM SITE CODES paclitaxel-nab injectable Breast palliative therapy for metastatic breast cancer BRAVABR I (ABRAXANE®) paclitaxel-nab first line treatment of locally advanced and metastatic pancreatic cancer injectable Gastrointestinal GIPGEMABR I (ABRAXANE®) (cont'd) with paclitaxel-nab (ABRAXANE®) and gemcitabine therapy of advanced breast cancer using palbociclib and aromatase palbociclib capsule Breast UBRAVPALAI R inhibitor with or without LHRH agonist pamidronate injectable Breast adjuvant treatment of post-menopausal women using pamidronate UBRAJPAM R bony metastases associated with breast cancer for patients who do not pamidronate injectable Breast BRAVCLOD I tolerate oral clodronate Not reimbursed for hypercalcemia prevention of skeletal related events secondary to breast cancer using pamidronate injectable Breast BRAVPAM I pamidronate pamidronate injectable Myeloma multiple myeloma MYPAM I palliative third-line treatment of metastatic colorectal cancer using panitumumab injectable Gastrointestinal GIAVPANI I panitumumab with wild type KRAS palliative combination chemotherapy for metastatic colorectal cancer panitumumab injectable Gastrointestinal UGIFFIRPAN R using irinotecan, fluorouracil, leucovorin, and panitumumab palliative combination chemotherapy for metastatic colorectal cancer panitumumab injectable Gastrointestinal UGIFFOXPAN R using oxaliplatin, fluorouracil, leucovorin, and panitumumab pazopanib tablet Genitourinary palliative therapy for renal cell carcinoma using pazopanib UGUPAZO R pegaspargase treatment of refractory or relapsing extranodal natural killer or T-Cell injectable Lymphoma LYASPMEDEX I (ONCASPAR®) lymphoma using pegaspargase, methotrexate and dexamethasone pegaspargase treatment of natural killer or T-Cell Lymphoma using dexamethasone, injectable Lymphoma LYSMILE I (ONCASPAR®) methotrexate, ifosfamide, pegaspargase and etoposide pegaspargase injectable Pediatric pediatric patients with leukemia or lymphoma I (ONCASPAR®) peginterferon alfa-2a injectable Leukemia therapy of chronic myeloid neoplasms and hypereosinophilic syndrome LKPEGIFN I second-line treatment of advanced non-small cell lung cancer using pembrolizumab injectable Lung ULUAVPMB R pembrolizumab first-line treatment of advanced non-small cell lung cancer using pembrolizumab injectable Lung ULUAVPMBF R pembrolizumab 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 maintenance therapy of advanced non-small cell lung cancer after first- pemetrexed injectable Lung LUAVPMTN I line chemotherapy first-line treatment of advanced non-small cell lung cancer with platinum pemetrexed injectable Lung LUAVPP I and pemetrexed pemetrexed (cont'd) injectable Lung treatment of malignant mesothelioma with platinum and pemetrexed LUMMPP I palliative therapy for metastatic breast cancer using pertuzumab, pertuzumab injectable Breast trastuzumab (HERCEPTIN) and docetaxel as first-line treatment for BRAVPTRAD I advanced breast cancer palliative therapy for metastatic breast cancer using pertuzumab, pertuzumab (cont'd) injectable Breast trastuzumab (HERCEPTIN), and paclitaxel as first-line treatment for BRAVPTRAT I advanced breast cancer plerixafor injectable hematopoietic stem cell mobilization PLERIXAFOR I pomalidomide capsule Myeloma therapy of multiple myeloma using pomalidomide with dexamethasone UMYPOMDEX R treatment of chronic myeloid leukemia and Ph+ acute lymphoblastic ponatinib tablet Leukemia ULKCMLP R leukemia using ponatinib

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DOSAGE TUMOUR PROTOCOL DRUG APPROVED INDICATIONS CLASS NOTES FORM SITE CODES photodynamic therapy in patients with high-grade dysplasia associated porfimer (PHOTOFRIN®) injectable Gastrointestinal UGI0 R with Barrett's esophagus, and who are not candidates for surgery prednisolone suspension Pediatric pediatric patients I palliative therapy for metastatic castration resistant prostate cancer sing prednisone tablet Genitourinary UGUPCABA R cabazitaxel and predniSONE palliative therapy for metastatic castration resistant prostate cancer prednisone (cont'd) tablet Genitourinary UGUPABI R using abiraterone and prednisone after failure of docetaxel therapy prednisone tablet Genitourinary palliative therapy for metastatic hormone refractory prostate cancer GUPDOC I palliative therapy for hormone-refractory prostate cancer using prednisone (cont'd) tablet Genitourinary GUPMX I mitoxantrone and prednisone treatment of lymphoma with doxorubicin, cyclophosphamide, vincristine prednisone tablet Lymphoma LYCHOP I and prednisone treatment of lymphoma with doxorubicin, cyclophosphamide, vincristine, prednisone (cont'd) tablet Lymphoma LYCHOPR I prednisone and rituximab central nervous system prophylaxis with high dose methotrexate, CHOP prednisone tablet Lymphoma LYCHOPRMTX I and rituximab in diffuse large B-cell lymphoma treatment of relapsed chronic lymphocytic leukemia using prednisone tablet Lymphoma LYCLLCVPR I cyclophosphamide, vincristine, prednisone and rituximab advanced indolent lymphoma using cyclophosphamide, vincristine and prednisone tablet Lymphoma LYCVP I prednisone treatment of advanced indolent lymphoma using cyclophosphamide, prednisone tablet Lymphoma LYCVPR I vincristine, prednisone and rituximab therapy of lymphoma, Hodgkin's disease, chronic lymphocytic leukemia prednisone tablet Lymphoma LYCYCLO I or multiple myeloma using cyclophosphamide treatment of lymphoma with dose-adjusted etoposide, doxorubicin, prednisone (cont'd) tablet Lymphoma vincristine, cyclophosphamide, prednisone and rituximab with LYEPOCHR I intrathecal methotrexate prednisone (cont'd) tablet Lymphoma lymphoma palliative chemotherapy LYPALL I treatment of multiple myeloma using bortezomib, dexamethasone with prednisone (cont'd) tablet Myeloma MYBORPRE I or without cyclophosphamide as induction pre-stem cell transplant treatment of relapsed multiple myeloma using bortezomib, prednisone (cont'd) tablet Myeloma MYBORREL I dexamethasone with or without cyclophosphamide treatment of relapsed and refractory multiple myeloma with prednisone (cont'd) tablet Myeloma daratumumab in combination with bortezomib and dexamethasone with UMYDARBD R or without cyclophosphamide treatment of relapsed and refractory multiple myeloma with UMYDARLD R daratumumab in combination with lenalidomide and dexamethasone prednisone (cont'd) tablet Myeloma treatment of multiple myeloma using melphalan and prednisone MYMP I treatment of multiple myeloma using melphalan, prednisone and weekly prednisone (cont'd) tablet Myeloma bortezomib with the option of substituting cyclophosphamide for MYMPBOR I melphalan Other tumour site Not Otherwise prednisone (cont'd) tablet code followed by I Specified ‘NOS’ (e.g. LKNOS)

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DOSAGE TUMOUR PROTOCOL DRUG APPROVED INDICATIONS CLASS NOTES FORM SITE CODES modified PCV chemotherapy of brain tumours using procarbazine, procarbazine capsule Neuro-Oncology CNMODPCV I lomustine and vincristine procarbazine capsule Neuro-Oncology standard procarbazine for second-line treatment of recurrent brain tumor CNPROC I

treatment of Hodgkin's Disease with cyclophosphamide, vinblastine, procarbazine (cont'd) capsule Lymphoma LYCVPPABO I procarbazine and prednisone procarbazine capsule Lymphoma lymphoma palliative chemotherapy LYPALL I Other tumour site Not Otherwise procarbazine (cont'd) capsule code followed by I Specified ‘NOS’ (e.g. CNNOS) quinagolide tablet Neuro-Oncology therapy for pituitary adenaomas using quinagolide CNQUIN I radio- therapy for metastatic castration resistant prostate cancer using radium- radium-223 Genitourinary UGUPRAD R pharmaceutical 223 unresectable or metastatic colorectal adenocarcinoma for patients with raltitrexed injectable Gastrointestinal GIRALT I previous fluorouracil toxicity adjuvant combination chemotherapy for node-positive colon cancer raltitrexed (cont'd) injectable Gastrointestinal using oxaliplatin and raltitrexed in patients intolerant to fluorouracil or UGIAJRALOX R capecitabine second-line therapy for metastatic or locally advanced gastric or ramucirumab injectable Gastrointestinal gastroesophageal junction cancer using weekly paclitaxel and GIGAVRAMT I ramucirumab third line treatment of advanced gastrointestinal stromal cell tumours regorafenib tablet Sarcoma USAAVGR R (GIST's) using regorafenib regorafenib tablet Gastrointestinal treatment of advanced hepatocellular carcinoma using regorafenib UGIREGO R pre-emptive rituximab therapy of Epstein-Barr virus related post- IV formulation only; Rituximab® rituximab IV injectable BMT BMTLPDRIT I transplant lymphoproliferative disease SC not funded IV / 1400 mg SC rituximab Lymphoma treatment of Non-Hodgkin Lymphoma with bendamustine and rituximab LYBENDR I injectable IV / 1400 mg SC treatment of indolent B-cell lymphoma and chronic lymphocytic leukemia rituximab Lymphoma LYCHLRR I injectable with chlorambucil and rituximab in combination with CHOP (cyclophosphamide, doxorubicin, prednisone, IV / 1400 mg SC rituximab (cont'd) Lymphoma vincristine), in all stages of newly diagnosed diffuse large B-cell LYCHOPR I injectable lymphoma and mantle cell lymphoma, advanced stage at diagnosis IV / 1400 mg SC central nervous system prophylaxis with high dose methotrexate, CHOP rituximab Lymphoma LYCHOPRMTX I injectable and rituximab in diffuse large B-cell lymphoma IV / 1600 mg SC treatment of relapsed/refractory chronic lymphocytic leukemia or small rituximab Lymphoma LYCLLBENDR I injectable lymphocytic lymphoma with bendamustine and rituximab IV / 1600 mg SC treatment of chronic lymphocytic leukemia with chlorambucil and rituximab Lymphoma LYCLLCHLR I injectable rituximab IV / 1600 mg SC treatment of relapsed chronic lymphocytic leukemia using rituximab Lymphoma LYCLLCVPR I injectable cyclophosphamide, vincristine, prednisone and rituximab IV / 1600 mg SC treatment of previously untreated chronic lymphocytic leukemia (CLL) LYCLLFBR I injectable with bendamustine and rituximab IV / 1600 mg SC treatment of chronic lymphocytic leukemia or prolymphocytic leukemia rituximab Lymphoma LYCLLFLUDR I injectable with fludarabine and rituximab

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DOSAGE TUMOUR PROTOCOL DRUG APPROVED INDICATIONS CLASS NOTES FORM SITE CODES IV / 1400 mg SC treatment of Burkitt’s lymphoma and leukemia with cyclophosphamide, rituximab (cont'd) Lymphoma LYCODOXMR I injectable vincristine, doxorubicin, methotrexate, leucovorin and rituximab IV / 1400 mg SC combination with CVP for advanced stage indolent lymphoma at rituximab (cont'd) Lymphoma LYCVPR I injectable diagnosis treatment of lymphoma with dose-adjusted etoposide, doxorubicin, IV / 1400 mg SC rituximab (cont'd) Lymphoma vincristine, cyclophosphamide, prednisone and rituximab with LYEPOCHR I injectable intrathecal methotrexate IV / 1600 mg SC treatment of chronic lymphocytic leukemia (CLL) or prolymphocytic rituximab (cont'd) Lymphoma LYFCR I injectable leukemia with fludarabine, cyclophosphamide and rituximab IV / 1400 mg SC rituximab Lymphoma treatment of relapsed indolent lymphoma with fludarabine and rituximab LYFLUDR I injectable IV / 1400 mg SC in combination with gemcitabine, dexamethasone and cisplatin for rituximab (cont'd) Lymphoma LYGDPR I injectable lymphoma IV / 1400 mg SC treatment of primary intracerebral lymphoma with high dose rituximab Lymphoma LYHDMRP I injectable methotrexate and rituximab IV / 1600 mg SC treatment of relapsed/refractory chronic lymphocytic leukemia or small rituximab (cont'd) Lymphoma ULYIDELAR R injectable lymphocytic lymphoma using idelalisib and rituximab IV / 1400 mg SC treatment of Burkitt’s lymphoma and leukemia with ifosfamide, mesna, rituximab (cont'd) Lymphoma LYIVACR I injectable etoposide, cytarabine and rituximab IV / 1400 mg SC treatment of advanced stage large B-cell non-Hodgkin’s lymphoma with rituximab (cont'd) Lymphoma ULYRICE R injectable ifosfamide, carboplatin, etoposide and rituximab follicular lymphoma progressive despite alkylating agents and purine IV / 1400 mg SC analogues (fludarabine or cladribine), post-transplant rituximab (cont'd) Lymphoma LYRITUX I injectable lymphoproliferative disease, or newly diagnosed (within 6 months) asymptomatic advanced follicular lymphoma palliative therapy for lymphoma using radioimmunotherapy: rituximab- IV formulation only; Rituximab® rituximab (cont'd) IV injectable Lymphoma 90 ULYRITZ R priming for ibritumomab Y (ZEVALIN®) SC not funded IV / 1400 mg SC rituximab (cont'd) Lymphoma maintenance treatment of indolent lymphoma LYRMTN I injectable pediatric patients treated on the COG protocols ANHL0221 for CD20 positive post-transplant lymphoproliferative disease following solid IV formulation only; Rituximab® rituximab (cont'd) IV injectable Pediatric I organ transplantation and ANHL01P1 for newly diagnosed advanced B- SC not funded cell leukemia/lymphoma treatment of relapsed or refractory Peripheral T-Cell lymphoma (PTCL) injectable Lymphoma ULYROMI R with romidepsin ruxolitinib tablet Leukemia treatment of symptomatic myelofibrosis with ruxolitinib ULKMFRUX R ruxolitinib tablet Leukemia treatment of polycythemia vera with ruxolitinib ULKPCVRUX R pediatric patients with neuroblastoma treated on the COG ANBL0032 sargramostim injectable Pediatric I protocol pediatric patients with relapsed neuroblastoma treated on the COG sargramostim injectable Pediatric I ANBL1021 protocol treatment of Multicentric Castleman’s Disease (MCD) negative for siltuximab injectable Lymphoma Human Immunodeficiency Virus (HIV) and Human Herpes Virus-8 (HHV- ULYSILTUX R 8) Using siltuximab sorafenib tablet Gastrointestinal sorafenib therapy for advanced hepatocellular carcinoma UGISORAF R palliative therapy for renal cell carcinoma in patients after cytokine sorafenib tablet Genitourinary UGUSORAF R failure sorafenib tablet Leukemia therapy of acute myeloid leukemia using azacitidine and sorafenib ULKAMLAS R

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DOSAGE TUMOUR PROTOCOL DRUG APPROVED INDICATIONS CLASS NOTES FORM SITE CODES palliative therapy for pancreatic endocrine tumours using streptozocin streptozocin injectable Gastrointestinal GIENDO2 I and doxorubicin Approval from Health Canada Other tumour site Special Access Programme is Not Otherwise streptozocin injectable code followed by I required for each patient Specified ‘NOS’ (e.g. GINOS) sunitinib capsule Gastrointestinal as palliative treatment of advance pancreatic neuroendocrine tumours UGIPNSUNI R palliative therapy for renal cell carcinoma in patients who are not sunitinib capsule Genitourinary UGUSUNI R suitable candidates for interferon second line treatment of advanced c-kit positive gastrointestinal stromal sunitinib (cont'd) capsule Sarcoma SAAVGS I cell tumours (GIST's) after imatinib neoadjuvant or adjuvant therapy for breast cancer using a LHRH tamoxifen tablet Breast BRAJLHRHT I agonist and tamoxifen 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 endometrial cancernon-aromatase inhibitor hormonal treatment of tamoxifen tablet Gynecology GOENDH I endometrial cancer tamoxifen tablet Gynecology therapy for advanced ovarian cancer using tamoxifen GOOVTAM I tamoxifen (cont'd) tablet Head and Neck treatment of recurrent/metastatic salivary gland cancers HNSAVTAM I tamoxifen tablet Sarcoma recurrent desmoid tumors/aggressive fibromatosis SATAM I concomitant (dual modality) and 12 cycles of adjuvant temozolomide for temozolomide capsule Neuro-Oncology CNAJ12TZRT I newly diagnosed astrocytomas and oligodendrogliomas with radiation concomitant and adjuvant temozolomide for newly diagnosed malignant temozolomide capsule Neuro-Oncology CNAJTZRT I gliomas with radiation treatment of elderly newly diagnosed glioma patient with concurrent and temozolomide capsule Neuro-Oncology CNELTZRT I adjuvant temozolomide and radiation therapy therapy for newly diagnosed malignant brain tumours with MGMT temozolomide capsule Neuro-Oncology CNTEM60 I methylation in elderly patients using temozolomide temozolomide capsule Neuro-Oncology therapy for malignant brain tumours CNTEMOZ I therapy for malignant brain tumours using metronomic dosing of temozolomide capsule Neuro-Oncology CNTEMOZMD I temozolomide

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DOSAGE TUMOUR PROTOCOL DRUG APPROVED INDICATIONS CLASS NOTES FORM SITE CODES therapy for recurrent malignant brain tumours using temozolomide and temozolomide (cont'd) capsule Neuro-Oncology CNTMZETO I etoposide palliative therapy of metastatic neuroendocrine cancer using temozolomide (cont'd) capsule Gastrointestinal GIAVTZCAP I temozolomide and capecitabine temozolomide (cont'd) capsule Pediatric pediatric patients with brain tumours I pediatric patients treated on the COG protocol ANBL0421 for recurrent temozolomide capsule Pediatric I neuroblastoma pediatric patients with rhabdomyosarcoma treated on the COG temozolomide (cont'd) capsule Pediatric I ARST08P1 protocol therapy for advanced solitary fibrous tumours and hemangiopericytoma temozolomide (cont'd) capsule Sarcoma USATEMBEV R using temozolomide and bevacizumab temozolomide (cont'd) capsule Skin & Melanoma palliative therapy for malignant melanoma with brain metastases SMAVTMZ I temsirolimus injectable Genitourinary therapy for advanced renal cancer using temsirolimus GUTEM I treatment of recurrent/refractory rhabdomysarcoma in pediatric patients temsirolimus injectable Pediatric with cyclophosphamide, vinorelbine and temsirolimus on the COG I ARST0921 protocol* Tumour site code Not Otherwise injectable followed by ‘NOS’ I Specified (e.g. GUNOS) Not reimbursed for symptom testosterone enanthate injectable Breast palliative therapy for metastatic breast cancer BRAVTEST I management or appetite stimulation Tumour site code Not Otherwise thioguanine tablet followed by ‘NOS’ I Specified (e.g. LYNOS) therapy for solid tumours using intrathecal methotrexate and/or thiotepa thiotepa injectable Miscellaneous Origins MOIT I and/or cytarabine Other tumour site Not Otherwise thiotepa (cont'd) injectable code followed by I Specified ‘NOS’ (e.g. GUNOS) thyrotropin alfa injectable Head and Neck radioiodine imaging in patients with thyroid cancer and treatment HNOTTSH I treatment of relapsed/progressive epithelial ovarian, fallopian tube or topotecan injectable Gynecology GOOVTOP I primary peritoneal cancer using topotecan topotecan injectable Lung second line treatment of recurrent small cell lung cancer LUSCTOP I topotecan (cont'd) injectable Pediatric pediatric sarcoma I intermediate-risk (COG ANBL0532) and high risk (COG ANBL0531) topotecan injectable Pediatric I pediatric neuroblastoma summary for treatment of recurrent/refractory neuroblastoma, ewing’s topotecan injectable Sarcoma sarcoma, osteogenic sarcoma or rhabdomyosarcoma with SAAVTC I topotecan/cyclophosphamide

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DOSAGE TUMOUR PROTOCOL DRUG APPROVED INDICATIONS CLASS NOTES FORM SITE CODES treatment of BRAF V600 mutation-positive unresectable or metastatic trametinib tablet Skin & Melanoma USMAVDT R melanoma using dabrafenib and trametinib treatment of BRAF V600 mutation-positive unresectable or metastatic trametinib tablet Skin & Melanoma USMAVTRA R melanoma using trametinib neoadjuvant or adjuvant therapy for breast cancer using doxorubicin trastuzumab (HERCEPTIN) injectable Breast BRAJACTT I and cyclophosphamide followed by paclitaxel and trastuzumab neoadjuvant or adjuvant therapy for breast cancer using dose dense therapy: doxorubicin and cyclophosphamide followed by paclitaxel and BRAJACTTG I trastuzumab (HERCEPTIN) neoadjuvant or adjuvant therapy for breast cancer using carboplatin, trastuzumab (HERCEPTIN) Injectable Breast BRAJDCARBT I docetaxel and trastuzumab (HERCEPTIN) neoadjuvant or adjuvant therapy for breast cancer using fluorouracil, trastuzumab (HERCEPTIN) Injectable Breast epirubicin and cyclophosphamide followed by docetaxel and BRAJFECDT I trastuzumab (HERCEPTIN) trastuzumab (HERCEPTIN) neoadjuvant or adjuvant therapy for breast cancer using trastuzumab Injectable Breast BRAJTDC I cont'd (HERCEPTIN), docetaxel and cyclophosphamide adjuvant therapy for breast cancer using trastuzumab (HERCEPTIN) trastuzumab (HERCEPTIN) Injectable Breast BRAJTR I following the completion of chemotherapy (sequential) trastuzumab (HERCEPTIN) adjuvant therapy for breast cancer using weekly paclitaxel and injectable Breast BRAJTTW I (cont'd) trastuzumab (HERCEPTIN) palliative therapy for metastatic breast cancer using pertuzumab, trastuzumab (HERCEPTIN) injectable Breast trastuzumab (HERCEPTIN) and docetaxel as first-line treatment for BRAVPTRAD I (cont'd) advanced breast cancer palliative therapy for metastatic breast cancer using pertuzumab, trastuzumab (HERCEPTIN) injectable Breast trastuzumab (HERCEPTIN), and paclitaxel as first-line treatment for BRAVPTRAT I (cont'd) advanced breast cancer combination with capecitabine as second-line treatment of HER-2 trastuzumab (HERCEPTIN) injectable Breast positive metastatic breast cancer after prior treatment with trastuzumab UBRAVTCAP R (cont'd) (HERCEPTIN) combination with paclitaxel and carboplatin as palliative therapy for trastuzumab (HERCEPTIN) injectable Breast metastatic breast cancer as first-line treatment for recurrent breast BRAVTPCARB I (cont'd) cancer refractory to anthracycline chemotherapy single agent therapy for metastatic breast cancer progressing after 1 trastuzumab (HERCEPTIN) prior regimens (e.g., taxane) and responding to trastuzumab injectable Breast BRAVTR I (cont'd) (HERCEPTIN) in combination with paclitaxel, with paclitaxel and carboplatin, or with vinorelbine trastuzumab (HERCEPTIN) with docetaxel as first-line treatment for advanced breast cancer Injectable Breast BRAVTRAD I (cont'd) refractory to anthracycline adjuvant chemotherapy trastuzumab (HERCEPTIN) with paclitaxel as first-line treatment for advanced breast cancer Injectable Breast BRAVTRAP I (cont'd) refractory to anthracycline adjuvant chemotherapy trastuzumab (HERCEPTIN) combination with 3-weekly vinorelbine as palliative therapy for Injectable Breast BRAVTRVIN I (cont'd) metastatic breast cancer

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DOSAGE TUMOUR PROTOCOL DRUG APPROVED INDICATIONS CLASS NOTES FORM SITE CODES treatment of locally advanced breast cancer using doxorubicin and trastuzumab (HERCEPTIN) Injectable Breast cyclophosphamide followed by docetaxel and trastuzumab BRLAACDT I (cont'd) (HERCEPTIN) palliative treatment of metastatic or locally advanced gastric, trastuzumab (HERCEPTIN) Injectable Gastrointestinal gastroesophageal junction, or esophageal adenocarcinoma using GIGAVCCT I (cont'd) cisplatin, capecitabine and trastuzumab (HERCEPTIN) palliative treatment of metastatic or inoperable, locally advanced gastric trastuzumab (HERCEPTIN) Injectable Gastrointestinal or gastroesophageal junction adenocarcinoma using cisplatin, infusional GIGAVCFT I (cont'd) fluorouracil and trastuzumab (HERCEPTIN) palliative treatment of metastatic or locally advanced gastric, trastuzumab (HERCEPTIN) Injectable Gastrointestinal gastroesophageal junction, or esophageal adenocarcinoma using GIGAVCOXT I (cont'd) capecitabine, oxaliplatin and trastuzumab (HERCEPTIN) palliative treatment of metastatic or locally advanced HER-2 positive trastuzumab (HERCEPTIN) Injectable Gastrointestinal gastric, gastroesophageal junction, or esophageal adenocarcinoma GIGAVFFOXT I (cont'd) using oxaliplatin, fluorouracil, leucovorin, and trastuzumab continuation of palliative treatment of metastatic or inoperable, locally trastuzumab (HERCEPTIN) injectable Gastrointestinal advanced gastric or gastroesophageal junction adenocarcinoma using GIGAVTR I (cont'd) trastuzumab (HERCEPTIN) trastuzumab emtansine palliative therapy for metastatic breast cancer using trastuzumab injectable Breast UBRAVKAD R (KADCYLA) emtansine (KADCYLA) tretinoin (VESANOID®) capsule Leukemia acute promyelocytic leukemia LKNOS I tretinoin (VESANOID®) first-line induction and consolidation therapy of acute promyelocytic capsule Leukemia LKATOATRA I (cont'd) leukemia using arsenic trioxide and tretinoin first-line induction and consolidation therapy of acute promyelocytic tretinoin (VESANOID®) capsule Leukemia LKATOP I leukemia using arsenic trioxide, tretinoin and daunorubicin induction and consolidation therapy of relapsed acute promyelocytic tretinoin (VESANOID®) capsule Leukemia LKATOR I leukemia using arsenic trioxide and tretinoin (All-Trans Retinoic Acid) treatment for locally advanced or metastatic medullary thyroid cancer vandetanib tablet Head and Neck UHNOTVAN R using vandetanib treatment of BRAF V600 mutation-positive unresectable or metastatic vemurafenib tablet Skin & Melanoma USMAVVEM R melanoma using vemurafenib treatment of BRAF V600 mutation-positive unresectable or metastatic vemurafenib tablet Skin & Melanoma USMAVVC R melanoma using vemurafenib and cobimetinib therapy for transitional cell cancers of the urothelium using vinblastine injectable Genitourinary GUMVAC I methotrexate, vinblastine, doxorubicin and cisplatin consolidation/ salvage treatment for germ cell cancer using vinblastine, vinblastine injectable Genitourinary GUVEIP I cisplatin, ifosfamide and mesna vinblastine injectable Kaposi's Sarcoma therapy for Kaposi's Sarcoma using vinblastine-vincristine KSVB I treatment of Hodgkin's disease with doxorubicin, bleomycin, vinblastine vinblastine injectable Lymphoma LYABVD I and dacarbazine vinblastine (cont'd) injectable Lymphoma lymphoma palliative chemotherapy LYPALL I palliative therapy for aggressive fibromatosis using weekly or alternate vinblastine (cont'd) injectable Sarcoma SAMV I week methotrexate and vinblastine intravenously Other tumour site Not Otherwise vinblastine injectable code followed by I Specified ‘NOS’ (e.g. LYNOS)

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DOSAGE TUMOUR PROTOCOL DRUG APPROVED INDICATIONS CLASS NOTES FORM SITE CODES adjuvant lomustine, cisplatin and vincristine in adult high-risk vincristine injectable Neuro-Oncology CNCCV I medulloblastoma or other primitive neuroectodermal tumour modified PCV chemotherapy of brain tumours using procarbazine, vincristine (cont'd) injectable Neuro-Oncology CNMODPCV I lomustine and vincristine therapy for high-risk Gestational Trophoblastic Neoplasia (GTN) using vincristine (cont'd) injectable Gynecology etoposide, methotrexate, leucovorin (folinic acid), dactinomycin, GOTDEMACO I cyclophosphamide and vincristine vincristine (cont'd) injectable Kaposi's sarcoma therapy for Kaposi's Sarcoma using vinblastine-vincristine KSVB I treatment of thymoma/thymic carcinoma with cyclophosphamide, vincristine (cont'd) injectable Lung LUOTCAV I doxorubicin and vincristine treatment of extensive small cell lung cancer with cyclophosphamide, vincristine (cont'd) injectable Lung LUSCCAV I doxorubicin and vincristine treatment of lymphoma with doxorubicin, cyclophosphamide, vincristine vincristine (cont'd) injectable Lymphoma LYCHOP I and prednisone treatment of lymphoma with doxorubicin, cyclophosphamide, vincristine, vincristine (cont'd) injectable Lymphoma LYCHOPR I prednisone and rituximab central nervous system prophylaxis with high dose methotrexate, CHOP vincristine (cont'd) injectable Lymphoma LYCHOPRMTX I and rituximab in diffuse large B-cell lymphoma treatment of relapsed chronic lymphocytic leukemia using vincristine (cont'd) injectable Lymphoma LYCLLCVPR I cyclophosphamide, vincristine, prednisone and rituximab treatment of Burkitt’s Lymphoma and Leukemia with cyclophosphamide, vincristine (cont'd) injectable Lymphoma LYCODOXMR I vincristine, doxorubicin, methotrexate, leucovorin and rituximab advanced indolent lymphoma using cyclophosphamide, vincristine and vincristine (cont'd) injectable Lymphoma LYCVP I prednisone treatment of Hodgkin's Disease with cyclophosphamide, vinblastine, vincristine (cont'd) injectable Lymphoma LYCVPPABO I procarbazine and prednisone treatment of advanced indolent lymphoma using cyclophosphamide, vincristine (cont'd) injectable Lymphoma LYCVPR I vincristine, prednisone and rituximab treatment of lymphoma with dose-adjusted etoposide, doxorubicin, vincristine (cont'd) injectable Lymphoma vincristine, cyclophosphamide, prednisone and rituximab with LYEPOCHR I intrathecal methotrexate vincristine (cont'd) injectable Lymphoma lymphoma palliative chemotherapy LYPALL I SAIME alternating with SAVAC or SAVACM with filgrastim support at a TWO weekly interval for newly diagnosed Ewing's Sarcoma/Ewing’s vincristine (cont'd) injectable Sarcoma SAALT2W I Family of Tumours, Desmoplastic Intra-Abdominal Small Round Blue Cell Tumour or Rhabdomyosarcoma SAIME alternating with SAVAC or SAVACM with filgrastim support at a THREE weekly interval for newly diagnosed Ewing's Sarcoma/Ewing’s vincristine (cont'd) injectable Sarcoma SAALT3W I Family of Tumours, Desmoplastic Intra-Abdominal Small Round Blue Cell Tumour or Rhabdomyosarcoma treatment of sarcomas with vincristine, doxorubicin and vincristine (cont'd) injectable Sarcoma SAVAC I cyclophosphamide

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DOSAGE TUMOUR PROTOCOL DRUG APPROVED INDICATIONS CLASS NOTES FORM SITE CODES treatment of sarcomas with pelvic primaries or chemotherapy induced vincristine (cont'd) injectable Sarcoma SAVACM I hematuria using vincristine, doxorubicin, cyclophosphamide and mesna adjuvant therapy for rhabdomyosarcoma using vincristine, dactinomycin vincristine (cont'd) injectable Sarcoma SAVDC I and cyclophosphamide adjuvant therapy for rhabdomyosarcoma using vincristine, dactinomycin, vincristine (cont'd) injectable Sarcoma SAVDCM I cyclophosphamide and mesna Other tumour site Not Otherwise vincristine (cont'd) injectable code followed by I Specified ‘NOS’ (e.g. LYNOS) vinorelbine injectable Breast palliative therapy for metastatic breast cancer BRAVNAV I combination with 3-weekly trastuzumab (HERCEPTIN) as palliative vinorelbine injectable Breast BRAVTRVIN I therapy for metastatic breast cancer treatment of platinum resistant epithelial ovarian cancer with vinorelbine injectable Gynecology UGOOVBEVV R bevacizumab and vinorelbine palliative chemotherapy for re-treatment of ovarian, tubal, and peritoneal vinorelbine injectable Gynecology GOOVVIN I cancer combination with cisplatin as treatment of advanced salivary gland vinorelbine injectable Head and Neck HNSAVNP I cancers with cisplatin and vinorelbine adjuvant cisplatin and vinorelbine following resection of stage I, II and vinorelbine (cont'd) injectable Lung LUAJNP I IIIA non-small cell lung cancer combination with cisplatin as treatment for advanced non-small cell lung vinorelbine (cont'd) injectable Lung LUAVNP I cancer vinorelbine (cont'd) injectable Lung advanced non-small cell lung cancer in elderly patients LUAVVIN I vinorelbine (cont'd) injectable Lung malignant mesothelioma LUMMVIN I pediatric patients treated on the COG protocol AHOD0521 for vinorelbine (cont'd) injectable Pediatric I refractory/recurrent Hodgkin’s disease treatment of recurrent/refractory rhabdomysarcoma in pediatric patients vinorelbine (cont'd) injectable Pediatric with cyclophosphamide, vinorelbine and temsirolimus on the COG I ARST0921 protocol* vismodegib capsule Skin & Melanoma treatment of metastatic or locally advanced basal cell carcinoma USMAVVIS R transarterial radioembolisation of hepatocellular carcinoma with portal yttrium-90 injectable Gastrointestinal venous invasion or T3 tumours, and metastatic neuroendocrine UGIYTT R tumours zoledronic acid injectable Breast adjuvant treatment of post-menopausal women using zoledronic acid BRAJZOL5 I adjuvant treatment breast cancer in post-menopausal women using 3- BRAJZOL2 I monthly zoledronic acid treatment of acute bone pain secondary to breast cancer metastases BRAVZOL I using IV zoledronic acid zoledronic acid injectable Breast treatment of multiple myeloma with zoledronic acid MYZOL I

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DOSAGE TUMOUR PROTOCOL DRUG APPROVED INDICATIONS CLASS NOTES FORM SITE CODES Protocol Code Definitions Bone Marrow Transplantation BMT Breast BR Gastrointestinal GI Genitourinary GU Gynecologic GO Head and Neck HN Kaposi’s sarcoma KS Leukemia LK Lung LU Lymphoma LY Miscellaneous Origin MO Myeloma MY Neuro-Oncology CN Ocular OC Primary Unknown PU Sarcoma SA Skin & Melanoma SM

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