The Royal Marsden NHS Foundation Trust Drug & Therapeutic Committee minutes 28th April 2020

Present: Consultant Breast and AOS (deputy chair) Drug Resource Manager (secretary) Consultant AOS Consultant GI Consultant Pharmacist Clinical Oncology Consultant DDU fellow (Medical Oncology) Consultant in Medical Oncology - Sarcoma Consultant Haemato-oncology Consultant Microbiologist In attendance:

1. Minutes of the January meeting (to note February meeting cancelled, March meeting virtual due to COVID19). Minutes – approved.

Review of approvals by the committee following the March virtual meeting. Each submission was reviewed by two consultants, a primary reviewer and a secondary reviewer. ➢ DPD (dihydropyrimidine dehydrogenase) mutation testing for palliative care in metastatic in Breast ca. ➢ Tazometostat (via compassionate supply) in metastatic and locally advanced epithelioid sarcoma. ➢ Olaparib (via compassionate supply) in maintenance treatment of adult patients with gBRAm metastatic pancreatic adenocarcinoma. ➢ Cetuximab & Encorafenib (via compassionate supply) in metastatic CRC (BRAF V600E mutant). ➢ Isatuximab (via compassionate supply) in combination with poamlidomide and dexamethasone in relapsed and refractory multiple myeloma. ➢ Nab-sirolimus (via compassionate supply) in the treatment of PEComas. ➢ Eribulin (via compassionate supply) as 2nd/3rd line treatment of metatastic liposarcoma and leiomyosarcoma. ➢ Tamsulosin PGD: approved, to audit the PGD after 6 months of use to ensure nothing gets missed in terms of contraindications of drug interactions. The PGD will then be reviewed post the audit and amendments made if required. All proposals approved.

2. Conflict of Interest. No conflicts raised.

3. NICE Guidance update. 1. TA627: Lenalidomide with rituximab for previously treated follicular lymphoma (grade 1-3a). Relevant clinical leads made aware of the guidance.

4. One off drug use requests. 1. Dabrafenib in BRAF mutant glioblastoma. 1

2. Tocilizumab in refractory Gut GVHD. 3. MP1032 in COVID to alleviate clinical signs of generalised and localised inflammation causing Lung damage. Approved were Clinical Trials are not suitable for patients. 4. Acalabrutinib in 1st line CLL. 5. Afatanib for metastatic chordoma. 6. Osimertinib (x2) in 1st line EGFR+ve NSCLC . 1. Bortezomib in AIHA. 2. Tazemetostat in epithelioid sarcoma. 3. Encorafenib and cetuximab in MCRC (BRAF V600E mutant). 4. Carboplatin monotherapy in CRPC. 5. Isatuximab (in combination with pomalidomide and dexamethasone) in Multiple Myeloma. 6. Olaparib in metastatic breast ca with BRCA2 mutation. 7. Dabrafenib in BRAF V600E mutant HCL. 8. Selenixor in multiple myeloma via CUP. 9. Crizotinib in NSCLC with exon skip14 mutation. 10. Tocilizumab in COVID. All requests approved.

5. Daratumumab via SC admin route. Presented by Haemato-oncology unit. Proposed for use via SC administration (currently unlicensed) as part of a compassionate supply program. Daratumumab is licensed and NHS approved for the treatment of relapsed myeloma, either as monotherapy or in combination with bortezomib and dexamethasone, it is currently administered as a long IV infusion. Action: Approved.

6. Acute Coronary Syndrome Guidelines. Presented by the Pharmacy. Update to guidance, guidance is aligned to that of the Royal Brompton Hospital and also review of medicines to be used and that they are accessible via the emergency drug cupboards at each site. Action: Approved.

7. Immunoglobulin Policy Update. Presented by Pharmacy. Policy updated in line with the Sub Regional Immunoglobulin Assessment Panel processes and requirements. Action: Approved.

8. PGD: MRSA colonisation. Presented by Pharmacy. Action: Approved.

9. AOB Date of the Next Meeting: Thursday 28th of May (pm), 15:00 – 17:00

Minutes Approved DTC chair: Thursday 28th May 2020

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Date of next meeting 28th May 2020.

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