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Systemic Anti-Cancer Therapy Regimen Library
New Zealand Formulary
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Request a new Regimen
Request a new regimen
Applicant name
(required)
Applicant organisation
(required)
Applicant email
(required)
Regimen name
(required)
Indications and intent
What is the potential impact of adding this Regimen to the SACT library? (tick all that apply)
Equity - significant inequities can be addressed
Clinical outcome gains - improvement in progression free survival or overall survival
Toxicity gains - reduction in clinically significant toxicity
It will impact a large number of patients
There are major cost savings
What evidence supports the addition of this regimen? (tick all that apply)
All medications are Pharmac funded
All medications are used for Medsafe approved indications
New published RCT phase 3, (score of 4 or 5 on ESMO MCBS)
Unpublished RCT phase 3 conducted by academic group/institute (score of 4 or 5 on ESMO MCBS)
New published RCT phase 3, (score of 3 on ESMO MCBS)
Unpublished RCT phase 3 conducted by commercial sponsor (score of 4 or 5 on ESMO MCBS)
Further evidence
References
(required)
Drug and Dose Information
Drug name
Dose
Units
Route
Frequency per day
Days of each cycle
Cycle duration (days)
Add another drug
Number of cycles
Additional cycle/frequency information
Is this regimen required urgently?
Reason for urgency
