National Systemic Anti-Cancer Therapy (SACT) consent forms – forms for melanoma regimens and generic immunotherapy form published

By * BOPA Committee on 14 December 2016

The regimen-specific consent forms for melanoma and a generic form for immunotherapy have been published on the Cancer Research UK (CRUK) website.  There are 13 forms for melanoma:
  • Carboplatin
  • Cobimetinib-Vemurafenib
  • CVD (cisplatin-vinblastine-dacarbazine)
  • Dabrafenib
  • Dabrafenib-Trametinib
  • Dacarbazine
  • Ipilimumab
  • Ipilimumab-Nivolumab
  • Nivolumab
  • Pembrolizumab
  • Talimogene laherparepvec (Imlyglic®)
  • Temozolomide
  • Vemurafenib
Please visit to view and download the forms.  Other forms, national guidance on consent for SACT, and further information is also available via
The National Chemotherapy Board published guidance on consent for SACT in July 2016 and recommends use of the regimen-specific forms in the UK.  The forms have been produced with support from CRUK.
Please do not hesitate to contact Rena Chauhan (Oncology Pharmacist – CRUK information lead, Guy’s and St. Thomas’ NHS Foundation Trust) if you have any queries:
Rena Chauhan
14th December 2016