Difference between revisions of "Antiemesis"
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− | Adapted from the NCCN<ref>[ | + | <span id="BackToTop"></span> |
+ | <div class="noprint" style="background-color:LightGray; position:fixed; bottom:2%; right:0.25%; padding-left:5px; padding-right:5px; margin: 15px; opacity:0.8; border-style: solid; border-color:DarkGray; border-width: 1px"> | ||
+ | [[#top|Back to Top]] | ||
+ | </div> | ||
+ | Adapted from the NCCN<ref>[https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1415 NCCN antiemesis guidelines]</ref>, ASCO<ref>ASCO antiemesis guidelines<nowiki/>https://ascopubs.org/doi/abs/10.1200/JCO.20.01296 | ||
</ref> and MASCC/ESMO<ref>MASCC antiemetic guidlines https://www.mascc.org/antiemetic-guidelines</ref> | </ref> and MASCC/ESMO<ref>MASCC antiemetic guidlines https://www.mascc.org/antiemetic-guidelines</ref> | ||
+ | =Guidelines= | ||
+ | '''Given the rapid change in evidence in many areas of hematology/oncology, readers are encouraged to consider any guideline published 5+ years ago to be for historical purposes, only.''' | ||
+ | ==ASCO== | ||
+ | *'''2020:''' Hesketh et al. [https://doi.org/10.1200/jco.20.01296 Antiemetics: ASCO Guideline Update] [https://pubmed.ncbi.nlm.nih.gov/32658626/ PubMed] | ||
+ | **'''2017:''' Hesketh et al. [https://doi.org/10.1200/jco.2017.74.4789 Antiemetics: American Society of Clinical Oncology Clinical Practice Guideline Update] [https://pubmed.ncbi.nlm.nih.gov/28759346/ PubMed] | ||
+ | **'''2015:''' Hesketh et al. [https://doi.org/10.1200/jco.2015.64.3635 Antiemetics: American Society of Clinical Oncology Focused Guideline Update] [https://pubmed.ncbi.nlm.nih.gov/26527784/ PubMed] | ||
+ | **'''2011:''' Basch et al. [https://www.ncbi.nlm.nih.gov/pmc/articles/pmc4876353/ Antiemetics: American Society of Clinical Oncology clinical practice guideline update] [https://pubmed.ncbi.nlm.nih.gov/21947834/ PubMed] | ||
+ | **'''2006:''' Kris et al. [https://doi.org/10.1200/jco.2006.06.9591 American Society of Clinical Oncology guideline for antiemetics in oncology: update 2006] [https://pubmed.ncbi.nlm.nih.gov/16717289/ PubMed] | ||
+ | ==ESMO== | ||
+ | *'''2009:''' Herrstedt & Roila. [https://doi.org/10.1093/annonc/mdp160 Chemotherapy-induced nausea and vomiting: ESMO clinical recommendations for prophylaxis] [https://pubmed.ncbi.nlm.nih.gov/19454442/ PubMed] | ||
+ | **'''2008:''' Herrstedt & Roila. [https://doi.org/10.1093/annonc/mdn105 Chemotherapy-induced nausea and vomiting: ESMO clinical recommendations for prophylaxis] [https://pubmed.ncbi.nlm.nih.gov/18456745/ PubMed] | ||
+ | **'''2007:''' Herrstedt. [https://doi.org/10.1093/annonc/mdm050 Chemotherapy-induced nausea and vomiting: ESMO clinical recommendations for prophylaxis] [https://pubmed.ncbi.nlm.nih.gov/17491061/ PubMed] | ||
+ | **'''2005:''' Herrstedt et al. [https://doi.org/10.1093/annonc/mdi805 ESMO Minimum Clinical Recommendations for prophylaxis of chemotherapy-induced nausea and vomiting (NV)] [https://pubmed.ncbi.nlm.nih.gov/15888767/ PubMed] | ||
+ | **'''2001:''' [https://doi.org/10.1023/a:1017413507554 ESMO Recommendations for prophylaxis of chemotherapy-induced nausea and vomiting (NV)] [https://pubmed.ncbi.nlm.nih.gov/11583185/ PubMed] | ||
+ | ==MASCC/ESMO== | ||
+ | *'''2016:''' Herrstedt et al. [https://doi.org/10.1007/s00520-016-3313-0 2016 Updated MASCC/ESMO Consensus Recommendations: Prevention of Nausea and Vomiting Following High Emetic Risk Chemotherapy] [https://pubmed.ncbi.nlm.nih.gov/27443154/ PubMed] | ||
+ | *'''2016:''' Einhorn et al. [https://doi.org/10.1007/s00520-016-3449-y 2016 updated MASCC/ESMO consensus recommendations: prevention of nausea and vomiting following multiple-day chemotherapy, high-dose chemotherapy, and breakthrough nausea and vomiting] [https://pubmed.ncbi.nlm.nih.gov/27815710/ PubMed] | ||
+ | *'''2016:''' Roila et al. [https://doi.org/10.1007/s00520-016-3365-1 2016 updated MASCC/ESMO consensus recommendations: Prevention of nausea and vomiting following moderately emetogenic chemotherapy] [https://pubmed.ncbi.nlm.nih.gov/27510316/ PubMed] | ||
+ | *'''2016:''' Olver et al. [https://doi.org/10.1007/s00520-016-3391-z 2016 Updated MASCC/ESMO Consensus Recommendations: Controlling nausea and vomiting with chemotherapy of low or minimal emetic potential] [https://pubmed.ncbi.nlm.nih.gov/27572335/ PubMed] | ||
+ | **'''2010:''' Olver et al. [https://doi.org/10.1007/s00520-010-0985-8 Guidelines for the control of nausea and vomiting with chemotherapy of low or minimal emetic potential] [https://pubmed.ncbi.nlm.nih.gov/20803222/ PubMed] | ||
+ | *'''2016:''' Dupuis et al. [https://doi.org/10.1007/s00520-016-3384-y 2016 updated MASCC/ESMO consensus recommendations: Prevention of acute chemotherapy-induced nausea and vomiting in children] [https://pubmed.ncbi.nlm.nih.gov/27565788/ PubMed] | ||
+ | ==NCCN== | ||
+ | *[https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1415 NCCN Guidelines - Antiemesis] | ||
+ | **'''2012:''' Ettinger et al. [https://doi.org/10.6004/Jnccn.2012.0047 Antiemesis.] [https://pubmed.ncbi.nlm.nih.gov/22491046/ PubMed] | ||
+ | **'''2009:''' Ettinger et al. [https://doi.org/10.6004/Jnccn.2009.0039 Antiemesis. Clinical Practice Guidelines in Oncology.] [https://pubmed.ncbi.nlm.nih.gov/19460282/ PubMed] | ||
+ | **'''2007:''' Ettinger et al. [https://doi.org/10.6004/Jnccn.2007.0004 Antiemesis.] [https://pubmed.ncbi.nlm.nih.gov/17239323/ PubMed] | ||
+ | **'''2004:''' Ettinger et al. [https://doi.org/10.6004/Jnccn.2004.0037 Antiemesis clinical practice guidelines in oncology.] [https://pubmed.ncbi.nlm.nih.gov/19780255/ PubMed] | ||
=Emetic risk of chemotherapy, immunotherapy, TKIs and other agents= | =Emetic risk of chemotherapy, immunotherapy, TKIs and other agents= | ||
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*Moderate: 30-90% frequency of emesis (MEC) | *Moderate: 30-90% frequency of emesis (MEC) | ||
*Low: 10-30% frequency of emesis | *Low: 10-30% frequency of emesis | ||
− | *Minimal: | + | *Minimal: less than 10% frequency of emesis |
− | + | ASCO guidelines say that in cases of combination chemotherapy regimens, patients should be given antiemetics that are recommended for the individual medication with the highest emetic risk. The exception is with anthracycline and [[Cyclophosphamide (Cytoxan)]] combinations as described below. | |
− | ASCO guidelines say that in cases of combination chemotherapy regimens, patients should be given antiemetics that are recommended for the individual medication with the highest emetic risk. | ||
− | |||
{| class="wikitable sortable" border="1" style="text-align:center;" | {| class="wikitable sortable" border="1" style="text-align:center;" | ||
!Drug | !Drug | ||
− | !NCCN emetogenic potential ( | + | !NCCN emetogenic potential (2021) |
!ASCO emetogenic potential | !ASCO emetogenic potential | ||
− | ( | + | (2020) |
− | !MASCC/ESMO emetogenic potential ( | + | !MASCC/ESMO emetogenic potential (2019) |
!Comment | !Comment | ||
|- | |- | ||
− | | align="left" | [[ | + | | align="left" |[[Trastuzumab emtansine (Kadcyla)]] |
+ | |Low | ||
+ | |Low | ||
|Low | |Low | ||
− | |||
− | |||
| | | | ||
|- | |- | ||
− | | align="left" | Anthracycline (see differences between NCCN & ASCO) & [[Cyclophosphamide (Cytoxan)]] combination chemotherapy | + | | align="left" |Anthracycline (see differences between NCCN & ASCO) & [[Cyclophosphamide (Cytoxan)]] combination chemotherapy |
|High ([[Doxorubicin (Adriamycin)]] or [[Epirubicin (Ellence)]] with [[Cyclophosphamide (Cytoxan)]]) | |High ([[Doxorubicin (Adriamycin)]] or [[Epirubicin (Ellence)]] with [[Cyclophosphamide (Cytoxan)]]) | ||
|High ([[Daunorubicin (Cerubidine)]], [[Doxorubicin (Adriamycin)]], [[Epirubicin (Ellence)]], or [[Idarubicin (Idamycin)]] with [[Cyclophosphamide (Cytoxan)]]) | |High ([[Daunorubicin (Cerubidine)]], [[Doxorubicin (Adriamycin)]], [[Epirubicin (Ellence)]], or [[Idarubicin (Idamycin)]] with [[Cyclophosphamide (Cytoxan)]]) | ||
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|MASCC comment - in patients with breast cancer | |MASCC comment - in patients with breast cancer | ||
|- | |- | ||
− | | align="left" | [[Aldesleukin (Proleukin)]] | + | | align="left" |[[Aldesleukin (Proleukin)]] |
|Moderate: >12 to 15 million international units/m<sup>2</sup><br>Low: ≤12 million international units/m<sup>2</sup> | |Moderate: >12 to 15 million international units/m<sup>2</sup><br>Low: ≤12 million international units/m<sup>2</sup> | ||
| | | | ||
Line 40: | Line 69: | ||
| | | | ||
|- | |- | ||
− | | align="left" | [[Alemtuzumab (Campath)]] | + | | align="left" |[[Alemtuzumab (Campath)]] |
|Minimal | |Minimal | ||
|Moderate | |Moderate | ||
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| | | | ||
|- | |- | ||
− | | align="left" | [[Altretamine (Hexalen)]] or | + | | align="left" |[[Altretamine (Hexalen)]] or Hexamethylmelamine (oral) |
− | |High | + | |Moderate/High |
− | |High | + | |Moderate/High |
| | | | ||
− | |NCCN did not further delineate between degrees of emetic potential | + | |NCCN and ASCO did not further delineate between degrees of emetic potential |
|- | |- | ||
− | | align="left" | [[Amifostine (Ethyol)]] | + | | align="left" |[[Amifostine (Ethyol)]] |
− | |Moderate: >300 mg/m<sup>2</sup><br>Low: ≤300 mg | + | |Moderate: >300 mg/m<sup>2</sup><br>Low: ≤300 mg/m2 |
| | | | ||
| | | | ||
| | | | ||
|- | |- | ||
− | | align="left" | [[Arsenic trioxide (Trisenox)]] | + | | align="left" |[[Arsenic trioxide (Trisenox)]] |
+ | |Low | ||
|Moderate | |Moderate | ||
− | |||
| | | | ||
| | | | ||
|- | |- | ||
− | | align="left" | [[Asparaginase (Elspar)]] | + | | align="left" |[[Asparaginase (Elspar)]] |
|Minimal | |Minimal | ||
| | | | ||
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| | | | ||
|- | |- | ||
− | |Atezolizumab | + | | align="left" |[[Atezolizumab (Tecentriq)]] |
− | | | + | |Minimal |
− | | | + | |Minimal |
| | | | ||
| | | | ||
|- | |- | ||
− | | align="left" | [[Axitinib (Inlyta)]] (oral) | + | | align="left" |[[Axitinib (Inlyta)]] (oral) |
− | |Low | + | |Minimal/Low |
− | | | + | |Minimal/Low |
|Low | |Low | ||
| | | | ||
|- | |- | ||
− | | align="left" | [[Azacitidine (Vidaza)]] | + | | align="left" |[[Azacitidine (Vidaza)]] |
|Moderate | |Moderate | ||
|Moderate | |Moderate | ||
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| | | | ||
|- | |- | ||
− | | align="left" | [[Bendamustine]] | + | | align="left" |[[Bendamustine]] |
|Moderate | |Moderate | ||
|Moderate | |Moderate | ||
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| | | | ||
|- | |- | ||
− | | align="left" | [[Bevacizumab (Avastin)]] | + | | align="left" |[[Belinostat (Beleodaq)]] |
+ | | | ||
+ | | | ||
+ | |Low | ||
+ | | | ||
+ | |- | ||
+ | | align="left" |[[Bevacizumab (Avastin)]] | ||
|Minimal | |Minimal | ||
|Minimal | |Minimal | ||
Line 100: | Line 135: | ||
| | | | ||
|- | |- | ||
− | | align="left" | [[Bexarotene (Targretin)]] (oral) | + | | align="left" |[[Bexarotene (Targretin)]] (oral) |
|Low/Minimal | |Low/Minimal | ||
| | | | ||
| | | | ||
− | |NCCN did not further delineate between degrees of emetic potential | + | |NCCN did not further delineate between degrees of emetic potential |
|- | |- | ||
− | | align="left" | [[Bleomycin (Blenoxane)]] | + | | align="left" |[[Bleomycin (Blenoxane)]] |
|Minimal | |Minimal | ||
|Minimal | |Minimal | ||
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| | | | ||
|- | |- | ||
− | |Blinatumomab | + | | align="left" |[[Blinatumomab (Blincyto)]] |
| | | | ||
|Low | |Low | ||
− | | | + | |Low |
| | | | ||
|- | |- | ||
− | | align="left" | [[Bortezomib (Velcade)]] | + | | align="left" |[[Bortezomib (Velcade)]] |
|Minimal | |Minimal | ||
|Low | |Low | ||
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| | | | ||
|- | |- | ||
− | | align="left" | [[Bosutinib (Bosulif)]] (oral) | + | | align="left" |[[Bosutinib (Bosulif)]] (oral) |
|Low/Minimal | |Low/Minimal | ||
|Moderate | |Moderate | ||
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| | | | ||
|- | |- | ||
− | | align="left" | [[Brentuximab vedotin (Adcetris)]] | + | | align="left" |[[Brentuximab vedotin (Adcetris)]] |
|Low | |Low | ||
| | | | ||
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| | | | ||
|- | |- | ||
− | | align="left" | [[Busulfan (Myleran)]] | + | | align="left" |[[Busulfan (Myleran)]] |
− | |High/Moderate: | + | |High/Moderate: at least 4 mg/day <br> Low/Minimal: less than 4 mg/day |
|Minimal | |Minimal | ||
|Minimal | |Minimal | ||
| | | | ||
|- | |- | ||
− | | align="left" | [[Busulfan (Myleran)]] (oral) | + | | align="left" |[[Busulfan (Myleran)]] (oral) |
− | |High/Moderate: | + | |High/Moderate: at least 4 mg/day<br>Low/Minimal: less than 4 mg/day |
| | | | ||
| | | | ||
− | |NCCN did not further delineate between degrees of emetic potential | + | |NCCN did not further delineate between degrees of emetic potential |
|- | |- | ||
− | | align="left" | [[Cabazitaxel (Jevtana)]] | + | | align="left" |[[Cabazitaxel (Jevtana)]] |
|Low | |Low | ||
|Low | |Low | ||
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| | | | ||
|- | |- | ||
− | | align="left" | [[Cabozantinib (Cometriq)]] (oral) | + | | align="left" |[[Cabozantinib (Cometriq)]] (oral) |
|Low/Minimal | |Low/Minimal | ||
|Moderate | |Moderate | ||
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| | | | ||
|- | |- | ||
− | | align="left" | [[Capecitabine (Xeloda)]] (oral) | + | | align="left" |[[Capecitabine (Xeloda)]] (oral) |
|Low/Minimal | |Low/Minimal | ||
| | | | ||
|Low | |Low | ||
− | |NCCN did not further delineate between degrees of emetic potential | + | |NCCN did not further delineate between degrees of emetic potential |
|- | |- | ||
− | | align="left" | [[Carboplatin (Paraplatin)]] | + | | align="left" |[[Carboplatin (Paraplatin)]] |
− | |High: AUC | + | |High: AUC 4 or more |
− | Moderate: AUC | + | Moderate: AUC less than 4 |
− | |Moderate (but recommended triplet combination of NK1, 5-HT3, and Dex if AUC | + | |Moderate (but recommended triplet combination of NK1, 5-HT3, and Dex if AUC 4 or more) |
|Moderate (but recommended triplet combination of NK1, 5-HT3, and dexamethasone) | |Moderate (but recommended triplet combination of NK1, 5-HT3, and dexamethasone) | ||
|MASCC/ESMO did not subclassify based on dose | |MASCC/ESMO did not subclassify based on dose | ||
|- | |- | ||
− | | align="left" | [[Carfilzomib (Kyprolis)]] | + | | align="left" |[[Carfilzomib (Kyprolis)]] |
|Low | |Low | ||
| | | | ||
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| | | | ||
|- | |- | ||
− | | align="left" | [[Carmustine (BCNU)]] | + | | align="left" |[[Carmustine (BCNU)]] |
|High: >250 mg/m<sup>2</sup><br>Moderate: ≤250 mg/m<sup>2</sup> | |High: >250 mg/m<sup>2</sup><br>Moderate: ≤250 mg/m<sup>2</sup> | ||
|High | |High | ||
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|ASCO and MASCC/ESMO did not subclassify based on dose | |ASCO and MASCC/ESMO did not subclassify based on dose | ||
|- | |- | ||
− | | align="left" | [[Catumaxomab (Removab)]] | + | | align="left" |[[Catumaxomab (Removab)]] |
| | | | ||
|Low | |Low | ||
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| | | | ||
|- | |- | ||
− | | align="left" | [[Cetuximab (Erbitux)]] | + | | align="left" |[[Cetuximab (Erbitux)]] |
|Minimal | |Minimal | ||
|Minimal | |Minimal | ||
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| | | | ||
|- | |- | ||
− | |Ceritinib | + | | align="left" |[[Ceritinib (Zykadia)]] |
| | | | ||
− | |Moderate | + | |Moderate |
| | | | ||
| | | | ||
|- | |- | ||
− | | align="left" | [[Chlorambucil (Leukeran)]] (oral) | + | | align="left" |[[Chlorambucil (Leukeran)]] (oral) |
|Low/Minimal | |Low/Minimal | ||
| | | | ||
|Minimal | |Minimal | ||
− | |NCCN did not further delineate between degrees of emetic potential | + | |NCCN did not further delineate between degrees of emetic potential |
|- | |- | ||
− | | align="left" | [[Cisplatin (Platinol)]] | + | | align="left" |[[Cisplatin (Platinol)]] |
|High | |High | ||
|High | |High | ||
|High | |High | ||
− | |Some only consider emetogenic potential high when dose | + | |Some only consider emetogenic potential high when dose 70 mg/m<sup>2</sup> or more |
|- | |- | ||
− | | align="left" | [[Cladribine (Leustatin)]] | + | | align="left" |[[Cladribine (Leustatin)]] |
|Minimal | |Minimal | ||
|Minimal | |Minimal | ||
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| | | | ||
|- | |- | ||
− | | align="left" | [[Clofarabine (Clolar)]] | + | | align="left" |[[Clofarabine (Clolar)]] |
|Moderate | |Moderate | ||
|Moderate | |Moderate | ||
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| | | | ||
|- | |- | ||
− | | align="left" | [[Crizotinib (Xalkori)]] (oral) | + | | align="left" |[[Crizotinib (Xalkori)]] (oral) |
|High/Moderate | |High/Moderate | ||
|Moderate | |Moderate | ||
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| | | | ||
|- | |- | ||
− | | align="left" | [[Cyclophosphamide (Cytoxan)]] | + | | align="left" |[[Cyclophosphamide (Cytoxan)]] |
− | |High: | + | |High: greater than 1500 mg/m<sup>2</sup> or [[#Emetic_risk_of_chemotherapy|when given with certain anthracyclines]]<br>Moderate: up to and including 1500 mg/m<sup>2</sup> |
− | |High: | + | |High: 1500 mg/m<sup>2</sup> or more, or [[#Emetic_risk_of_chemotherapy|when given with anthracyclines]]<br>Moderate: less than 1500 mg/m<sup>2</sup> |
− | |High: > 1500 mg/ | + | |High: > 1500 mg/m<sup>2</sup> or when combined with anthracyclines (in breast cancer patients) |
Moderate: < 1500 mg/m2 | Moderate: < 1500 mg/m2 | ||
| | | | ||
|- | |- | ||
− | | align="left" | [[Cyclophosphamide (Cytoxan)]] (oral) | + | | align="left" |[[Cyclophosphamide (Cytoxan)]] (oral) |
− | |High/Moderate: | + | |High/Moderate: 100 mg/m<sup>2</sup>/day or more<br>Low/Minimal: less than 100 mg/m<sup>2</sup>/day |
− | |Moderate | + | |Moderate |
|Moderate | |Moderate | ||
− | |NCCN did not further delineate between degrees of emetic potential | + | |NCCN did not further delineate between degrees of emetic potential |
|- | |- | ||
− | | align="left" | [[Cytarabine (Ara-C)]] | + | | align="left" |[[Cytarabine (Ara-C)]] |
− | |Moderate: >200 mg/m<sup>2</sup><br>Low: 100 to 200 mg/m<sup>2</sup><br>Minimal: | + | |Moderate: >200 mg/m<sup>2</sup><br>Low: 100 to 200 mg/m<sup>2</sup><br>Minimal: less than 100 mg/m<sup>2</sup> |
|Moderate: >1000 mg/m<sup>2</sup><br>Low: ≤1000 mg/m<sup>2</sup> | |Moderate: >1000 mg/m<sup>2</sup><br>Low: ≤1000 mg/m<sup>2</sup> | ||
− | |Moderate: > 1000 mg/ | + | |Moderate: > 1000 mg/m2 |
Low: < 1000 mg/m2 | Low: < 1000 mg/m2 | ||
| | | | ||
|- | |- | ||
− | | align="left" | [[Dabrafenib (Tafinlar)]] (oral) | + | | align="left" |[[Dabrafenib (Tafinlar)]] (oral) |
|Low/Minimal | |Low/Minimal | ||
| | | | ||
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| | | | ||
|- | |- | ||
− | | align="left" | [[Dacarbazine (DTIC)]] | + | | align="left" |[[Dacarbazine (DTIC)]] |
|High | |High | ||
|High | |High | ||
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| | | | ||
|- | |- | ||
− | |Daratumumab | + | | align="left" |[[Daratumumab (Darzalex)]] |
| | | | ||
|Minimal | |Minimal | ||
Line 271: | Line 306: | ||
| | | | ||
|- | |- | ||
− | | align="left" | [[Dactinomycin (Cosmegen)]] | + | | align="left" |[[Dactinomycin (Cosmegen)]] |
|Moderate | |Moderate | ||
|High | |High | ||
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| | | | ||
|- | |- | ||
− | | align="left" | [[Dasatinib (Sprycel)]] (oral) | + | | align="left" |[[Dasatinib (Sprycel)]] (oral) |
|Low/Minimal | |Low/Minimal | ||
| | | | ||
|Low | |Low | ||
− | |NCCN did not further delineate between degrees of emetic potential | + | |NCCN did not further delineate between degrees of emetic potential |
|- | |- | ||
− | | align="left" | [[Daunorubicin (Cerubidine)]] | + | | align="left" |[[Daunorubicin (Cerubidine)]] |
|Moderate | |Moderate | ||
|High when given with [[Cyclophosphamide (Cytoxan)]]<br>Moderate when used alone | |High when given with [[Cyclophosphamide (Cytoxan)]]<br>Moderate when used alone | ||
|High: when given with combined with cyclophosphamide (in breast cancer patients) | |High: when given with combined with cyclophosphamide (in breast cancer patients) | ||
− | |||
Moderate: when used alone | Moderate: when used alone | ||
| | | | ||
|- | |- | ||
− | | align="left" | [[Decitabine (Dacogen)]] | + | | align="left" |[[Decitabine (Dacogen)]] |
|Minimal | |Minimal | ||
| | | | ||
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| | | | ||
|- | |- | ||
− | | align="left" | [[Denileukin diftitox (Ontak)]] | + | | align="left" |[[Denileukin diftitox (Ontak)]] |
|Minimal | |Minimal | ||
| | | | ||
Line 303: | Line 337: | ||
| | | | ||
|- | |- | ||
− | | align="left" | [[Dexrazoxane (Zinecard)]] | + | | align="left" |[[Dexrazoxane (Zinecard)]] |
|Minimal | |Minimal | ||
| | | | ||
Line 309: | Line 343: | ||
| | | | ||
|- | |- | ||
− | | align="left" | [[Docetaxel (Taxotere)]] | + | | align="left" |[[Docetaxel (Taxotere)]] |
|Low | |Low | ||
|Low | |Low | ||
Line 315: | Line 349: | ||
| | | | ||
|- | |- | ||
− | | align="left" | [[Doxorubicin (Adriamycin)]] | + | | align="left" |[[Doxorubicin (Adriamycin)]] |
− | |High: | + | |High: 60 mg/m<sup>2</sup> or more, or when given at any dose with [[Cyclophosphamide (Cytoxan)]]<br>Moderate: less than 60 mg/m<sup>2</sup> |
|High when given with [[Cyclophosphamide (Cytoxan)]]<br>Moderate when used alone | |High when given with [[Cyclophosphamide (Cytoxan)]]<br>Moderate when used alone | ||
|High: when given with combined with cyclophosphamide (in breast cancer patients) | |High: when given with combined with cyclophosphamide (in breast cancer patients) | ||
− | |||
Moderate: when used alone | Moderate: when used alone | ||
| | | | ||
|- | |- | ||
− | | align="left" | [[Pegylated liposomal doxorubicin (Doxil)]] | + | | align="left" |[[Pegylated liposomal doxorubicin (Doxil)]] |
|Low | |Low | ||
|Low | |Low | ||
Line 329: | Line 362: | ||
| | | | ||
|- | |- | ||
− | | align="left" | [[Epirubicin (Ellence)]] | + | | align="left" |[[Epirubicin (Ellence)]] |
|High: >90 mg/m<sup>2</sup> or when given at any dose with [[Cyclophosphamide (Cytoxan)]]<br>Moderate: ≤90 mg/m<sup>2</sup> | |High: >90 mg/m<sup>2</sup> or when given at any dose with [[Cyclophosphamide (Cytoxan)]]<br>Moderate: ≤90 mg/m<sup>2</sup> | ||
|High when given with [[Cyclophosphamide (Cytoxan)]]<br>Moderate when used alone | |High when given with [[Cyclophosphamide (Cytoxan)]]<br>Moderate when used alone | ||
|High: when combined with cyclophosphamide (in breast cancer patients) | |High: when combined with cyclophosphamide (in breast cancer patients) | ||
− | |||
Moderate: when used alone | Moderate: when used alone | ||
| | | | ||
|- | |- | ||
− | | align="left" | [[Eribulin (Halaven)]] | + | | align="left" |[[Eribulin (Halaven)]] |
|Low | |Low | ||
| | | | ||
Line 343: | Line 375: | ||
| | | | ||
|- | |- | ||
− | | align="left" | [[Erlotinib (Tarceva)]] (oral) | + | | align="left" |[[Erlotinib (Tarceva)]] (oral) |
|Low/Minimal | |Low/Minimal | ||
| | | | ||
|Minimal | |Minimal | ||
− | |NCCN did not further delineate between degrees of emetic potential | + | |NCCN did not further delineate between degrees of emetic potential |
|- | |- | ||
− | | align="left" | [[Estramustine (Emcyt)]] (oral) | + | | align="left" |[[Estramustine (Emcyt)]] (oral) |
|High/Moderate | |High/Moderate | ||
| | | | ||
| | | | ||
− | |NCCN did not further delineate between degrees of emetic potential | + | |NCCN did not further delineate between degrees of emetic potential |
|- | |- | ||
− | | align="left" | [[Etoposide (Vepesid)]] | + | | align="left" |[[Etoposide (Vepesid)]] |
|Low | |Low | ||
|Low | |Low | ||
Line 361: | Line 393: | ||
| | | | ||
|- | |- | ||
− | | align="left" | [[Etoposide (Vepesid)]] (oral) | + | | align="left" |[[Etoposide (Vepesid)]] (oral) |
|High/Moderate | |High/Moderate | ||
| | | | ||
|Low | |Low | ||
− | |NCCN did not further delineate between degrees of emetic potential | + | |NCCN did not further delineate between degrees of emetic potential |
|- | |- | ||
− | | align="left" | [[Everolimus (Afinitor)]] (oral) | + | | align="left" |[[Everolimus (Afinitor)]] (oral) |
|Low/Minimal | |Low/Minimal | ||
| | | | ||
|Low | |Low | ||
− | |NCCN did not further delineate between degrees of emetic potential | + | |NCCN did not further delineate between degrees of emetic potential |
|- | |- | ||
− | | align="left" | [[Floxuridine (FUDR)]] | + | | align="left" |[[Floxuridine (FUDR)]] |
|Low | |Low | ||
| | | | ||
Line 379: | Line 411: | ||
| | | | ||
|- | |- | ||
− | | align="left" | [[Fludarabine (Fludara)]] | + | | align="left" |[[Fludarabine (Fludara)]] |
|Minimal | |Minimal | ||
|Minimal | |Minimal | ||
Line 385: | Line 417: | ||
| | | | ||
|- | |- | ||
− | | align="left" | [[Fludarabine (Fludara)]] (oral) | + | | align="left" |[[Fludarabine (Fludara)]] (oral) |
|Low/Minimal | |Low/Minimal | ||
| | | | ||
|Low | |Low | ||
− | |NCCN did not further delineate between degrees of emetic potential | + | |NCCN did not further delineate between degrees of emetic potential |
|- | |- | ||
− | | align="left" | [[Fluorouracil (5-FU)]] | + | | align="left" |[[Fluorouracil (5-FU)]] |
|Low | |Low | ||
|Low | |Low | ||
Line 397: | Line 429: | ||
| | | | ||
|- | |- | ||
− | | align="left" | [[Gefitinib (Iressa)]] (oral) | + | | align="left" |[[Gefitinib (Iressa)]] (oral) |
|Low/Minimal | |Low/Minimal | ||
| | | | ||
|Minimal | |Minimal | ||
− | |NCCN did not further delineate between degrees of emetic potential | + | |NCCN did not further delineate between degrees of emetic potential |
|- | |- | ||
− | | align="left" | [[Gemcitabine (Gemzar)]] | + | | align="left" |[[Gemcitabine (Gemzar)]] |
|Low | |Low | ||
|Low | |Low | ||
Line 409: | Line 441: | ||
| | | | ||
|- | |- | ||
− | | align="left" | [[Hydroxyurea (Hydrea)]] (oral) | + | | align="left" |[[Hydroxyurea (Hydrea)]] (oral) |
|Low/Minimal | |Low/Minimal | ||
| | | | ||
|Minimal | |Minimal | ||
− | |NCCN did not further delineate between degrees of emetic potential | + | |NCCN did not further delineate between degrees of emetic potential |
|- | |- | ||
− | | align="left" | [[Idarubicin (Idamycin)]] | + | | align="left" |[[Idarubicin (Idamycin)]] |
|Moderate | |Moderate | ||
|High when given with [[Cyclophosphamide (Cytoxan)]]<br>Moderate when used alone | |High when given with [[Cyclophosphamide (Cytoxan)]]<br>Moderate when used alone | ||
Line 421: | Line 453: | ||
| | | | ||
|- | |- | ||
− | | align="left" | [[Ifosfamide (Ifex)]] | + | | align="left" |[[Ifosfamide (Ifex)]] |
− | |High: | + | |High: 2000 mg/m<sup>2</sup> or more per dose <br> Moderate: <2 g/m<sup>2</sup> per dose |
|Moderate | |Moderate | ||
|Moderate | |Moderate | ||
|ASCO and MASCC did not subclassify based on dose | |ASCO and MASCC did not subclassify based on dose | ||
|- | |- | ||
− | | align="left" | [[Imatinib (Gleevec)]] (oral) | + | | align="left" |[[Imatinib (Gleevec)]] (oral) |
|Low/Minimal | |Low/Minimal | ||
− | |||
|Moderate | |Moderate | ||
− | |NCCN did not further delineate between degrees of emetic potential | + | |Moderate |
+ | |NCCN did not further delineate between degrees of emetic potential | ||
|- | |- | ||
− | | align="left" | [[Interferon alfa-2a (Roferon-A)]] | + | | align="left" |[[Interferon alfa-2a (Roferon-A)]] |
− | |Moderate: | + | |Moderate: 10 million international units/m<sup>2</sup> or more<br>Low: between 5 and 10 million international units/m<sup>2</sup><br>Minimal: 5 million international units/m<sup>2</sup> or less |
| | | | ||
| | | | ||
|NCCN did not specify interferon alfa-2a vs. 2b | |NCCN did not specify interferon alfa-2a vs. 2b | ||
|- | |- | ||
− | | align="left" | [[Interferon alfa-2b (Intron-A)]] | + | | align="left" |[[Interferon alfa-2b (Intron-A)]] |
− | |Moderate: | + | |Moderate: 10 million international units/m<sup>2</sup> or more<br>Low: between 5 and 10 million international units/m<sup>2</sup><br>Minimal: 5 million international units/m<sup>2</sup> or less |
| | | | ||
| | | | ||
|NCCN did not specify interferon alfa-2a vs. 2b | |NCCN did not specify interferon alfa-2a vs. 2b | ||
|- | |- | ||
− | | align="left" | [[Ipilimumab (Yervoy)]] | + | | align="left" |[[Ipilimumab (Yervoy)]] |
|Minimal | |Minimal | ||
| | | | ||
Line 451: | Line 483: | ||
| | | | ||
|- | |- | ||
− | | align="left" | [[Irinotecan (Camptosar)]] | + | | align="left" |[[Irinotecan (Camptosar)]] |
|Moderate | |Moderate | ||
|Moderate | |Moderate | ||
Line 457: | Line 489: | ||
| | | | ||
|- | |- | ||
− | | align="left" | [[Ixabepilone (Ixempra)]] | + | | align="left" |[[Ixabepilone (Ixempra)]] |
|Low | |Low | ||
|Low | |Low | ||
Line 463: | Line 495: | ||
| | | | ||
|- | |- | ||
− | | align="left" | [[Lapatinib (Tykerb)]] (oral) | + | | align="left" |[[Lapatinib (Tykerb)]] (oral) |
|Low/Minimal | |Low/Minimal | ||
| | | | ||
|Low | |Low | ||
− | |NCCN did not further delineate between degrees of emetic potential | + | |NCCN did not further delineate between degrees of emetic potential |
|- | |- | ||
− | | align="left" | [[Lenalidomide (Revlimid)]] (oral) | + | | align="left" |[[Lenalidomide (Revlimid)]] (oral) |
|Low/Minimal | |Low/Minimal | ||
| | | | ||
|Low | |Low | ||
− | |NCCN did not further delineate between degrees of emetic potential | + | |NCCN did not further delineate between degrees of emetic potential |
|- | |- | ||
− | |Lenvatinib | + | |align="left" |[[Lenvatinib (Lenvima)]] (oral) |
| | | | ||
− | |Moderate | + | |Moderate |
| | | | ||
| | | | ||
|- | |- | ||
− | | align="left" | [[Lomustine (CCNU)]] (oral) | + | | align="left" |[[Lomustine (CCNU)]] (oral) |
|High/Moderate (single day) | |High/Moderate (single day) | ||
| | | | ||
| | | | ||
− | |single day; NCCN did not further delineate between degrees of emetic potential | + | |single day; NCCN did not further delineate between degrees of emetic potential |
+ | |- | ||
+ | | align="left" |[[Lurbinectedin (Zepzelca)]] | ||
+ | |Moderate | ||
+ | | | ||
+ | | | ||
+ | | | ||
+ | |- | ||
+ | |[[Margetuximab (Margenza)]] | ||
+ | |Minimal | ||
+ | | | ||
+ | | | ||
+ | | | ||
|- | |- | ||
− | | align="left" | [[Mechlorethamine (Mustargen)]] | + | | align="left" |[[Mechlorethamine (Mustargen)]] |
|High | |High | ||
|High | |High | ||
Line 493: | Line 537: | ||
| | | | ||
|- | |- | ||
− | | align="left" | [[Melphalan (Alkeran)]] | + | | align="left" |[[Melphalan (Alkeran)]] |
|Moderate | |Moderate | ||
| | | | ||
| | | | ||
− | |ASCO and MASCC recommend combination of NK1+5-HT3+DEX when melphalan is used at high dose for BMT conditioning. | + | |ASCO and MASCC recommend combination of NK1+5-HT3+DEX when melphalan is used at high dose for BMT conditioning. |
|- | |- | ||
− | | align="left" | [[Melphalan (Alkeran)]] (oral) | + | | align="left" |[[Melphalan (Alkeran)]] (oral) |
|Low/Minimal | |Low/Minimal | ||
| | | | ||
|Minimal | |Minimal | ||
− | |NCCN did not further delineate between degrees of emetic potential | + | |NCCN did not further delineate between degrees of emetic potential |
|- | |- | ||
− | | align="left" | [[Mercaptopurine (6-MP)]] (oral) | + | | align="left" |[[Mercaptopurine (6-MP)]] (oral) |
|Low/Minimal | |Low/Minimal | ||
| | | | ||
| | | | ||
− | |NCCN did not further delineate between degrees of emetic potential | + | |NCCN did not further delineate between degrees of emetic potential |
|- | |- | ||
− | | align="left" | [[Methotrexate (MTX)]] | + | | align="left" |[[Methotrexate (MTX)]] |
− | |Moderate: | + | |Moderate: 250 mg/m<sup>2</sup> or more<br>Low: between 50 and 250 mg/m<sup>2</sup><br>Minimal: 50 mg/m<sup>2</sup> or less |
|Low | |Low | ||
|Low | |Low | ||
|ASCO and MASCC did not subclassify based on dose | |ASCO and MASCC did not subclassify based on dose | ||
|- | |- | ||
− | | align="left" | [[Methotrexate (MTX)]] (oral) | + | | align="left" |[[Methotrexate (MTX)]] (oral) |
|Low/Minimal | |Low/Minimal | ||
| | | | ||
|Minimal | |Minimal | ||
− | |NCCN did not further delineate between degrees of emetic potential | + | |NCCN did not further delineate between degrees of emetic potential |
|- | |- | ||
− | | align="left" | [[Mitomycin (Mutamycin)]] | + | | align="left" |[[Mitomycin (Mutamycin)]] |
|Low | |Low | ||
|Low | |Low | ||
Line 529: | Line 573: | ||
| | | | ||
|- | |- | ||
− | | align="left" | [[Mitotane (Lysodren)]] (oral) | + | | align="left" |[[Mitotane (Lysodren)]] (oral) |
|High/Moderate | |High/Moderate | ||
| | | | ||
Line 535: | Line 579: | ||
| | | | ||
|- | |- | ||
− | | align="left" | [[Mitoxantrone (Novantrone)]] | + | | align="left" |[[Mitoxantrone (Novantrone)]] |
|Low | |Low | ||
|Low | |Low | ||
Line 541: | Line 585: | ||
| | | | ||
|- | |- | ||
− | | align="left" | [[Nelarabine (Arranon)]] | + | | align="left" |[[Nelarabine (Arranon)]] |
|Minimal | |Minimal | ||
| | | | ||
Line 547: | Line 591: | ||
| | | | ||
|- | |- | ||
− | | align="left" | [[Nilotinib (Tasigna)]] (oral) | + | | align="left" |[[Nilotinib (Tasigna)]] (oral) |
|Low/Minimal | |Low/Minimal | ||
| | | | ||
|Low | |Low | ||
− | |NCCN did not further delineate between degrees of emetic potential | + | |NCCN did not further delineate between degrees of emetic potential |
+ | |- | ||
+ | | align="left" |[[Niraparib (Zejula)]] (oral) | ||
+ | |Moderate to high | ||
+ | | | ||
+ | | | ||
+ | |NCCN did not further delineate between degrees of emetic potential (>30%) | ||
|- | |- | ||
− | | align="left" | [[Ofatumumab (Arzzera)]] | + | | align="left" |[[Ofatumumab (Arzzera)]] |
|Minimal | |Minimal | ||
| | | | ||
Line 559: | Line 609: | ||
| | | | ||
|- | |- | ||
− | | align="left" | [[Omacetaxine (Synribo)]] | + | | align="left" |[[Omacetaxine (Synribo)]] |
|Low | |Low | ||
| | | | ||
Line 565: | Line 615: | ||
| | | | ||
|- | |- | ||
− | | align="left" | [[Oxaliplatin (Eloxatin)]] | + | | align="left" |[[Olaparib (Lynparza)]] (oral) |
+ | |Moderate to high | ||
+ | | | ||
+ | | | ||
+ | |NCCN did not further delineate between degrees of emetic potential (>30%) | ||
+ | |- | ||
+ | | align="left" |[[Oxaliplatin (Eloxatin)]] | ||
|Moderate | |Moderate | ||
|Moderate | |Moderate | ||
Line 571: | Line 627: | ||
| | | | ||
|- | |- | ||
− | | align="left" | [[Paclitaxel (Taxol)]] | + | | align="left" |[[Paclitaxel (Taxol)]] |
|Low | |Low | ||
|Low | |Low | ||
Line 577: | Line 633: | ||
| | | | ||
|- | |- | ||
− | | align="left" | [[Paclitaxel, nanoparticle albumin-bound (Abraxane)]] | + | | align="left" |[[Paclitaxel, nanoparticle albumin-bound (Abraxane)]] |
|Low | |Low | ||
| | | | ||
Line 583: | Line 639: | ||
| | | | ||
|- | |- | ||
− | | align="left" | [[Panitumumab (Vectibix)]] | + | | align="left" |[[Panitumumab (Vectibix)]] |
|Minimal | |Minimal | ||
| | | | ||
− | | | + | |Low |
| | | | ||
|- | |- | ||
− | | align="left" | [[Pazopanib (Votrient)]] (oral) | + | | align="left" |[[Pazopanib (Votrient)]] (oral) |
|Low/Minimal | |Low/Minimal | ||
| | | | ||
|Low | |Low | ||
− | |NCCN did not further delineate between degrees of emetic potential | + | |NCCN did not further delineate between degrees of emetic potential |
|- | |- | ||
− | | align="left" | [[Peg-asparginase (Oncaspar)]] | + | | align="left" |[[Peg-asparginase (Oncaspar)]] |
|Minimal | |Minimal | ||
| | | | ||
Line 601: | Line 657: | ||
| | | | ||
|- | |- | ||
− | | align="left" | [[Peginterferon alfa-2a (Pegasys)]] | + | | align="left" |[[Peginterferon alfa-2a (Pegasys)]] |
|Minimal | |Minimal | ||
| | | | ||
Line 607: | Line 663: | ||
|NCCN did not specify interferon alfa-2a vs. 2b | |NCCN did not specify interferon alfa-2a vs. 2b | ||
|- | |- | ||
− | | align="left" | [[Peginterferon alfa-2b ( | + | | align="left" |[[Peginterferon alfa-2b (Sylatron)]] |
|Minimal | |Minimal | ||
| | | | ||
Line 613: | Line 669: | ||
|NCCN did not specify interferon alfa-2a vs. 2b | |NCCN did not specify interferon alfa-2a vs. 2b | ||
|- | |- | ||
− | | align="left" | [[Pemetrexed (Alimta)]] | + | | align="left" |[[Pembrolizumab (Keytruda)]] |
+ | | | ||
+ | | | ||
+ | |Minimal | ||
+ | | | ||
+ | |- | ||
+ | | align="left" |[[Pemetrexed (Alimta)]] | ||
|Low | |Low | ||
|Low | |Low | ||
Line 619: | Line 681: | ||
| | | | ||
|- | |- | ||
− | | align="left" | [[Pentostatin (Nipent)]] | + | | align="left" |[[Pentostatin (Nipent)]] |
|Low | |Low | ||
| | | | ||
Line 625: | Line 687: | ||
| | | | ||
|- | |- | ||
− | | align="left" | [[Pertuzumab (Perjeta)]] | + | | align="left" |[[Pertuzumab (Perjeta)]] |
|Minimal | |Minimal | ||
| | | | ||
Line 631: | Line 693: | ||
| | | | ||
|- | |- | ||
− | | align="left" | [[Pomalidomide (Pomalyst)]] (oral) | + | | align="left" |[[Pixantrone (Pixuvri)]] |
+ | | | ||
+ | | | ||
+ | |Minimal | ||
+ | | | ||
+ | |- | ||
+ | | align="left" |[[Pomalidomide (Pomalyst)]] (oral) | ||
|Low/Minimal | |Low/Minimal | ||
| | | | ||
Line 637: | Line 705: | ||
| | | | ||
|- | |- | ||
− | | align="left" | [[Ponatinib (Iclusig)]] (oral) | + | | align="left" |[[Ponatinib (Iclusig)]] (oral) |
|Low/Minimal | |Low/Minimal | ||
| | | | ||
Line 643: | Line 711: | ||
| | | | ||
|- | |- | ||
− | | align="left" | [[Pralatrexate (Folotyn)]] | + | | align="left" |[[Pralatrexate (Folotyn)]] |
|Low | |Low | ||
|Minimal | |Minimal | ||
Line 649: | Line 717: | ||
| | | | ||
|- | |- | ||
− | | align="left" | [[Procarbazine (Matulane)]] (oral) | + | | align="left" |[[Procarbazine (Matulane)]] (oral) |
|High/Moderate | |High/Moderate | ||
− | |||
|High | |High | ||
− | |NCCN did not further delineate between degrees of emetic potential | + | |High |
+ | |NCCN did not further delineate between degrees of emetic potential | ||
|- | |- | ||
− | | align="left" | [[Regorafenib (Stivarga)]] (oral) | + | | align="left" |[[Regorafenib (Stivarga)]] (oral) |
|Low/Minimal | |Low/Minimal | ||
| | | | ||
Line 661: | Line 729: | ||
| | | | ||
|- | |- | ||
− | | align="left" | [[Rituximab (Rituxan)]] | + | | align="left" |[[Rituximab (Rituxan)]] |
|Minimal | |Minimal | ||
|Minimal | |Minimal | ||
Line 667: | Line 735: | ||
| | | | ||
|- | |- | ||
− | | align="left" | [[Romidepsin (Istodax)]] | + | | align="left" |[[Romidepsin (Istodax)]] |
|Low | |Low | ||
| | | | ||
Line 673: | Line 741: | ||
| | | | ||
|- | |- | ||
− | | align="left" | [[Ruxolitinib (Jakafi)]] (oral) | + | | align="left" |[[Rucaparib (Rubraca)]] |
+ | |Moderate to high | ||
+ | | | ||
+ | | | ||
+ | |NCCN did not further delineate between degrees of emetic potential (>30%) | ||
+ | |- | ||
+ | | align="left" |[[Ruxolitinib (Jakafi)]] (oral) | ||
|Low/Minimal | |Low/Minimal | ||
| | | | ||
Line 679: | Line 753: | ||
| | | | ||
|- | |- | ||
− | | align="left" | [[Sorafenib (Nexavar)]] (oral) | + | | align="left" |[[Selinexor (Xpovio)]] (oral) |
+ | |Moderate/High | ||
+ | |Moderate/High | ||
+ | | | ||
+ | |NCCN and ASCO did not further delineate between degrees of emetic potential | ||
+ | |- | ||
+ | | align="left" |[[Sorafenib (Nexavar)]] (oral) | ||
|Low/Minimal | |Low/Minimal | ||
| | | | ||
|Minimal | |Minimal | ||
− | |NCCN did not further delineate between degrees of emetic potential | + | |NCCN did not further delineate between degrees of emetic potential |
|- | |- | ||
− | | align="left" | [[Streptozocin (Zanosar)]] | + | | align="left" |[[Streptozocin (Zanosar)]] |
|High | |High | ||
|High | |High | ||
Line 691: | Line 771: | ||
| | | | ||
|- | |- | ||
− | | align="left" | [[Sunitinib (Sutent)]] (oral) | + | | align="left" |[[Sunitinib (Sutent)]] (oral) |
|Low/Minimal | |Low/Minimal | ||
| | | | ||
|Low | |Low | ||
− | |NCCN did not further delineate between degrees of emetic potential | + | |NCCN did not further delineate between degrees of emetic potential |
|- | |- | ||
− | | align="left" | [[Temozolmide (Temodar)]] | + | | align="left" |[[Temozolmide (Temodar)]] |
|Moderate | |Moderate | ||
| | | | ||
Line 704: | Line 784: | ||
similar safety profile | similar safety profile | ||
|- | |- | ||
− | | align="left" | [[Temozolmide (Temodar)]] (oral) | + | | align="left" |[[Temozolmide (Temodar)]] (oral) |
|High/Moderate: >75 mg/m<sup>2</sup>/day<br>Low/Minimal: ≤75 mg/m<sup>2</sup>/day | |High/Moderate: >75 mg/m<sup>2</sup>/day<br>Low/Minimal: ≤75 mg/m<sup>2</sup>/day | ||
− | |||
|Moderate | |Moderate | ||
− | |NCCN did not further delineate between degrees of emetic potential | + | |Moderate |
+ | |NCCN did not further delineate between degrees of emetic potential | ||
|- | |- | ||
− | | align="left" | [[Temsirolimus (Torisel)]] | + | | align="left" |[[Temsirolimus (Torisel)]] |
|Minimal | |Minimal | ||
|Low | |Low | ||
Line 716: | Line 796: | ||
| | | | ||
|- | |- | ||
− | | align="left" | [[Thalidomide (Thalomid)]] (oral) | + | | align="left" |[[Thalidomide (Thalomid)]] (oral) |
|Low/Minimal | |Low/Minimal | ||
| | | | ||
|Low | |Low | ||
− | |NCCN did not further delineate between degrees of emetic potential | + | |NCCN did not further delineate between degrees of emetic potential |
|- | |- | ||
− | | align="left" | [[Thioguanine (Tabloid)]] (oral) | + | | align="left" |[[Thioguanine (Tabloid)]] (oral) |
|Low/Minimal | |Low/Minimal | ||
| | | | ||
|Minimal | |Minimal | ||
− | |NCCN did not further delineate between degrees of emetic potential | + | |NCCN did not further delineate between degrees of emetic potential |
|- | |- | ||
− | | align="left" | [[Thiotepa (Thioplex)]] | + | | align="left" |[[Thiotepa (Thioplex)]] |
|Low | |Low | ||
| | | | ||
Line 734: | Line 814: | ||
| | | | ||
|- | |- | ||
− | | align="left" | [[Topotecan (Hycamtin)]] | + | | align="left" |[[Topotecan (Hycamtin)]] |
|Low | |Low | ||
|Low | |Low | ||
Line 740: | Line 820: | ||
| | | | ||
|- | |- | ||
− | | align="left" | [[Topotecan (Hycamtin)]] (oral) | + | | align="left" |[[Topotecan (Hycamtin)]] (oral) |
|Low/Minimal | |Low/Minimal | ||
| | | | ||
| | | | ||
− | |NCCN did not further delineate between degrees of emetic potential | + | |NCCN did not further delineate between degrees of emetic potential |
|- | |- | ||
− | | align="left" | [[Trametinib (Mekinist)]] (oral) | + | | align="left" |[[Trabectedin (Yondelis)]] |
+ | | | ||
+ | | | ||
+ | |Moderate | ||
+ | | | ||
+ | |- | ||
+ | | align="left" |[[Trametinib (Mekinist)]] (oral) | ||
|Low/Minimal | |Low/Minimal | ||
| | | | ||
Line 752: | Line 838: | ||
| | | | ||
|- | |- | ||
− | | align="left" | [[Trastuzumab (Herceptin)]] | + | | align="left" |[[Trastuzumab (Herceptin)]] |
|Minimal | |Minimal | ||
|Low | |Low | ||
Line 758: | Line 844: | ||
| | | | ||
|- | |- | ||
− | | align="left" | [[All-trans retinoic acid (ATRA)]] (oral) | + | | align="left" |[[Trastuzumab deruxtecan (Enhertu)]] |
+ | |High | ||
+ | |Moderate | ||
+ | | | ||
+ | | | ||
+ | |- | ||
+ | | align="left" |[[All-trans retinoic acid (ATRA)]] (oral) | ||
+ | |Low/Minimal | ||
+ | | | ||
+ | | | ||
+ | |NCCN did not further delineate between degrees of emetic potential | ||
+ | |- | ||
+ | |[[Umbralisib (Ukoniq)|Umbralisib (Ukoniq]]) (oral) | ||
|Low/Minimal | |Low/Minimal | ||
| | | | ||
| | | | ||
− | | | + | | |
|- | |- | ||
− | | align="left" | [[Valrubicin (Valstar)]] | + | | align="left" |[[Valrubicin (Valstar)]] |
|Minimal | |Minimal | ||
| | | | ||
Line 770: | Line 868: | ||
| | | | ||
|- | |- | ||
− | | align="left" | [[Vandetanib (Caprelsa)]] (oral) | + | | align="left" |[[Vandetanib (Caprelsa)]] (oral) |
|Low/Minimal | |Low/Minimal | ||
| | | | ||
|Low | |Low | ||
− | |NCCN did not further delineate between degrees of emetic potential | + | |NCCN did not further delineate between degrees of emetic potential |
|- | |- | ||
− | | align="left" | [[Vemurafenib (Zelboraf)]] (oral) | + | | align="left" |[[Vemurafenib (Zelboraf)]] (oral) |
|Low/Minimal | |Low/Minimal | ||
| | | | ||
Line 782: | Line 880: | ||
| | | | ||
|- | |- | ||
− | | align="left" | [[Vinblastine (Velban)]] | + | | align="left" |[[Vinblastine (Velban)]] |
|Minimal | |Minimal | ||
|Minimal | |Minimal | ||
Line 788: | Line 886: | ||
| | | | ||
|- | |- | ||
− | | align="left" | [[Vincristine (Oncovin)]] | + | | align="left" |[[Vincristine (Oncovin)]] |
|Minimal | |Minimal | ||
|Minimal | |Minimal | ||
Line 794: | Line 892: | ||
| | | | ||
|- | |- | ||
− | | align="left" | [[Vincristine liposomal (Marqibo)]] | + | | align="left" |[[Vincristine liposomal (Marqibo)]] |
|Minimal | |Minimal | ||
| | | | ||
Line 800: | Line 898: | ||
| | | | ||
|- | |- | ||
− | | align="left" | [[Vinorelbine (Navelbine)]] | + | | align="left" |[[Vinflunine (Javlor)]] |
+ | | | ||
+ | | | ||
+ | |Low | ||
+ | | | ||
+ | |- | ||
+ | | align="left" |[[Vinorelbine (Navelbine)]] | ||
|Minimal | |Minimal | ||
|Minimal | |Minimal | ||
Line 806: | Line 910: | ||
| | | | ||
|- | |- | ||
− | |Vinorelbine (oral) | + | | align="left" |[[Vinorelbine (Navelbine)]] (oral) |
| | | | ||
|Moderate | |Moderate | ||
Line 812: | Line 916: | ||
| | | | ||
|- | |- | ||
− | | align="left" | [[Vismodegib (Erivedge)]] (oral) | + | | align="left" |[[Vismodegib (Erivedge)]] (oral) |
|High/Moderate | |High/Moderate | ||
| | | | ||
Line 818: | Line 922: | ||
| | | | ||
|- | |- | ||
− | | align="left" | [[Vorinostat (Zolinza)]] (oral) | + | | align="left" |[[Vorinostat (Zolinza)]] (oral) |
|Low/Minimal | |Low/Minimal | ||
| | | | ||
|Low | |Low | ||
− | |NCCN did not further delineate between degrees of emetic potential | + | |NCCN did not further delineate between degrees of emetic potential |
|- | |- | ||
− | | align="left" | [[Ziv-aflibercept (Zaltrap)]] | + | | align="left" |[[Ziv-aflibercept (Zaltrap)]] |
|Low | |Low | ||
| | | | ||
− | | | + | |Low |
− | | | + | |- |
|} | |} | ||
Line 835: | Line 939: | ||
| | | | ||
|'''Day 1 CINV prophylaxis''' | |'''Day 1 CINV prophylaxis''' | ||
− | |'''Day 2-4 | + | |'''Day 2-4 CINV prophylaxis''' |
|- | |- | ||
|ASCO 2017 | |ASCO 2017 | ||
− | |NK1 | + | |NK1 + 5-HT3 + DEX + OLN |
|DEX + OLN | |DEX + OLN | ||
− | + | ''(if APR on day 1, then + APR days 2-3)'' | |
− | ''(if APR on day 1, then +APR days | ||
|- | |- | ||
− | |MASCC | + | |MASCC 2019 |
− | |NK1 | + | |NK1 + 5-HT3 + DEX +/- OLN |
− | |DEX | + | |DEX +/- OLN |
− | + | ''(if APR on day 1, then + APR days 2-3)'' | |
− | ''(if APR on day 1, then +APR days | ||
|- | |- | ||
− | | rowspan="3" |NCCN | + | | rowspan="3" |NCCN 2022 |
− | |<nowiki>- NK1 | + | |<nowiki>- NK1 + 5-HT3 + DEX + OLN</nowiki> |
|DEX + OLN | |DEX + OLN | ||
+ | ''(if po APR on day 1, then + APR days 2-3)'' | ||
|- | |- | ||
− | |<nowiki>- NK1 | + | |<nowiki>- NK1 + 5-HT3 + DEX</nowiki> |
|DEX | |DEX | ||
+ | ''(if po APR on day 1, then + APR days 2-3)'' | ||
|- | |- | ||
− | | | + | | - OLN + Palonosetron + DEX |
|OLN | |OLN | ||
|} | |} | ||
− | |||
==Neurokinin-1 (NK1) antagonist-containing regimen (except netupitant)== | ==Neurokinin-1 (NK1) antagonist-containing regimen (except netupitant)== | ||
− | ===Neurokinin 1 (NK1) antagonist === | + | ===Neurokinin 1 (NK1) antagonist=== |
*[[Aprepitant (Emend)]] 125 mg PO once on day 1, then 80 mg PO once per day on days 2 & 3 | *[[Aprepitant (Emend)]] 125 mg PO once on day 1, then 80 mg PO once per day on days 2 & 3 | ||
+ | *Aprepitant injectable emulsion (Cinvanti) 130 mg IV once on day 1 | ||
*[[Fosaprepitant (Emend for Injection)]] 150 mg IV once on day 1 | *[[Fosaprepitant (Emend for Injection)]] 150 mg IV once on day 1 | ||
*[[Rolapitant (Varubi)]] 180 mg PO once on day 1 | *[[Rolapitant (Varubi)]] 180 mg PO once on day 1 | ||
− | ''Note: All of the above NK1 antagonists are equally effective in IV and PO formulations at recommended doses <ref>Grunberg S, Chua D, Maru A, Dinis J, DeVandry S, Boice JA, Hardwick JS, Beckford E, Taylor A, Carides A, Roila F, Herrstedt J. Single-dose fosaprepitant for the prevention of chemotherapy-induced nausea and vomiting associated with cisplatin therapy: randomized, double-blind study protocol--EASE. J Clin Oncol. 2011 Apr 10;29(11):1495-501. Epub 2011 Mar 7. [ | + | ''Note: All of the above NK1 antagonists are equally effective in IV and PO formulations at recommended doses <ref>Grunberg S, Chua D, Maru A, Dinis J, DeVandry S, Boice JA, Hardwick JS, Beckford E, Taylor A, Carides A, Roila F, Herrstedt J. Single-dose fosaprepitant for the prevention of chemotherapy-induced nausea and vomiting associated with cisplatin therapy: randomized, double-blind study protocol--EASE. J Clin Oncol. 2011 Apr 10;29(11):1495-501. Epub 2011 Mar 7. [https://doi.org/10.1200/JCO.2010.31.7859 link to original article] [https://pubmed.ncbi.nlm.nih.gov/21383291/ PubMed]</ref>'' |
− | |||
===Serotonin (5-HT3) antagonist=== | ===Serotonin (5-HT3) antagonist=== | ||
*[[Dolasetron (Anzemet)]] 100 mg PO once on day 1 | *[[Dolasetron (Anzemet)]] 100 mg PO once on day 1 | ||
*[[Granisetron]] (choose one of the options below): | *[[Granisetron]] (choose one of the options below): | ||
**2 mg PO once on day 1 | **2 mg PO once on day 1 | ||
− | **0.01 mg/kg (maximum dose 1 mg) IV once on day 1 | + | **0.01 mg/kg (maximum dose 1 mg) IV once on day 1 |
**transdermal patch as 3.1 mg/24H patch (containing 34.3 mg granisetron total dose) placed ~24 to 48 hours before the first dose of chemotherapy. May use patch up to 7 days. | **transdermal patch as 3.1 mg/24H patch (containing 34.3 mg granisetron total dose) placed ~24 to 48 hours before the first dose of chemotherapy. May use patch up to 7 days. | ||
*[[Ondansetron (Zofran)]] (choose one of the options below): | *[[Ondansetron (Zofran)]] (choose one of the options below): | ||
− | **8 to 16 mg IV<ref name="ondansetron QTc">As of 6/28/2012, the once daily dose of ondansetron (Zofran) 32 mg is no longer recommended due to dose-dependent QTc prolongation. | + | **8 to 16 mg IV<ref name="ondansetron QTc">As of 6/28/2012, the once daily dose of ondansetron (Zofran) 32 mg is no longer recommended due to dose-dependent QTc prolongation. The [http://us.gsk.com/products/assets/us_zofran.pdf Ondansetron (Zofran) package insert] recommends only a maximum of 16 mg per dose, which can be given as often as every 4 hours x up to 3 doses, as detailed in the 6/29/2012 [http://www.fda.gov/Drugs/DrugSafety/ucm310190.htm FDA Drug Safety Communication].</ref> once on day 1 |
*[[Palonosetron (Aloxi)]] 0.25 mg IV once on day 1 | *[[Palonosetron (Aloxi)]] 0.25 mg IV once on day 1 | ||
*[[Tropisetron (Navoban)]] 5 mg IV or PO day 1 | *[[Tropisetron (Navoban)]] 5 mg IV or PO day 1 | ||
− | ''Note: When given at | + | ''Note: When given at biologically equivalent doses, all of the above 5-HT3 antagonists are equally efficacious and appear to be interchangeable''<ref>Karin Jordan et al. "Comparative activity of antiemetic drugs" |
− | |||
https://www-sciencedirect-com.elibrary.einstein.yu.edu/science/article/pii/S1040842806001661#tbl2 | https://www-sciencedirect-com.elibrary.einstein.yu.edu/science/article/pii/S1040842806001661#tbl2 | ||
</ref> | </ref> | ||
''Note: Ramosetron is another available 5-HT3, but not approved by FDA'' | ''Note: Ramosetron is another available 5-HT3, but not approved by FDA'' | ||
− | |||
===Dexamethasone (DEX)=== | ===Dexamethasone (DEX)=== | ||
''Steroids contraindicated for use with interleukin-2 and interferon.'' | ''Steroids contraindicated for use with interleukin-2 and interferon.'' | ||
− | *If [[Aprepitant (Emend)]] used: | + | *If [[Aprepitant (Emend)]] used: |
**[[Dexamethasone (Decadron)]] 12 mg IV or PO once on day 1, then 8 mg PO once per day on days 2 to 4 | **[[Dexamethasone (Decadron)]] 12 mg IV or PO once on day 1, then 8 mg PO once per day on days 2 to 4 | ||
*If [[Fosaprepitant (Emend for Injection)]] used: | *If [[Fosaprepitant (Emend for Injection)]] used: | ||
Line 892: | Line 993: | ||
*If [[Rolapitant (Varubi)]] used: | *If [[Rolapitant (Varubi)]] used: | ||
**[[Dexamethasone (Decadron)]] 12 mg IV or PO once on day 1, then 8 mg PO twice per day on days 2 to 4 | **[[Dexamethasone (Decadron)]] 12 mg IV or PO once on day 1, then 8 mg PO twice per day on days 2 to 4 | ||
− | |||
''Dexamethasone use beyond day 1 might be revised based on the 2018 meta analysis results''<ref name=":1">Ronald CHow et Al. "Efficacy and safety of 1-day versus 3-day dexamethasone for the prophylaxis of chemotherapy-induced nausea and vomiting: a systematic review and meta-analysis of randomized controlled trials" | ''Dexamethasone use beyond day 1 might be revised based on the 2018 meta analysis results''<ref name=":1">Ronald CHow et Al. "Efficacy and safety of 1-day versus 3-day dexamethasone for the prophylaxis of chemotherapy-induced nausea and vomiting: a systematic review and meta-analysis of randomized controlled trials" | ||
− | |||
http://jhmhp.amegroups.com/article/view/4296 | http://jhmhp.amegroups.com/article/view/4296 | ||
− | </ref> | + | </ref> |
− | |||
==Netupitant-containing regimen== | ==Netupitant-containing regimen== | ||
*[[Netupitant and palonosetron (Akynzeo)]] 300/0.5 mg PO once on day 1 as a fixed oral formulation | *[[Netupitant and palonosetron (Akynzeo)]] 300/0.5 mg PO once on day 1 as a fixed oral formulation | ||
*[[Dexamethasone (Decadron)]] 12 mg PO or IV once on day 1, then 8 mg PO or IV once per day on days 2 to 4 | *[[Dexamethasone (Decadron)]] 12 mg PO or IV once on day 1, then 8 mg PO or IV once per day on days 2 to 4 | ||
− | |||
==Olanzapine (OLN) containing regimen== | ==Olanzapine (OLN) containing regimen== | ||
− | |||
*[[Olanzapine (Zyprexa)]] 10 mg PO once per day on days 1 to 4 | *[[Olanzapine (Zyprexa)]] 10 mg PO once per day on days 1 to 4 | ||
*[[Aprepitant (Emend)]] 125 mg PO once on day 1, then 80 mg PO once per day on days 2 & 3, '''OR''' [[Fosaprepitant (Emend for Injection)]] 150 mg IV once on day 1 | *[[Aprepitant (Emend)]] 125 mg PO once on day 1, then 80 mg PO once per day on days 2 & 3, '''OR''' [[Fosaprepitant (Emend for Injection)]] 150 mg IV once on day 1 | ||
− | *[[Palonosetron (Aloxi)]] 0.25 mg IV once on day 1, '''OR''' Granisetron 1mg IV or 2mg PO, | + | *[[Palonosetron (Aloxi)]] 0.25 mg IV once on day 1, '''OR''' Granisetron 1mg IV or 2mg PO, '''OR''' Ondansetron 8 mg PO or IV |
*[[Dexamethasone (Decadron)]] 12 mg PO on day 1, and 8 mg PO on days 2, 3, and 4 | *[[Dexamethasone (Decadron)]] 12 mg PO on day 1, and 8 mg PO on days 2, 3, and 4 | ||
− | + | Reference: | |
+ | #''[https://doi.org/10.1056/NEJMoa1515725 Navari et al. 2016]<ref name=":3">Navari RM, Qin R, Ruddy KJ, Liu H, Powell SF, Bajaj M, Dietrich L, Biggs D, Lafky JM, Loprinzi CL. Olanzapine for the Prevention of Chemotherapy-Induced Nausea and Vomiting. N Engl J Med. 2016 Jul 14;375(2):134-42. [https://doi.org/10.1056/NEJMoa1515725 link to original article] [https://pubmed.ncbi.nlm.nih.gov/27410922/ PubMed]</ref>''<br /> | ||
=Moderately emetogenic IV chemotherapy (MEC)= | =Moderately emetogenic IV chemotherapy (MEC)= | ||
{| class="wikitable" | {| class="wikitable" | ||
Line 916: | Line 1,013: | ||
|- | |- | ||
|ASCO 2017 | |ASCO 2017 | ||
− | |5-HT3 | + | |5-HT3 + DEX |
− | |DEX maybe offered for: oxaliplatin, | + | |DEX maybe offered for: oxaliplatin, or anthracycline, or cyclophosphamide |
|- | |- | ||
|MASCC 2016 | |MASCC 2016 | ||
− | |5-HT3 | + | |5-HT3 + DEX |
− | |DEX can be considered for: oxaliplatin, | + | |DEX can be considered for: oxaliplatin, or anthracycline, or cyclophosphamide |
|- | |- | ||
− | | rowspan="3" |NCCN | + | | rowspan="3" |NCCN 2022 |
− | |<nowiki>- 5-HT3 | + | |<nowiki>- 5-HT3 + DEX</nowiki> |
|DEX or 5-HT3 | |DEX or 5-HT3 | ||
|- | |- | ||
− | |<nowiki>- NK1 | + | |<nowiki>- NK1 + 5-HT3 + DEX </nowiki> |
− | + | (for selected patients with additional risk factors or previous Rx failure) | |
− | (for | + | |Aprepitant PO daily days 2 and 3 if aprepitant POused on day 1 |
− | |<nowiki>+/- DEX</nowiki> | + | <nowiki>+/- DEX</nowiki> |
|- | |- | ||
− | | | + | | - OLN + Palonosetron + DEX |
|OLN | |OLN | ||
|} | |} | ||
− | |||
===Serotonin (5-HT3) antagonist=== | ===Serotonin (5-HT3) antagonist=== | ||
*[[Dolasetron (Anzemet)]] 100 mg PO once on day 1 | *[[Dolasetron (Anzemet)]] 100 mg PO once on day 1 | ||
*[[Granisetron]] (choose one of the options below): | *[[Granisetron]] (choose one of the options below): | ||
**2 mg PO once on day 1 | **2 mg PO once on day 1 | ||
− | **0.01 mg/kg (maximum dose 1 mg) IV once on day 1 | + | **0.01 mg/kg (maximum dose 1 mg) IV once on day 1 |
**transdermal patch as 3.1 mg/24H patch (containing 34.3 mg granisetron total dose) placed ~24 to 48 hours before the first dose of chemotherapy. May use patch up to 7 days. | **transdermal patch as 3.1 mg/24H patch (containing 34.3 mg granisetron total dose) placed ~24 to 48 hours before the first dose of chemotherapy. May use patch up to 7 days. | ||
*[[Ondansetron (Zofran)]] (choose one of the options below): | *[[Ondansetron (Zofran)]] (choose one of the options below): | ||
− | **8 to 16 mg IV<ref name="ondansetron QTc">As of 6/28/2012, the once daily dose of ondansetron (Zofran) 32 mg is no longer recommended due to dose-dependent QTc prolongation. | + | **8 to 16 mg IV<ref name="ondansetron QTc">As of 6/28/2012, the once daily dose of ondansetron (Zofran) 32 mg is no longer recommended due to dose-dependent QTc prolongation. The [http://us.gsk.com/products/assets/us_zofran.pdf Ondansetron (Zofran) package insert] recommends only a maximum of 16 mg per dose, which can be given as often as every 4 hours x up to 3 doses, as detailed in the 6/29/2012 [http://www.fda.gov/Drugs/DrugSafety/ucm310190.htm FDA Drug Safety Communication].</ref> once on day 1 |
*[[Palonosetron (Aloxi)]] 0.25 mg IV once on day 1 | *[[Palonosetron (Aloxi)]] 0.25 mg IV once on day 1 | ||
*[[Tropisetron (Navoban)]] 5 mg IV or PO day 1 | *[[Tropisetron (Navoban)]] 5 mg IV or PO day 1 | ||
− | |||
===Dexamethasone (DEX)=== | ===Dexamethasone (DEX)=== | ||
''Steroids contraindicated for use with interleukin-2 and interferon.'' | ''Steroids contraindicated for use with interleukin-2 and interferon.'' | ||
− | *If [[Aprepitant (Emend)]] used: | + | *If [[Aprepitant (Emend)]] used: |
**[[Dexamethasone (Decadron)]] 12 mg IV or PO once on day 1, then 8 mg PO once per day on days 2 to 4 | **[[Dexamethasone (Decadron)]] 12 mg IV or PO once on day 1, then 8 mg PO once per day on days 2 to 4 | ||
*If [[Fosaprepitant (Emend for Injection)]] used: | *If [[Fosaprepitant (Emend for Injection)]] used: | ||
Line 956: | Line 1,051: | ||
**[[Dexamethasone (Decadron)]] 12 mg IV or PO once on day 1, then 8 mg PO twice per day on days 2 to 4 | **[[Dexamethasone (Decadron)]] 12 mg IV or PO once on day 1, then 8 mg PO twice per day on days 2 to 4 | ||
''Dexamethasone use beyond day 1 might be revised based on the 2018 meta analysis results''<ref name=":1" /> | ''Dexamethasone use beyond day 1 might be revised based on the 2018 meta analysis results''<ref name=":1" /> | ||
− | |||
==Netupitant-containing regimen== | ==Netupitant-containing regimen== | ||
*[[Netupitant and palonosetron (Akynzeo)]] 300/0.5 mg PO once on day 1 as a fixed oral formulation | *[[Netupitant and palonosetron (Akynzeo)]] 300/0.5 mg PO once on day 1 as a fixed oral formulation | ||
*[[Dexamethasone (Decadron)]] 12 mg PO or IV once on day 1, then 8 mg PO or IV once per day on days 2 to 4 | *[[Dexamethasone (Decadron)]] 12 mg PO or IV once on day 1, then 8 mg PO or IV once per day on days 2 to 4 | ||
− | |||
==Olanzapine (OLN) containing regimen== | ==Olanzapine (OLN) containing regimen== | ||
− | ''Note: a 4-drug regimen based on [https:// | + | ''Note: a 4-drug regimen based on [https://doi.org/10.1056/NEJMoa1515725 Navari et al. 2016]<ref>Navari RM, Qin R, Ruddy KJ, Liu H, Powell SF, Bajaj M, Dietrich L, Biggs D, Lafky JM, Loprinzi CL. Olanzapine for the Prevention of Chemotherapy-Induced Nausea and Vomiting. N Engl J Med. 2016 Jul 14;375(2):134-42. [https://doi.org/10.1056/NEJMoa1515725 link to original article] [https://pubmed.ncbi.nlm.nih.gov/27410922/ PubMed]</ref>'' |
*[[Olanzapine (Zyprexa)]] 10 mg PO once per day on days 1 to 4 | *[[Olanzapine (Zyprexa)]] 10 mg PO once per day on days 1 to 4 | ||
*[[Aprepitant (Emend)]] 125 mg PO once on day 1, then 80 mg PO once per day on days 2 & 3, '''OR''' [[Fosaprepitant (Emend for Injection)]] 150 mg IV once on day 1 | *[[Aprepitant (Emend)]] 125 mg PO once on day 1, then 80 mg PO once per day on days 2 & 3, '''OR''' [[Fosaprepitant (Emend for Injection)]] 150 mg IV once on day 1 | ||
− | *[[Palonosetron (Aloxi)]] 0.25 mg IV once on day 1, '''OR''' Granisetron 1mg IV or 2mg PO, | + | *[[Palonosetron (Aloxi)]] 0.25 mg IV once on day 1, '''OR''' Granisetron 1mg IV or 2mg PO, '''OR''' Ondansetron 8 mg PO or IV |
*[[Dexamethasone (Decadron)]] 12 mg PO on day 1, and 8 mg PO on days 2, 3, and 4 | *[[Dexamethasone (Decadron)]] 12 mg PO on day 1, and 8 mg PO on days 2, 3, and 4 | ||
− | + | =Carboplatin based chemotherapy= | |
− | = Carboplatin based chemotherapy = | ||
{| class="wikitable" | {| class="wikitable" | ||
− | |'''Guideline and | + | |'''Guideline and emetic risk''' |
|'''Day 1 CINV prophylaxis''' | |'''Day 1 CINV prophylaxis''' | ||
|'''Day 2-4 CINV prophylaxis''' | |'''Day 2-4 CINV prophylaxis''' | ||
|- | |- | ||
|ASCO 2017 (MEC) | |ASCO 2017 (MEC) | ||
− | + | AUC 4 or more | |
− | AUC | + | |NK1 + 5-HT3 + DEX |
− | |NK1 | ||
|NONE | |NONE | ||
− | + | (if APR on day 1, then +APR days 2-3) | |
− | (if APR on day 1, then +APR days | ||
|- | |- | ||
− | |MASCC | + | |MASCC 2019 (MEC) |
− | |||
(doesn’t specify AUC) | (doesn’t specify AUC) | ||
− | |NK1 | + | |NK1 + 5-HT3 + DEX |
|NONE | |NONE | ||
+ | (if APR on day 1, then +APR days 2-3) | ||
+ | |- | ||
+ | | rowspan="2" |NCCN 2019 | ||
+ | AUC 4 or more (HEC) | ||
− | ( | + | AUC less than 4 (MEC) |
+ | |NK1 + 5-HT3 + DEX | ||
+ | |DEX | ||
+ | |- | ||
+ | |5-HT3 + DEX | ||
+ | |- | ||
+ | |} | ||
+ | Recommendation to add NK1 is largely based on 2 phase III studies<ref name=":2">Yahata H, Kobayashi H, Sonoda K, et al: Effi- cacy of aprepitant for the prevention of chemotherapy- induced nausea and vomiting with a moderately emetogenic chemotherapy regimen: A multicenter, placebo-controlled, double-blind, randomized study in patients with gynecologic cancer receiving pac- litaxel and carboplatin. Int J Clin Oncol 21:491-497, 2016 | ||
+ | https://pubmed.ncbi.nlm.nih.gov/26662632 | ||
+ | </ref><ref>Hesketh PJ, Schnadig ID, Schwartzberg LS, et al: Efficacy of the neurokinin-1 receptor antagonist rolapitant in preventing nausea and vomiting in pa- tients receiving carboplatin-based chemotherapy. Cancer 122:2418-2425, 2016<nowiki/>https://pubmed.ncbi.nlm.nih.gov/27176138</ref>. One of them was conducted in female patients with GYN malignancy only. <ref name=":2" /> 5-HT3 used in those trials was either granisetron or ondansetron. | ||
+ | =Bone marrow transplant (BMT) conditioning regimens= | ||
+ | ''Note: Day 0 is the day of BMT, days with "-" in front are days prior to transplant, days with "+" afterwards are days after transplant'' | ||
+ | =Allogeneic BMT conditioning regimens= | ||
+ | {| class="wikitable" | ||
+ | !Conditioning regimen | ||
+ | !CINV prophylaxis | ||
|- | |- | ||
− | | | + | |FMT (fludarabine, melphalan, thiotepa) |
+ | | - NK1 on day -7 | ||
+ | - 5-HT3 on days -7 to -1 | ||
+ | |- | ||
+ | |Flu/Mel (fludarabine, melphalan) | ||
+ | | - NK1 on day -2 | ||
+ | - 5-HT3 on days -6 to -1 | ||
− | + | - DEX on days -6 to -1 | |
+ | |- | ||
+ | |Flu/Cy/TBI (fludarabine, cyclophosphamide, total body irradiation) | ||
+ | | | ||
+ | |- | ||
+ | |Cy/TBI (cyclophosphamide, total body irradiation) | ||
+ | | - NK1 on day -6 | ||
+ | - 5-HT3 on days -6 to -1 | ||
− | + | - DEX on days -6 to -4 | |
− | |||
− | |||
|- | |- | ||
− | | | + | |Bu/Flu (bufulfan, fludarabine) |
| | | | ||
+ | |- | ||
+ | |Bu/Cy (busulfan, cyclophosphamide) | ||
+ | |- | ||
|} | |} | ||
− | + | ==Autologous BMT conditioning regimens== | |
− | + | {| class="wikitable" | |
− | + | !Conditioning regimen | |
− | < | + | !CINV prophylaxis |
+ | |- | ||
+ | |High dose melphalan<ref>{{#pmid:25225424}}</ref> | ||
+ | | - NK1 on days -3 to 0 | ||
+ | - 5-HT3 on days -3 to 0 | ||
+ | - DEX on days -3 to -1 | ||
+ | |- | ||
+ | |BEAM (busulfan, etoposide, cytarabine, melphalan) | ||
+ | | | ||
+ | |- | ||
+ | |TBC (thiotepa, busulfan, cyclophosphamide) | ||
+ | |- | ||
+ | |}<br /> | ||
=Highly to moderately emetogenic PO chemotherapy= | =Highly to moderately emetogenic PO chemotherapy= | ||
− | '''These are NCCN recommendations only. | + | '''These are NCCN recommendations only. ASCO did not provide separate antiemetic recommendations for PO vs. IV chemotherapy.'''<br> |
Start before chemotherapy and continue once per day: | Start before chemotherapy and continue once per day: | ||
==Serotonin (5-HT3) antagonist== | ==Serotonin (5-HT3) antagonist== | ||
Line 1,013: | Line 1,147: | ||
**2 mg PO once per day | **2 mg PO once per day | ||
**1 mg PO twice per day | **1 mg PO twice per day | ||
− | *[[Ondansetron (Zofran)]] 16 to 24 mg PO once per day | + | *[[Ondansetron (Zofran)]] 16 to 24 mg PO once per day |
− | |||
==Optional== | ==Optional== | ||
− | *[[Lorazepam (Ativan)]] 0.5 to 2 mg PO/IV/sublingual Q4-6H prn nausea on days 1 to 4 | + | *[[Lorazepam (Ativan)]] 0.5 to 2 mg PO/IV/sublingual Q4-6H prn nausea on days 1 to 4 |
*[[:Category:H2-receptor antagonists|H2 blocker]] or [[:Category:Proton pump inhibitors|proton pump inhibitor]] | *[[:Category:H2-receptor antagonists|H2 blocker]] or [[:Category:Proton pump inhibitors|proton pump inhibitor]] | ||
− | |||
=Low emetic risk IV chemotherapy= | =Low emetic risk IV chemotherapy= | ||
{| class="wikitable" | {| class="wikitable" | ||
Line 1,026: | Line 1,158: | ||
|- | |- | ||
|ASCO 2017 | |ASCO 2017 | ||
− | |Single | + | |Single dose 5-HT3 or DEX 8mg |
|No routine prophylaxis | |No routine prophylaxis | ||
|- | |- | ||
|MASCC 2016 | |MASCC 2016 | ||
− | |5-HT3 | + | |5-HT3 or DEX or Dopamine RA |
|No routine prophylaxis | |No routine prophylaxis | ||
|- | |- | ||
− | |NCCN | + | |NCCN 2022 |
− | | | + | |DEX or Metoclopramide or Prochlorperazine or |
− | + | 5-HT3 other than Palonosetron | |
− | 5-HT3 | ||
|No routine prophylaxis | |No routine prophylaxis | ||
|} | |} | ||
− | '''Repeat once per day for chemotherapy regimens that last more than one day.''' | + | '''Repeat once per day for chemotherapy regimens that last more than one day.''' |
− | *[[Dexamethasone (Decadron)]] | + | *[[Dexamethasone (Decadron)]] |
**NCCN: 12 mg IV or PO on the days of chemotherapy | **NCCN: 12 mg IV or PO on the days of chemotherapy | ||
**ASCO: 8 mg IV or PO on the days of chemotherapy | **ASCO: 8 mg IV or PO on the days of chemotherapy | ||
*[[Metoclopramide (Reglan)]] 10-40 mg IV or PO x1, then Q4-6H prn nausea | *[[Metoclopramide (Reglan)]] 10-40 mg IV or PO x1, then Q4-6H prn nausea | ||
− | *[[Prochlorperazine (Compazine)]] | + | *[[Prochlorperazine (Compazine)]] 10 mg IV or PO x1, then Q4-6H prn nausea |
− | |||
=Minimal emetic risk chemotherapy= | =Minimal emetic risk chemotherapy= | ||
− | *No routine prophylaxis recommended by all 3 guideline groups. Assess patient prior to cycle 2 and add | + | *No routine prophylaxis recommended by all 3 guideline groups. Assess patient prior to cycle 2 and add single agent prophylactic antiemetic if patient had emesis with cycle 1. |
− | |||
=Low to minimal emetic risk PO chemotherapy= | =Low to minimal emetic risk PO chemotherapy= | ||
*use antiemetics prn first | *use antiemetics prn first | ||
− | |||
==If nausea/vomiting== | ==If nausea/vomiting== | ||
Choose one of the medications below to start before chemotherapy and continue once per day: | Choose one of the medications below to start before chemotherapy and continue once per day: | ||
*[[Metoclopramide (Reglan)]] 10-40 mg IV or PO x1, then Q4-6H prn nausea | *[[Metoclopramide (Reglan)]] 10-40 mg IV or PO x1, then Q4-6H prn nausea | ||
− | *[[Prochlorperazine (Compazine)]] | + | *[[Prochlorperazine (Compazine)]] 10 mg IV or PO x1, then Q4-6H prn nausea |
− | *[[Haloperidol (Haldol)]] 0.5 to 2 mg IV or PO Q4-6H prn nausea (monitor for dystonic reactions) | + | *[[Haloperidol (Haldol)]] 0.5 to 2 mg IV or PO Q4-6H prn nausea (monitor for dystonic reactions) |
− | |||
==Optional== | ==Optional== | ||
− | *[[Lorazepam (Ativan)]] 0.5 to 2 mg PO/IV/sublingual Q4-6H prn nausea days 1-4 | + | *[[Lorazepam (Ativan)]] 0.5 to 2 mg PO/IV/sublingual Q4-6H prn nausea days 1-4 |
*[[:Category:H2-receptor antagonists|H2 blocker]] or [[:Category:Proton pump inhibitors|proton pump inhibitor]] | *[[:Category:H2-receptor antagonists|H2 blocker]] or [[:Category:Proton pump inhibitors|proton pump inhibitor]] | ||
− | |||
==If continued nausea/vomiting== | ==If continued nausea/vomiting== | ||
Use serotonin (5-HT3) antagonist: | Use serotonin (5-HT3) antagonist: | ||
Line 1,067: | Line 1,193: | ||
**2 mg PO once per day | **2 mg PO once per day | ||
**1 mg PO twice per day | **1 mg PO twice per day | ||
− | *[[Ondansetron (Zofran)]] 16 to 24 mg PO once per day | + | *[[Ondansetron (Zofran)]] 16 to 24 mg PO once per day |
− | |||
=Breakthrough CINV treatment= | =Breakthrough CINV treatment= | ||
General Principles | General Principles | ||
Line 1,077: | Line 1,202: | ||
-5-HT3 and NK1 RA are generally not effective or approved for treatment of breakthrough nausea/vomiting (assuming they were used as part of prophylaxis) | -5-HT3 and NK1 RA are generally not effective or approved for treatment of breakthrough nausea/vomiting (assuming they were used as part of prophylaxis) | ||
− | ==Olanzapine == | + | ==Olanzapine== |
− | * [[Olanzapine (Zyprexa)]] 10 mg PO daily on days 1-3 if CINV develop in the first 24 hours after HEC <ref name=":0">R. M. Navari, C. K. Nagy, and S. E. Gray, “The use of olanzapine versus metoclopramide for the treatment of breakthrough chemotherapy-induced nausea and vomiting in patients receiving highly emetogenic chemotherapy, | + | *[[Olanzapine (Zyprexa)]] 10 mg PO daily on days 1-3 if CINV develop in the first 24 hours after HEC <ref name=":0">R. M. Navari, C. K. Nagy, and S. E. Gray, “The use of olanzapine versus metoclopramide for the treatment of breakthrough chemotherapy-induced nausea and vomiting in patients receiving highly emetogenic chemotherapy,” Supportive Care in Cancer, vol. 21, no. 6, pp. 1655–1663, 2013</ref>. Use 5 mg if 10 mg is not well tolerated.<ref>S. Chanthawong, S. Subongkot, and A. Sookprasert, “Effectiveness of olanzapine for the treatment of breakthrough chemotherapy induced nausea and vomiting,” Journal of the Medical Association of Thailand, vol. 97, pp. 349–355, 2014</ref> |
− | |||
==Metoclopromide== | ==Metoclopromide== | ||
− | * [[Metoclopramide (Reglan)]] 10 mg PO (IV) every 8 hours | + | *[[Metoclopramide (Reglan)]] 10 mg PO (IV) every 8 hours on days 1-3 if CINV develop in the first 24 hours after HEC <ref name=":0" />. |
− | |||
==Benzodiazepine== | ==Benzodiazepine== | ||
*[[Lorazepam (Ativan)]] 0.5 to 2 mg PO (IV) Q4-6H prn nausea | *[[Lorazepam (Ativan)]] 0.5 to 2 mg PO (IV) Q4-6H prn nausea | ||
− | |||
==Cannabinoid== | ==Cannabinoid== | ||
*[[Dronabinol (Marinol)]] 5-10 mg PO Q3-6H prn nausea | *[[Dronabinol (Marinol)]] 5-10 mg PO Q3-6H prn nausea | ||
*[[Nabilone (Cesamet)]] 1-2 mg PO twice per day prn nausea | *[[Nabilone (Cesamet)]] 1-2 mg PO twice per day prn nausea | ||
− | + | ==Other agents== | |
− | ==Other agents == | + | *[[Haloperidol (Haldol)]] 0.5 to 2 mg IV or PO Q4-6H prn nausea (monitor for dystonic reactions) |
− | *[[Haloperidol (Haldol)]] 0.5 to 2 mg IV or PO Q4-6H prn nausea (monitor for dystonic reactions) | ||
*[[Scopolamine (Scopoderm)]] 1 patch Q72H prn nausea | *[[Scopolamine (Scopoderm)]] 1 patch Q72H prn nausea | ||
*[[Prochlorperazine (Compazine)]] (choose one of the options below): | *[[Prochlorperazine (Compazine)]] (choose one of the options below): | ||
− | **25 mg suppository PR every 12 hours prn nausea | + | **25 mg suppository PR every 12 hours prn nausea |
− | ** | + | **10 mg IV or PO Q4-6H prn nausea |
*[[Promethazine (Phenergan)]] 12.5-25 mg IV or PO every 6 hours for 1-3 days | *[[Promethazine (Phenergan)]] 12.5-25 mg IV or PO every 6 hours for 1-3 days | ||
*[[Dexamethasone (Decadron)]] 8 mg PO (IV) every 6-8 hours | *[[Dexamethasone (Decadron)]] 8 mg PO (IV) every 6-8 hours | ||
− | |||
==Serotonin 5-HT3 antagonists== | ==Serotonin 5-HT3 antagonists== | ||
Are generally ineffective for breakthrough CINV (assuming they were used as part of prophylactic regimen). | Are generally ineffective for breakthrough CINV (assuming they were used as part of prophylactic regimen). | ||
*[[Ondansetron (Zofran)]] 8 to 16 mg PO once per day prn nausea | *[[Ondansetron (Zofran)]] 8 to 16 mg PO once per day prn nausea | ||
− | |||
=Anticipatory nausea/vomiting= | =Anticipatory nausea/vomiting= | ||
*Prevent anticipation by optimizing antiemetic therapy for every cycle of chemotherapy | *Prevent anticipation by optimizing antiemetic therapy for every cycle of chemotherapy | ||
Line 1,112: | Line 1,231: | ||
*Acupuncture/acupressure | *Acupuncture/acupressure | ||
*[[Alprazolam (Xanax)]] 0.5 to 2 mg PO three times per day starting the night before treatment | *[[Alprazolam (Xanax)]] 0.5 to 2 mg PO three times per day starting the night before treatment | ||
− | *[[Lorazepam (Ativan)]] 0.5 to | + | *[[Lorazepam (Ativan)]] 0.5 to 1 mg PO beginning the night before treatment and then repeat the next 1-2 hours before anticancer therapy begins |
− | |||
=Reference= | =Reference= | ||
<references /> | <references /> | ||
− | + | [[Category:Supportive oncology]] | |
[[Category:General reference pages]] | [[Category:General reference pages]] | ||
− | [[Category: | + | [[Category:Emesis prevention]] |
Latest revision as of 12:19, 23 June 2024
Adapted from the NCCN[1], ASCO[2] and MASCC/ESMO[3]
Guidelines
Given the rapid change in evidence in many areas of hematology/oncology, readers are encouraged to consider any guideline published 5+ years ago to be for historical purposes, only.
ASCO
- 2020: Hesketh et al. Antiemetics: ASCO Guideline Update PubMed
- 2017: Hesketh et al. Antiemetics: American Society of Clinical Oncology Clinical Practice Guideline Update PubMed
- 2015: Hesketh et al. Antiemetics: American Society of Clinical Oncology Focused Guideline Update PubMed
- 2011: Basch et al. Antiemetics: American Society of Clinical Oncology clinical practice guideline update PubMed
- 2006: Kris et al. American Society of Clinical Oncology guideline for antiemetics in oncology: update 2006 PubMed
ESMO
- 2009: Herrstedt & Roila. Chemotherapy-induced nausea and vomiting: ESMO clinical recommendations for prophylaxis PubMed
- 2008: Herrstedt & Roila. Chemotherapy-induced nausea and vomiting: ESMO clinical recommendations for prophylaxis PubMed
- 2007: Herrstedt. Chemotherapy-induced nausea and vomiting: ESMO clinical recommendations for prophylaxis PubMed
- 2005: Herrstedt et al. ESMO Minimum Clinical Recommendations for prophylaxis of chemotherapy-induced nausea and vomiting (NV) PubMed
- 2001: ESMO Recommendations for prophylaxis of chemotherapy-induced nausea and vomiting (NV) PubMed
MASCC/ESMO
- 2016: Herrstedt et al. 2016 Updated MASCC/ESMO Consensus Recommendations: Prevention of Nausea and Vomiting Following High Emetic Risk Chemotherapy PubMed
- 2016: Einhorn et al. 2016 updated MASCC/ESMO consensus recommendations: prevention of nausea and vomiting following multiple-day chemotherapy, high-dose chemotherapy, and breakthrough nausea and vomiting PubMed
- 2016: Roila et al. 2016 updated MASCC/ESMO consensus recommendations: Prevention of nausea and vomiting following moderately emetogenic chemotherapy PubMed
- 2016: Olver et al. 2016 Updated MASCC/ESMO Consensus Recommendations: Controlling nausea and vomiting with chemotherapy of low or minimal emetic potential PubMed
- 2016: Dupuis et al. 2016 updated MASCC/ESMO consensus recommendations: Prevention of acute chemotherapy-induced nausea and vomiting in children PubMed
NCCN
- NCCN Guidelines - Antiemesis
- 2012: Ettinger et al. Antiemesis. PubMed
- 2009: Ettinger et al. Antiemesis. Clinical Practice Guidelines in Oncology. PubMed
- 2007: Ettinger et al. Antiemesis. PubMed
- 2004: Ettinger et al. Antiemesis clinical practice guidelines in oncology. PubMed
Emetic risk of chemotherapy, immunotherapy, TKIs and other agents
Hint: You can sort the table by clicking on the boxes containing arrows at the top of each column.
All drugs are IV route unless otherwise specified.
NCCN, ASCO and MASCC categories of emetic risk in the absence of prophylaxis:
- High: >90% frequency of emesis (HEC)
- Moderate: 30-90% frequency of emesis (MEC)
- Low: 10-30% frequency of emesis
- Minimal: less than 10% frequency of emesis
ASCO guidelines say that in cases of combination chemotherapy regimens, patients should be given antiemetics that are recommended for the individual medication with the highest emetic risk. The exception is with anthracycline and Cyclophosphamide (Cytoxan) combinations as described below.
Drug | NCCN emetogenic potential (2021) | ASCO emetogenic potential
(2020) |
MASCC/ESMO emetogenic potential (2019) | Comment |
---|---|---|---|---|
Trastuzumab emtansine (Kadcyla) | Low | Low | Low | |
Anthracycline (see differences between NCCN & ASCO) & Cyclophosphamide (Cytoxan) combination chemotherapy | High (Doxorubicin (Adriamycin) or Epirubicin (Ellence) with Cyclophosphamide (Cytoxan)) | High (Daunorubicin (Cerubidine), Doxorubicin (Adriamycin), Epirubicin (Ellence), or Idarubicin (Idamycin) with Cyclophosphamide (Cytoxan)) | High | MASCC comment - in patients with breast cancer |
Aldesleukin (Proleukin) | Moderate: >12 to 15 million international units/m2 Low: ≤12 million international units/m2 |
|||
Alemtuzumab (Campath) | Minimal | Moderate | Moderate | |
Altretamine (Hexalen) or Hexamethylmelamine (oral) | Moderate/High | Moderate/High | NCCN and ASCO did not further delineate between degrees of emetic potential | |
Amifostine (Ethyol) | Moderate: >300 mg/m2 Low: ≤300 mg/m2 |
|||
Arsenic trioxide (Trisenox) | Low | Moderate | ||
Asparaginase (Elspar) | Minimal | |||
Atezolizumab (Tecentriq) | Minimal | Minimal | ||
Axitinib (Inlyta) (oral) | Minimal/Low | Minimal/Low | Low | |
Azacitidine (Vidaza) | Moderate | Moderate | Moderate | |
Bendamustine | Moderate | Moderate | Moderate | |
Belinostat (Beleodaq) | Low | |||
Bevacizumab (Avastin) | Minimal | Minimal | Minimal | |
Bexarotene (Targretin) (oral) | Low/Minimal | NCCN did not further delineate between degrees of emetic potential | ||
Bleomycin (Blenoxane) | Minimal | Minimal | Minimal | |
Blinatumomab (Blincyto) | Low | Low | ||
Bortezomib (Velcade) | Minimal | Low | Low | |
Bosutinib (Bosulif) (oral) | Low/Minimal | Moderate | Moderate | |
Brentuximab vedotin (Adcetris) | Low | Low | ||
Busulfan (Myleran) | High/Moderate: at least 4 mg/day Low/Minimal: less than 4 mg/day |
Minimal | Minimal | |
Busulfan (Myleran) (oral) | High/Moderate: at least 4 mg/day Low/Minimal: less than 4 mg/day |
NCCN did not further delineate between degrees of emetic potential | ||
Cabazitaxel (Jevtana) | Low | Low | Low | |
Cabozantinib (Cometriq) (oral) | Low/Minimal | Moderate | ||
Capecitabine (Xeloda) (oral) | Low/Minimal | Low | NCCN did not further delineate between degrees of emetic potential | |
Carboplatin (Paraplatin) | High: AUC 4 or more
Moderate: AUC less than 4 |
Moderate (but recommended triplet combination of NK1, 5-HT3, and Dex if AUC 4 or more) | Moderate (but recommended triplet combination of NK1, 5-HT3, and dexamethasone) | MASCC/ESMO did not subclassify based on dose |
Carfilzomib (Kyprolis) | Low | Low | ||
Carmustine (BCNU) | High: >250 mg/m2 Moderate: ≤250 mg/m2 |
High | High | ASCO and MASCC/ESMO did not subclassify based on dose |
Catumaxomab (Removab) | Low | Low | ||
Cetuximab (Erbitux) | Minimal | Minimal | Low | |
Ceritinib (Zykadia) | Moderate | |||
Chlorambucil (Leukeran) (oral) | Low/Minimal | Minimal | NCCN did not further delineate between degrees of emetic potential | |
Cisplatin (Platinol) | High | High | High | Some only consider emetogenic potential high when dose 70 mg/m2 or more |
Cladribine (Leustatin) | Minimal | Minimal | Minimal | |
Clofarabine (Clolar) | Moderate | Moderate | Moderate | |
Crizotinib (Xalkori) (oral) | High/Moderate | Moderate | Moderate | |
Cyclophosphamide (Cytoxan) | High: greater than 1500 mg/m2 or when given with certain anthracyclines Moderate: up to and including 1500 mg/m2 |
High: 1500 mg/m2 or more, or when given with anthracyclines Moderate: less than 1500 mg/m2 |
High: > 1500 mg/m2 or when combined with anthracyclines (in breast cancer patients)
Moderate: < 1500 mg/m2 |
|
Cyclophosphamide (Cytoxan) (oral) | High/Moderate: 100 mg/m2/day or more Low/Minimal: less than 100 mg/m2/day |
Moderate | Moderate | NCCN did not further delineate between degrees of emetic potential |
Cytarabine (Ara-C) | Moderate: >200 mg/m2 Low: 100 to 200 mg/m2 Minimal: less than 100 mg/m2 |
Moderate: >1000 mg/m2 Low: ≤1000 mg/m2 |
Moderate: > 1000 mg/m2
Low: < 1000 mg/m2 |
|
Dabrafenib (Tafinlar) (oral) | Low/Minimal | Low | ||
Dacarbazine (DTIC) | High | High | High | |
Daratumumab (Darzalex) | Minimal | |||
Dactinomycin (Cosmegen) | Moderate | High | ||
Dasatinib (Sprycel) (oral) | Low/Minimal | Low | NCCN did not further delineate between degrees of emetic potential | |
Daunorubicin (Cerubidine) | Moderate | High when given with Cyclophosphamide (Cytoxan) Moderate when used alone |
High: when given with combined with cyclophosphamide (in breast cancer patients)
Moderate: when used alone |
|
Decitabine (Dacogen) | Minimal | |||
Denileukin diftitox (Ontak) | Minimal | |||
Dexrazoxane (Zinecard) | Minimal | |||
Docetaxel (Taxotere) | Low | Low | Low | |
Doxorubicin (Adriamycin) | High: 60 mg/m2 or more, or when given at any dose with Cyclophosphamide (Cytoxan) Moderate: less than 60 mg/m2 |
High when given with Cyclophosphamide (Cytoxan) Moderate when used alone |
High: when given with combined with cyclophosphamide (in breast cancer patients)
Moderate: when used alone |
|
Pegylated liposomal doxorubicin (Doxil) | Low | Low | Low | |
Epirubicin (Ellence) | High: >90 mg/m2 or when given at any dose with Cyclophosphamide (Cytoxan) Moderate: ≤90 mg/m2 |
High when given with Cyclophosphamide (Cytoxan) Moderate when used alone |
High: when combined with cyclophosphamide (in breast cancer patients)
Moderate: when used alone |
|
Eribulin (Halaven) | Low | Low | ||
Erlotinib (Tarceva) (oral) | Low/Minimal | Minimal | NCCN did not further delineate between degrees of emetic potential | |
Estramustine (Emcyt) (oral) | High/Moderate | NCCN did not further delineate between degrees of emetic potential | ||
Etoposide (Vepesid) | Low | Low | Low | |
Etoposide (Vepesid) (oral) | High/Moderate | Low | NCCN did not further delineate between degrees of emetic potential | |
Everolimus (Afinitor) (oral) | Low/Minimal | Low | NCCN did not further delineate between degrees of emetic potential | |
Floxuridine (FUDR) | Low | |||
Fludarabine (Fludara) | Minimal | Minimal | Minimal | |
Fludarabine (Fludara) (oral) | Low/Minimal | Low | NCCN did not further delineate between degrees of emetic potential | |
Fluorouracil (5-FU) | Low | Low | Low | |
Gefitinib (Iressa) (oral) | Low/Minimal | Minimal | NCCN did not further delineate between degrees of emetic potential | |
Gemcitabine (Gemzar) | Low | Low | Low | |
Hydroxyurea (Hydrea) (oral) | Low/Minimal | Minimal | NCCN did not further delineate between degrees of emetic potential | |
Idarubicin (Idamycin) | Moderate | High when given with Cyclophosphamide (Cytoxan) Moderate when used alone |
High: when combined with cyclophosphamide (in breast cancer patients) Moderate: when used alone | |
Ifosfamide (Ifex) | High: 2000 mg/m2 or more per dose Moderate: <2 g/m2 per dose |
Moderate | Moderate | ASCO and MASCC did not subclassify based on dose |
Imatinib (Gleevec) (oral) | Low/Minimal | Moderate | Moderate | NCCN did not further delineate between degrees of emetic potential |
Interferon alfa-2a (Roferon-A) | Moderate: 10 million international units/m2 or more Low: between 5 and 10 million international units/m2 Minimal: 5 million international units/m2 or less |
NCCN did not specify interferon alfa-2a vs. 2b | ||
Interferon alfa-2b (Intron-A) | Moderate: 10 million international units/m2 or more Low: between 5 and 10 million international units/m2 Minimal: 5 million international units/m2 or less |
NCCN did not specify interferon alfa-2a vs. 2b | ||
Ipilimumab (Yervoy) | Minimal | Low | ||
Irinotecan (Camptosar) | Moderate | Moderate | Moderate | |
Ixabepilone (Ixempra) | Low | Low | Low | |
Lapatinib (Tykerb) (oral) | Low/Minimal | Low | NCCN did not further delineate between degrees of emetic potential | |
Lenalidomide (Revlimid) (oral) | Low/Minimal | Low | NCCN did not further delineate between degrees of emetic potential | |
Lenvatinib (Lenvima) (oral) | Moderate | |||
Lomustine (CCNU) (oral) | High/Moderate (single day) | single day; NCCN did not further delineate between degrees of emetic potential | ||
Lurbinectedin (Zepzelca) | Moderate | |||
Margetuximab (Margenza) | Minimal | |||
Mechlorethamine (Mustargen) | High | High | High | |
Melphalan (Alkeran) | Moderate | ASCO and MASCC recommend combination of NK1+5-HT3+DEX when melphalan is used at high dose for BMT conditioning. | ||
Melphalan (Alkeran) (oral) | Low/Minimal | Minimal | NCCN did not further delineate between degrees of emetic potential | |
Mercaptopurine (6-MP) (oral) | Low/Minimal | NCCN did not further delineate between degrees of emetic potential | ||
Methotrexate (MTX) | Moderate: 250 mg/m2 or more Low: between 50 and 250 mg/m2 Minimal: 50 mg/m2 or less |
Low | Low | ASCO and MASCC did not subclassify based on dose |
Methotrexate (MTX) (oral) | Low/Minimal | Minimal | NCCN did not further delineate between degrees of emetic potential | |
Mitomycin (Mutamycin) | Low | Low | Low | |
Mitotane (Lysodren) (oral) | High/Moderate | |||
Mitoxantrone (Novantrone) | Low | Low | Low | |
Nelarabine (Arranon) | Minimal | |||
Nilotinib (Tasigna) (oral) | Low/Minimal | Low | NCCN did not further delineate between degrees of emetic potential | |
Niraparib (Zejula) (oral) | Moderate to high | NCCN did not further delineate between degrees of emetic potential (>30%) | ||
Ofatumumab (Arzzera) | Minimal | Minimal | ||
Omacetaxine (Synribo) | Low | |||
Olaparib (Lynparza) (oral) | Moderate to high | NCCN did not further delineate between degrees of emetic potential (>30%) | ||
Oxaliplatin (Eloxatin) | Moderate | Moderate | Moderate | |
Paclitaxel (Taxol) | Low | Low | Low | |
Paclitaxel, nanoparticle albumin-bound (Abraxane) | Low | Low | ||
Panitumumab (Vectibix) | Minimal | Low | ||
Pazopanib (Votrient) (oral) | Low/Minimal | Low | NCCN did not further delineate between degrees of emetic potential | |
Peg-asparginase (Oncaspar) | Minimal | |||
Peginterferon alfa-2a (Pegasys) | Minimal | NCCN did not specify interferon alfa-2a vs. 2b | ||
Peginterferon alfa-2b (Sylatron) | Minimal | NCCN did not specify interferon alfa-2a vs. 2b | ||
Pembrolizumab (Keytruda) | Minimal | |||
Pemetrexed (Alimta) | Low | Low | Low | |
Pentostatin (Nipent) | Low | |||
Pertuzumab (Perjeta) | Minimal | Low | ||
Pixantrone (Pixuvri) | Minimal | |||
Pomalidomide (Pomalyst) (oral) | Low/Minimal | Minimal | ||
Ponatinib (Iclusig) (oral) | Low/Minimal | Low | ||
Pralatrexate (Folotyn) | Low | Minimal | Minimal | |
Procarbazine (Matulane) (oral) | High/Moderate | High | High | NCCN did not further delineate between degrees of emetic potential |
Regorafenib (Stivarga) (oral) | Low/Minimal | Low | ||
Rituximab (Rituxan) | Minimal | Minimal | Minimal | |
Romidepsin (Istodax) | Low | Moderate | ||
Rucaparib (Rubraca) | Moderate to high | NCCN did not further delineate between degrees of emetic potential (>30%) | ||
Ruxolitinib (Jakafi) (oral) | Low/Minimal | Minimal | ||
Selinexor (Xpovio) (oral) | Moderate/High | Moderate/High | NCCN and ASCO did not further delineate between degrees of emetic potential | |
Sorafenib (Nexavar) (oral) | Low/Minimal | Minimal | NCCN did not further delineate between degrees of emetic potential | |
Streptozocin (Zanosar) | High | High | High | |
Sunitinib (Sutent) (oral) | Low/Minimal | Low | NCCN did not further delineate between degrees of emetic potential | |
Temozolmide (Temodar) | Moderate | Moderate | MASCC remark: No direct evidence found for temozolomide IV. Classification is based on oral temozolomide, since all sources indicate a
similar safety profile | |
Temozolmide (Temodar) (oral) | High/Moderate: >75 mg/m2/day Low/Minimal: ≤75 mg/m2/day |
Moderate | Moderate | NCCN did not further delineate between degrees of emetic potential |
Temsirolimus (Torisel) | Minimal | Low | ||
Thalidomide (Thalomid) (oral) | Low/Minimal | Low | NCCN did not further delineate between degrees of emetic potential | |
Thioguanine (Tabloid) (oral) | Low/Minimal | Minimal | NCCN did not further delineate between degrees of emetic potential | |
Thiotepa (Thioplex) | Low | Moderate | ||
Topotecan (Hycamtin) | Low | Low | Low | |
Topotecan (Hycamtin) (oral) | Low/Minimal | NCCN did not further delineate between degrees of emetic potential | ||
Trabectedin (Yondelis) | Moderate | |||
Trametinib (Mekinist) (oral) | Low/Minimal | |||
Trastuzumab (Herceptin) | Minimal | Low | Minimal | |
Trastuzumab deruxtecan (Enhertu) | High | Moderate | ||
All-trans retinoic acid (ATRA) (oral) | Low/Minimal | NCCN did not further delineate between degrees of emetic potential | ||
Umbralisib (Ukoniq) (oral) | Low/Minimal | |||
Valrubicin (Valstar) | Minimal | |||
Vandetanib (Caprelsa) (oral) | Low/Minimal | Low | NCCN did not further delineate between degrees of emetic potential | |
Vemurafenib (Zelboraf) (oral) | Low/Minimal | |||
Vinblastine (Velban) | Minimal | Minimal | Minimal | |
Vincristine (Oncovin) | Minimal | Minimal | Minimal | |
Vincristine liposomal (Marqibo) | Minimal | |||
Vinflunine (Javlor) | Low | |||
Vinorelbine (Navelbine) | Minimal | Minimal | Minimal | |
Vinorelbine (Navelbine) (oral) | Moderate | |||
Vismodegib (Erivedge) (oral) | High/Moderate | Minimal | ||
Vorinostat (Zolinza) (oral) | Low/Minimal | Low | NCCN did not further delineate between degrees of emetic potential | |
Ziv-aflibercept (Zaltrap) | Low | Low |
Highly emetogenic IV chemotherapy (HEC)
Day 1 CINV prophylaxis | Day 2-4 CINV prophylaxis | |
ASCO 2017 | NK1 + 5-HT3 + DEX + OLN | DEX + OLN
(if APR on day 1, then + APR days 2-3) |
MASCC 2019 | NK1 + 5-HT3 + DEX +/- OLN | DEX +/- OLN
(if APR on day 1, then + APR days 2-3) |
NCCN 2022 | - NK1 + 5-HT3 + DEX + OLN | DEX + OLN
(if po APR on day 1, then + APR days 2-3) |
- NK1 + 5-HT3 + DEX | DEX
(if po APR on day 1, then + APR days 2-3) | |
- OLN + Palonosetron + DEX | OLN |
Neurokinin-1 (NK1) antagonist-containing regimen (except netupitant)
Neurokinin 1 (NK1) antagonist
- Aprepitant (Emend) 125 mg PO once on day 1, then 80 mg PO once per day on days 2 & 3
- Aprepitant injectable emulsion (Cinvanti) 130 mg IV once on day 1
- Fosaprepitant (Emend for Injection) 150 mg IV once on day 1
- Rolapitant (Varubi) 180 mg PO once on day 1
Note: All of the above NK1 antagonists are equally effective in IV and PO formulations at recommended doses [4]
Serotonin (5-HT3) antagonist
- Dolasetron (Anzemet) 100 mg PO once on day 1
- Granisetron (choose one of the options below):
- 2 mg PO once on day 1
- 0.01 mg/kg (maximum dose 1 mg) IV once on day 1
- transdermal patch as 3.1 mg/24H patch (containing 34.3 mg granisetron total dose) placed ~24 to 48 hours before the first dose of chemotherapy. May use patch up to 7 days.
- Ondansetron (Zofran) (choose one of the options below):
- 8 to 16 mg IV[5] once on day 1
- Palonosetron (Aloxi) 0.25 mg IV once on day 1
- Tropisetron (Navoban) 5 mg IV or PO day 1
Note: When given at biologically equivalent doses, all of the above 5-HT3 antagonists are equally efficacious and appear to be interchangeable[6]
Note: Ramosetron is another available 5-HT3, but not approved by FDA
Dexamethasone (DEX)
Steroids contraindicated for use with interleukin-2 and interferon.
- If Aprepitant (Emend) used:
- Dexamethasone (Decadron) 12 mg IV or PO once on day 1, then 8 mg PO once per day on days 2 to 4
- If Fosaprepitant (Emend for Injection) used:
- Dexamethasone (Decadron) 12 mg IV or PO once on day 1, then 8 mg PO once per day on days 2 to 4
- If Rolapitant (Varubi) used:
- Dexamethasone (Decadron) 12 mg IV or PO once on day 1, then 8 mg PO twice per day on days 2 to 4
Dexamethasone use beyond day 1 might be revised based on the 2018 meta analysis results[7]
Netupitant-containing regimen
- Netupitant and palonosetron (Akynzeo) 300/0.5 mg PO once on day 1 as a fixed oral formulation
- Dexamethasone (Decadron) 12 mg PO or IV once on day 1, then 8 mg PO or IV once per day on days 2 to 4
Olanzapine (OLN) containing regimen
- Olanzapine (Zyprexa) 10 mg PO once per day on days 1 to 4
- Aprepitant (Emend) 125 mg PO once on day 1, then 80 mg PO once per day on days 2 & 3, OR Fosaprepitant (Emend for Injection) 150 mg IV once on day 1
- Palonosetron (Aloxi) 0.25 mg IV once on day 1, OR Granisetron 1mg IV or 2mg PO, OR Ondansetron 8 mg PO or IV
- Dexamethasone (Decadron) 12 mg PO on day 1, and 8 mg PO on days 2, 3, and 4
Reference:
Moderately emetogenic IV chemotherapy (MEC)
Day 1 CINV prophylaxis | Day 2-4 CINV prophylaxis | |
ASCO 2017 | 5-HT3 + DEX | DEX maybe offered for: oxaliplatin, or anthracycline, or cyclophosphamide |
MASCC 2016 | 5-HT3 + DEX | DEX can be considered for: oxaliplatin, or anthracycline, or cyclophosphamide |
NCCN 2022 | - 5-HT3 + DEX | DEX or 5-HT3 |
- NK1 + 5-HT3 + DEX
(for selected patients with additional risk factors or previous Rx failure) |
Aprepitant PO daily days 2 and 3 if aprepitant POused on day 1
+/- DEX | |
- OLN + Palonosetron + DEX | OLN |
Serotonin (5-HT3) antagonist
- Dolasetron (Anzemet) 100 mg PO once on day 1
- Granisetron (choose one of the options below):
- 2 mg PO once on day 1
- 0.01 mg/kg (maximum dose 1 mg) IV once on day 1
- transdermal patch as 3.1 mg/24H patch (containing 34.3 mg granisetron total dose) placed ~24 to 48 hours before the first dose of chemotherapy. May use patch up to 7 days.
- Ondansetron (Zofran) (choose one of the options below):
- 8 to 16 mg IV[5] once on day 1
- Palonosetron (Aloxi) 0.25 mg IV once on day 1
- Tropisetron (Navoban) 5 mg IV or PO day 1
Dexamethasone (DEX)
Steroids contraindicated for use with interleukin-2 and interferon.
- If Aprepitant (Emend) used:
- Dexamethasone (Decadron) 12 mg IV or PO once on day 1, then 8 mg PO once per day on days 2 to 4
- If Fosaprepitant (Emend for Injection) used:
- Dexamethasone (Decadron) 12 mg IV or PO once on day 1, then 8 mg PO once per day on days 2 to 4
- If Rolapitant (Varubi) used:
- Dexamethasone (Decadron) 12 mg IV or PO once on day 1, then 8 mg PO twice per day on days 2 to 4
Dexamethasone use beyond day 1 might be revised based on the 2018 meta analysis results[7]
Netupitant-containing regimen
- Netupitant and palonosetron (Akynzeo) 300/0.5 mg PO once on day 1 as a fixed oral formulation
- Dexamethasone (Decadron) 12 mg PO or IV once on day 1, then 8 mg PO or IV once per day on days 2 to 4
Olanzapine (OLN) containing regimen
Note: a 4-drug regimen based on Navari et al. 2016[9]
- Olanzapine (Zyprexa) 10 mg PO once per day on days 1 to 4
- Aprepitant (Emend) 125 mg PO once on day 1, then 80 mg PO once per day on days 2 & 3, OR Fosaprepitant (Emend for Injection) 150 mg IV once on day 1
- Palonosetron (Aloxi) 0.25 mg IV once on day 1, OR Granisetron 1mg IV or 2mg PO, OR Ondansetron 8 mg PO or IV
- Dexamethasone (Decadron) 12 mg PO on day 1, and 8 mg PO on days 2, 3, and 4
Carboplatin based chemotherapy
Guideline and emetic risk | Day 1 CINV prophylaxis | Day 2-4 CINV prophylaxis |
ASCO 2017 (MEC)
AUC 4 or more |
NK1 + 5-HT3 + DEX | NONE
(if APR on day 1, then +APR days 2-3) |
MASCC 2019 (MEC)
(doesn’t specify AUC) |
NK1 + 5-HT3 + DEX | NONE
(if APR on day 1, then +APR days 2-3) |
NCCN 2019
AUC 4 or more (HEC) AUC less than 4 (MEC) |
NK1 + 5-HT3 + DEX | DEX |
5-HT3 + DEX |
Recommendation to add NK1 is largely based on 2 phase III studies[10][11]. One of them was conducted in female patients with GYN malignancy only. [10] 5-HT3 used in those trials was either granisetron or ondansetron.
Bone marrow transplant (BMT) conditioning regimens
Note: Day 0 is the day of BMT, days with "-" in front are days prior to transplant, days with "+" afterwards are days after transplant
Allogeneic BMT conditioning regimens
Conditioning regimen | CINV prophylaxis |
---|---|
FMT (fludarabine, melphalan, thiotepa) | - NK1 on day -7
- 5-HT3 on days -7 to -1 |
Flu/Mel (fludarabine, melphalan) | - NK1 on day -2
- 5-HT3 on days -6 to -1 - DEX on days -6 to -1 |
Flu/Cy/TBI (fludarabine, cyclophosphamide, total body irradiation) | |
Cy/TBI (cyclophosphamide, total body irradiation) | - NK1 on day -6
- 5-HT3 on days -6 to -1 - DEX on days -6 to -4 |
Bu/Flu (bufulfan, fludarabine) | |
Bu/Cy (busulfan, cyclophosphamide) |
Autologous BMT conditioning regimens
Conditioning regimen | CINV prophylaxis |
---|---|
High dose melphalan[12] | - NK1 on days -3 to 0
- 5-HT3 on days -3 to 0 - DEX on days -3 to -1 |
BEAM (busulfan, etoposide, cytarabine, melphalan) | |
TBC (thiotepa, busulfan, cyclophosphamide) |
Highly to moderately emetogenic PO chemotherapy
These are NCCN recommendations only. ASCO did not provide separate antiemetic recommendations for PO vs. IV chemotherapy.
Start before chemotherapy and continue once per day:
Serotonin (5-HT3) antagonist
- Granisetron (choose one of the options below):
- 2 mg PO once per day
- 1 mg PO twice per day
- Ondansetron (Zofran) 16 to 24 mg PO once per day
Optional
- Lorazepam (Ativan) 0.5 to 2 mg PO/IV/sublingual Q4-6H prn nausea on days 1 to 4
- H2 blocker or proton pump inhibitor
Low emetic risk IV chemotherapy
Day 1 | Day 2-4 | |
ASCO 2017 | Single dose 5-HT3 or DEX 8mg | No routine prophylaxis |
MASCC 2016 | 5-HT3 or DEX or Dopamine RA | No routine prophylaxis |
NCCN 2022 | DEX or Metoclopramide or Prochlorperazine or
5-HT3 other than Palonosetron |
No routine prophylaxis |
Repeat once per day for chemotherapy regimens that last more than one day.
- Dexamethasone (Decadron)
- NCCN: 12 mg IV or PO on the days of chemotherapy
- ASCO: 8 mg IV or PO on the days of chemotherapy
- Metoclopramide (Reglan) 10-40 mg IV or PO x1, then Q4-6H prn nausea
- Prochlorperazine (Compazine) 10 mg IV or PO x1, then Q4-6H prn nausea
Minimal emetic risk chemotherapy
- No routine prophylaxis recommended by all 3 guideline groups. Assess patient prior to cycle 2 and add single agent prophylactic antiemetic if patient had emesis with cycle 1.
Low to minimal emetic risk PO chemotherapy
- use antiemetics prn first
If nausea/vomiting
Choose one of the medications below to start before chemotherapy and continue once per day:
- Metoclopramide (Reglan) 10-40 mg IV or PO x1, then Q4-6H prn nausea
- Prochlorperazine (Compazine) 10 mg IV or PO x1, then Q4-6H prn nausea
- Haloperidol (Haldol) 0.5 to 2 mg IV or PO Q4-6H prn nausea (monitor for dystonic reactions)
Optional
- Lorazepam (Ativan) 0.5 to 2 mg PO/IV/sublingual Q4-6H prn nausea days 1-4
- H2 blocker or proton pump inhibitor
If continued nausea/vomiting
Use serotonin (5-HT3) antagonist:
- Granisetron (choose one of the options below):
- 2 mg PO once per day
- 1 mg PO twice per day
- Ondansetron (Zofran) 16 to 24 mg PO once per day
Breakthrough CINV treatment
General Principles
-Use antiemetic from another class than the prophylactic regimen
-Agents which are successful in treating a patient’s breakthrough CINV should be given routinely for a period of time rather than on an as needed basis.
-5-HT3 and NK1 RA are generally not effective or approved for treatment of breakthrough nausea/vomiting (assuming they were used as part of prophylaxis)
Olanzapine
- Olanzapine (Zyprexa) 10 mg PO daily on days 1-3 if CINV develop in the first 24 hours after HEC [13]. Use 5 mg if 10 mg is not well tolerated.[14]
Metoclopromide
- Metoclopramide (Reglan) 10 mg PO (IV) every 8 hours on days 1-3 if CINV develop in the first 24 hours after HEC [13].
Benzodiazepine
- Lorazepam (Ativan) 0.5 to 2 mg PO (IV) Q4-6H prn nausea
Cannabinoid
- Dronabinol (Marinol) 5-10 mg PO Q3-6H prn nausea
- Nabilone (Cesamet) 1-2 mg PO twice per day prn nausea
Other agents
- Haloperidol (Haldol) 0.5 to 2 mg IV or PO Q4-6H prn nausea (monitor for dystonic reactions)
- Scopolamine (Scopoderm) 1 patch Q72H prn nausea
- Prochlorperazine (Compazine) (choose one of the options below):
- 25 mg suppository PR every 12 hours prn nausea
- 10 mg IV or PO Q4-6H prn nausea
- Promethazine (Phenergan) 12.5-25 mg IV or PO every 6 hours for 1-3 days
- Dexamethasone (Decadron) 8 mg PO (IV) every 6-8 hours
Serotonin 5-HT3 antagonists
Are generally ineffective for breakthrough CINV (assuming they were used as part of prophylactic regimen).
- Ondansetron (Zofran) 8 to 16 mg PO once per day prn nausea
Anticipatory nausea/vomiting
- Prevent anticipation by optimizing antiemetic therapy for every cycle of chemotherapy
- Behavioral therapy
- Relaxation/systemic desensitization
- Hypnosis/guided imagery
- Music therapy
- Acupuncture/acupressure
- Alprazolam (Xanax) 0.5 to 2 mg PO three times per day starting the night before treatment
- Lorazepam (Ativan) 0.5 to 1 mg PO beginning the night before treatment and then repeat the next 1-2 hours before anticancer therapy begins
Reference
- ↑ NCCN antiemesis guidelines
- ↑ ASCO antiemesis guidelineshttps://ascopubs.org/doi/abs/10.1200/JCO.20.01296
- ↑ MASCC antiemetic guidlines https://www.mascc.org/antiemetic-guidelines
- ↑ Grunberg S, Chua D, Maru A, Dinis J, DeVandry S, Boice JA, Hardwick JS, Beckford E, Taylor A, Carides A, Roila F, Herrstedt J. Single-dose fosaprepitant for the prevention of chemotherapy-induced nausea and vomiting associated with cisplatin therapy: randomized, double-blind study protocol--EASE. J Clin Oncol. 2011 Apr 10;29(11):1495-501. Epub 2011 Mar 7. link to original article PubMed
- ↑ 5.0 5.1 As of 6/28/2012, the once daily dose of ondansetron (Zofran) 32 mg is no longer recommended due to dose-dependent QTc prolongation. The Ondansetron (Zofran) package insert recommends only a maximum of 16 mg per dose, which can be given as often as every 4 hours x up to 3 doses, as detailed in the 6/29/2012 FDA Drug Safety Communication.
- ↑ Karin Jordan et al. "Comparative activity of antiemetic drugs" https://www-sciencedirect-com.elibrary.einstein.yu.edu/science/article/pii/S1040842806001661#tbl2
- ↑ 7.0 7.1 Ronald CHow et Al. "Efficacy and safety of 1-day versus 3-day dexamethasone for the prophylaxis of chemotherapy-induced nausea and vomiting: a systematic review and meta-analysis of randomized controlled trials" http://jhmhp.amegroups.com/article/view/4296
- ↑ Navari RM, Qin R, Ruddy KJ, Liu H, Powell SF, Bajaj M, Dietrich L, Biggs D, Lafky JM, Loprinzi CL. Olanzapine for the Prevention of Chemotherapy-Induced Nausea and Vomiting. N Engl J Med. 2016 Jul 14;375(2):134-42. link to original article PubMed
- ↑ Navari RM, Qin R, Ruddy KJ, Liu H, Powell SF, Bajaj M, Dietrich L, Biggs D, Lafky JM, Loprinzi CL. Olanzapine for the Prevention of Chemotherapy-Induced Nausea and Vomiting. N Engl J Med. 2016 Jul 14;375(2):134-42. link to original article PubMed
- ↑ 10.0 10.1 Yahata H, Kobayashi H, Sonoda K, et al: Effi- cacy of aprepitant for the prevention of chemotherapy- induced nausea and vomiting with a moderately emetogenic chemotherapy regimen: A multicenter, placebo-controlled, double-blind, randomized study in patients with gynecologic cancer receiving pac- litaxel and carboplatin. Int J Clin Oncol 21:491-497, 2016 https://pubmed.ncbi.nlm.nih.gov/26662632
- ↑ Hesketh PJ, Schnadig ID, Schwartzberg LS, et al: Efficacy of the neurokinin-1 receptor antagonist rolapitant in preventing nausea and vomiting in pa- tients receiving carboplatin-based chemotherapy. Cancer 122:2418-2425, 2016https://pubmed.ncbi.nlm.nih.gov/27176138
- ↑ . Aprepitant, granisetron, and dexamethasone for prevention of chemotherapy-induced nausea and vomiting after high-dose melphalan in autologous transplantation for multiple myeloma: results of a randomized, placebo-controlled phase III trial. J Clin Oncol. 2014;32:3413-20. PubMed ID 25225424.
- ↑ 13.0 13.1 R. M. Navari, C. K. Nagy, and S. E. Gray, “The use of olanzapine versus metoclopramide for the treatment of breakthrough chemotherapy-induced nausea and vomiting in patients receiving highly emetogenic chemotherapy,” Supportive Care in Cancer, vol. 21, no. 6, pp. 1655–1663, 2013
- ↑ S. Chanthawong, S. Subongkot, and A. Sookprasert, “Effectiveness of olanzapine for the treatment of breakthrough chemotherapy induced nausea and vomiting,” Journal of the Medical Association of Thailand, vol. 97, pp. 349–355, 2014