Difference between revisions of "Antiemesis"
m (Bone marrow transplant (BMT) conditioning regimens) Tag: visualeditor |
m (Allogeneic BMT conditioning) Tag: visualeditor |
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NCCN, ASCO and MASCC categories of emetic risk in the absence of prophylaxis: | NCCN, ASCO and MASCC categories of emetic risk in the absence of prophylaxis: | ||
+ | |||
*High: >90% frequency of emesis (HEC) | *High: >90% frequency of emesis (HEC) | ||
*Moderate: 30-90% frequency of emesis (MEC) | *Moderate: 30-90% frequency of emesis (MEC) | ||
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!Comment | !Comment | ||
|- | |- | ||
− | | align="left" | [[Ado-trastuzumab emtansine (Kadcyla)]] | + | | align="left" |[[Ado-trastuzumab emtansine (Kadcyla)]] |
|Low | |Low | ||
| | | | ||
Line 28: | Line 29: | ||
| | | | ||
|- | |- | ||
− | | 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)]]) | ||
Line 34: | Line 35: | ||
|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 41: | ||
| | | | ||
|- | |- | ||
− | | align="left" | [[Alemtuzumab (Campath)]] | + | | align="left" |[[Alemtuzumab (Campath)]] |
|Minimal | |Minimal | ||
|Moderate | |Moderate | ||
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| | | | ||
|- | |- | ||
− | | align="left" | [[Altretamine (Hexalen)]] or Hexamethylmelamine (oral) | + | | align="left" |[[Altretamine (Hexalen)]] or Hexamethylmelamine (oral) |
|High/Moderate | |High/Moderate | ||
|High | |High | ||
| | | | ||
− | |NCCN did not further delineate between degrees of emetic potential | + | |NCCN 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 | ||
| | | | ||
Line 58: | Line 59: | ||
| | | | ||
|- | |- | ||
− | | align="left" | [[Arsenic trioxide (Trisenox)]] | + | | align="left" |[[Arsenic trioxide (Trisenox)]] |
|Moderate | |Moderate | ||
| | | | ||
Line 64: | Line 65: | ||
| | | | ||
|- | |- | ||
− | | align="left" | [[Asparaginase (Elspar)]] | + | | align="left" |[[Asparaginase (Elspar)]] |
|Minimal | |Minimal | ||
| | | | ||
Line 76: | Line 77: | ||
| | | | ||
|- | |- | ||
− | | align="left" | [[Axitinib (Inlyta)]] (oral) | + | | align="left" |[[Axitinib (Inlyta)]] (oral) |
|Low/Minimal | |Low/Minimal | ||
| | | | ||
Line 82: | Line 83: | ||
| | | | ||
|- | |- | ||
− | | align="left" | [[Azacitidine (Vidaza)]] | + | | align="left" |[[Azacitidine (Vidaza)]] |
|Moderate | |Moderate | ||
|Moderate | |Moderate | ||
Line 88: | Line 89: | ||
| | | | ||
|- | |- | ||
− | | align="left" | [[Bendamustine]] | + | | align="left" |[[Bendamustine]] |
|Moderate | |Moderate | ||
|Moderate | |Moderate | ||
Line 94: | Line 95: | ||
| | | | ||
|- | |- | ||
− | | align="left" | [[Bevacizumab (Avastin)]] | + | | align="left" |[[Bevacizumab (Avastin)]] |
|Minimal | |Minimal | ||
|Minimal | |Minimal | ||
Line 100: | Line 101: | ||
| | | | ||
|- | |- | ||
− | | 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 | ||
Line 118: | Line 119: | ||
| | | | ||
|- | |- | ||
− | | align="left" | [[Bortezomib (Velcade)]] | + | | align="left" |[[Bortezomib (Velcade)]] |
|Minimal | |Minimal | ||
|Low | |Low | ||
Line 124: | Line 125: | ||
| | | | ||
|- | |- | ||
− | | align="left" | [[Bosutinib (Bosulif)]] (oral) | + | | align="left" |[[Bosutinib (Bosulif)]] (oral) |
|Low/Minimal | |Low/Minimal | ||
|Moderate | |Moderate | ||
Line 130: | Line 131: | ||
| | | | ||
|- | |- | ||
− | | align="left" | [[Brentuximab vedotin (Adcetris)]] | + | | align="left" |[[Brentuximab vedotin (Adcetris)]] |
|Low | |Low | ||
| | | | ||
Line 136: | Line 137: | ||
| | | | ||
|- | |- | ||
− | | align="left" | [[Busulfan (Myleran)]] | + | | align="left" |[[Busulfan (Myleran)]] |
|High/Moderate: ≥4 mg/day <br> Low/Minimal: <4 mg/day | |High/Moderate: ≥4 mg/day <br> Low/Minimal: <4 mg/day | ||
|Minimal | |Minimal | ||
Line 142: | Line 143: | ||
| | | | ||
|- | |- | ||
− | | align="left" | [[Busulfan (Myleran)]] (oral) | + | | align="left" |[[Busulfan (Myleran)]] (oral) |
|High/Moderate: ≥4 mg/day<br>Low/Minimal: <4 mg/day | |High/Moderate: ≥4 mg/day<br>Low/Minimal: <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 | ||
Line 160: | Line 161: | ||
| | | | ||
|- | |- | ||
− | | 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 ≥4 | |High: AUC ≥4 | ||
Moderate: AUC <4 | Moderate: AUC <4 | ||
Line 173: | Line 174: | ||
|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 | ||
| | | | ||
Line 179: | Line 180: | ||
| | | | ||
|- | |- | ||
− | | 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 | ||
Line 185: | Line 186: | ||
|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 | ||
Line 191: | Line 192: | ||
| | | | ||
|- | |- | ||
− | | align="left" | [[Cetuximab (Erbitux)]] | + | | align="left" |[[Cetuximab (Erbitux)]] |
|Minimal | |Minimal | ||
|Minimal | |Minimal | ||
Line 197: | Line 198: | ||
| | | | ||
|- | |- | ||
− | |Ceritinib | + | |Ceritinib |
| | | | ||
− | |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 | ||
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|Some only consider emetogenic potential high when dose ≥70 mg/m<sup>2</sup> | |Some only consider emetogenic potential high when dose ≥70 mg/m<sup>2</sup> | ||
|- | |- | ||
− | | align="left" | [[Cladribine (Leustatin)]] | + | | align="left" |[[Cladribine (Leustatin)]] |
|Minimal | |Minimal | ||
|Minimal | |Minimal | ||
Line 221: | Line 222: | ||
| | | | ||
|- | |- | ||
− | | align="left" | [[Clofarabine (Clolar)]] | + | | align="left" |[[Clofarabine (Clolar)]] |
|Moderate | |Moderate | ||
|Moderate | |Moderate | ||
Line 227: | Line 228: | ||
| | | | ||
|- | |- | ||
− | | align="left" | [[Crizotinib (Xalkori)]] (oral) | + | | align="left" |[[Crizotinib (Xalkori)]] (oral) |
|High/Moderate | |High/Moderate | ||
|Moderate | |Moderate | ||
Line 233: | Line 234: | ||
| | | | ||
|- | |- | ||
− | | align="left" | [[Cyclophosphamide (Cytoxan)]] | + | | align="left" |[[Cyclophosphamide (Cytoxan)]] |
|High: >1500 mg/m<sup>2</sup> or [[#Emetic_risk_of_chemotherapy|when given with certain anthracyclines]]<br>Moderate: ≤1500 mg/m<sup>2</sup> | |High: >1500 mg/m<sup>2</sup> or [[#Emetic_risk_of_chemotherapy|when given with certain anthracyclines]]<br>Moderate: ≤1500 mg/m<sup>2</sup> | ||
|High: ≥1500 mg/m<sup>2</sup> or [[#Emetic_risk_of_chemotherapy|when given with anthracyclines]]<br>Moderate: <1500 mg/m<sup>2</sup> | |High: ≥1500 mg/m<sup>2</sup> or [[#Emetic_risk_of_chemotherapy|when given with anthracyclines]]<br>Moderate: <1500 mg/m<sup>2</sup> | ||
Line 240: | Line 241: | ||
| | | | ||
|- | |- | ||
− | | align="left" | [[Cyclophosphamide (Cytoxan)]] (oral) | + | | align="left" |[[Cyclophosphamide (Cytoxan)]] (oral) |
|High/Moderate: ≥100 mg/m<sup>2</sup>/day<br>Low/Minimal: <100 mg/m<sup>2</sup>/day | |High/Moderate: ≥100 mg/m<sup>2</sup>/day<br>Low/Minimal: <100 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" | [[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: <100 mg/m<sup>2</sup> | |Moderate: >200 mg/m<sup>2</sup><br>Low: 100 to 200 mg/m<sup>2</sup><br>Minimal: <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> | ||
Line 253: | Line 254: | ||
| | | | ||
|- | |- | ||
− | | align="left" | [[Dabrafenib (Tafinlar)]] (oral) | + | | align="left" |[[Dabrafenib (Tafinlar)]] (oral) |
|Low/Minimal | |Low/Minimal | ||
| | | | ||
Line 259: | Line 260: | ||
| | | | ||
|- | |- | ||
− | | align="left" | [[Dacarbazine (DTIC)]] | + | | align="left" |[[Dacarbazine (DTIC)]] |
|High | |High | ||
|High | |High | ||
Line 265: | Line 266: | ||
| | | | ||
|- | |- | ||
− | |Daratumumab | + | |Daratumumab |
| | | | ||
|Minimal | |Minimal | ||
Line 271: | Line 272: | ||
| | | | ||
|- | |- | ||
− | | align="left" | [[Dactinomycin (Cosmegen)]] | + | | align="left" |[[Dactinomycin (Cosmegen)]] |
|Moderate | |Moderate | ||
|High | |High | ||
Line 277: | Line 278: | ||
| | | | ||
|- | |- | ||
− | | 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 | ||
Line 291: | Line 292: | ||
| | | | ||
|- | |- | ||
− | | align="left" | [[Decitabine (Dacogen)]] | + | | align="left" |[[Decitabine (Dacogen)]] |
|Minimal | |Minimal | ||
| | | | ||
Line 297: | Line 298: | ||
| | | | ||
|- | |- | ||
− | | align="left" | [[Denileukin diftitox (Ontak)]] | + | | align="left" |[[Denileukin diftitox (Ontak)]] |
|Minimal | |Minimal | ||
| | | | ||
Line 303: | Line 304: | ||
| | | | ||
|- | |- | ||
− | | align="left" | [[Dexrazoxane (Zinecard)]] | + | | align="left" |[[Dexrazoxane (Zinecard)]] |
|Minimal | |Minimal | ||
| | | | ||
Line 309: | Line 310: | ||
| | | | ||
|- | |- | ||
− | | align="left" | [[Docetaxel (Taxotere)]] | + | | align="left" |[[Docetaxel (Taxotere)]] |
|Low | |Low | ||
|Low | |Low | ||
Line 315: | Line 316: | ||
| | | | ||
|- | |- | ||
− | | align="left" | [[Doxorubicin (Adriamycin)]] | + | | align="left" |[[Doxorubicin (Adriamycin)]] |
|High: ≥60 mg/m<sup>2</sup> or when given at any dose with [[Cyclophosphamide (Cytoxan)]]<br>Moderate: <60 mg/m<sup>2</sup> | |High: ≥60 mg/m<sup>2</sup> or when given at any dose with [[Cyclophosphamide (Cytoxan)]]<br>Moderate: <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 | ||
Line 323: | Line 324: | ||
| | | | ||
|- | |- | ||
− | | align="left" | [[Pegylated liposomal doxorubicin (Doxil)]] | + | | align="left" |[[Pegylated liposomal doxorubicin (Doxil)]] |
|Low | |Low | ||
|Low | |Low | ||
Line 329: | Line 330: | ||
| | | | ||
|- | |- | ||
− | | 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 | ||
Line 337: | Line 338: | ||
| | | | ||
|- | |- | ||
− | | align="left" | [[Eribulin (Halaven)]] | + | | align="left" |[[Eribulin (Halaven)]] |
|Low | |Low | ||
| | | | ||
Line 343: | Line 344: | ||
| | | | ||
|- | |- | ||
− | | 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 362: | ||
| | | | ||
|- | |- | ||
− | | 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 380: | ||
| | | | ||
|- | |- | ||
− | | align="left" | [[Fludarabine (Fludara)]] | + | | align="left" |[[Fludarabine (Fludara)]] |
|Minimal | |Minimal | ||
|Minimal | |Minimal | ||
Line 385: | Line 386: | ||
| | | | ||
|- | |- | ||
− | | 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 398: | ||
| | | | ||
|- | |- | ||
− | | 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 410: | ||
| | | | ||
|- | |- | ||
− | | 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 422: | ||
| | | | ||
|- | |- | ||
− | | align="left" | [[Ifosfamide (Ifex)]] | + | | align="left" |[[Ifosfamide (Ifex)]] |
|High: ≥2 g/m<sup>2</sup> per dose <br> Moderate: <2 g/m<sup>2</sup> per dose | |High: ≥2 g/m<sup>2</sup> per dose <br> Moderate: <2 g/m<sup>2</sup> per dose | ||
|Moderate | |Moderate | ||
Line 427: | Line 428: | ||
|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: ≥10 million international units/m<sup>2</sup><br>Low: >5, <10 million international units/m<sup>2</sup><br>Minimal: ≤5 million international units/m<sup>2</sup> | |Moderate: ≥10 million international units/m<sup>2</sup><br>Low: >5, <10 million international units/m<sup>2</sup><br>Minimal: ≤5 million international units/m<sup>2</sup> | ||
| | | | ||
Line 439: | Line 440: | ||
|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: ≥10 million international units/m<sup>2</sup><br>Low: >5, <10 million international units/m<sup>2</sup><br>Minimal: ≤5 million international units/m<sup>2</sup> | |Moderate: ≥10 million international units/m<sup>2</sup><br>Low: >5, <10 million international units/m<sup>2</sup><br>Minimal: ≤5 million international units/m<sup>2</sup> | ||
| | | | ||
Line 445: | Line 446: | ||
|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 452: | ||
| | | | ||
|- | |- | ||
− | | align="left" | [[Irinotecan (Camptosar)]] | + | | align="left" |[[Irinotecan (Camptosar)]] |
|Moderate | |Moderate | ||
|Moderate | |Moderate | ||
Line 457: | Line 458: | ||
| | | | ||
|- | |- | ||
− | | align="left" | [[Ixabepilone (Ixempra)]] | + | | align="left" |[[Ixabepilone (Ixempra)]] |
|Low | |Low | ||
|Low | |Low | ||
Line 463: | Line 464: | ||
| | | | ||
|- | |- | ||
− | | 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 | |Lenvatinib | ||
| | | | ||
− | |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" | [[Mechlorethamine (Mustargen)]] | + | | align="left" |[[Mechlorethamine (Mustargen)]] |
|High | |High | ||
|High | |High | ||
Line 493: | Line 494: | ||
| | | | ||
|- | |- | ||
− | | 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: ≥250 mg/m<sup>2</sup><br>Low: >50, <250 mg/m<sup>2</sup><br>Minimal: ≤50 mg/m<sup>2</sup> | |Moderate: ≥250 mg/m<sup>2</sup><br>Low: >50, <250 mg/m<sup>2</sup><br>Minimal: ≤50 mg/m<sup>2</sup> | ||
|Low | |Low | ||
Line 517: | Line 518: | ||
|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 530: | ||
| | | | ||
|- | |- | ||
− | | align="left" | [[Mitotane (Lysodren)]] (oral) | + | | align="left" |[[Mitotane (Lysodren)]] (oral) |
|High/Moderate | |High/Moderate | ||
| | | | ||
Line 535: | Line 536: | ||
| | | | ||
|- | |- | ||
− | | align="left" | [[Mitoxantrone (Novantrone)]] | + | | align="left" |[[Mitoxantrone (Novantrone)]] |
|Low | |Low | ||
|Low | |Low | ||
Line 541: | Line 542: | ||
| | | | ||
|- | |- | ||
− | | align="left" | [[Nelarabine (Arranon)]] | + | | align="left" |[[Nelarabine (Arranon)]] |
|Minimal | |Minimal | ||
| | | | ||
Line 547: | Line 548: | ||
| | | | ||
|- | |- | ||
− | | 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" | [[Ofatumumab (Arzzera)]] | + | | align="left" |[[Ofatumumab (Arzzera)]] |
|Minimal | |Minimal | ||
| | | | ||
Line 559: | Line 560: | ||
| | | | ||
|- | |- | ||
− | | align="left" | [[Omacetaxine (Synribo)]] | + | | align="left" |[[Omacetaxine (Synribo)]] |
|Low | |Low | ||
| | | | ||
Line 565: | Line 566: | ||
| | | | ||
|- | |- | ||
− | | align="left" | [[Oxaliplatin (Eloxatin)]] | + | | align="left" |[[Oxaliplatin (Eloxatin)]] |
|Moderate | |Moderate | ||
|Moderate | |Moderate | ||
Line 571: | Line 572: | ||
| | | | ||
|- | |- | ||
− | | align="left" | [[Paclitaxel (Taxol)]] | + | | align="left" |[[Paclitaxel (Taxol)]] |
|Low | |Low | ||
|Low | |Low | ||
Line 577: | Line 578: | ||
| | | | ||
|- | |- | ||
− | | align="left" | [[Paclitaxel, nanoparticle albumin-bound (Abraxane)]] | + | | align="left" |[[Paclitaxel, nanoparticle albumin-bound (Abraxane)]] |
|Low | |Low | ||
| | | | ||
Line 583: | Line 584: | ||
| | | | ||
|- | |- | ||
− | | align="left" | [[Panitumumab (Vectibix)]] | + | | align="left" |[[Panitumumab (Vectibix)]] |
|Minimal | |Minimal | ||
| | | | ||
Line 589: | Line 590: | ||
| | | | ||
|- | |- | ||
− | | 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 602: | ||
| | | | ||
|- | |- | ||
− | | align="left" | [[Peginterferon alfa-2a (Pegasys)]] | + | | align="left" |[[Peginterferon alfa-2a (Pegasys)]] |
|Minimal | |Minimal | ||
| | | | ||
Line 607: | Line 608: | ||
|NCCN did not specify interferon alfa-2a vs. 2b | |NCCN did not specify interferon alfa-2a vs. 2b | ||
|- | |- | ||
− | | align="left" | [[Peginterferon alfa-2b (PegIntron)]] | + | | align="left" |[[Peginterferon alfa-2b (PegIntron)]] |
|Minimal | |Minimal | ||
| | | | ||
Line 613: | Line 614: | ||
|NCCN did not specify interferon alfa-2a vs. 2b | |NCCN did not specify interferon alfa-2a vs. 2b | ||
|- | |- | ||
− | | align="left" | [[Pemetrexed (Alimta)]] | + | | align="left" |[[Pemetrexed (Alimta)]] |
|Low | |Low | ||
|Low | |Low | ||
Line 619: | Line 620: | ||
| | | | ||
|- | |- | ||
− | | align="left" | [[Pentostatin (Nipent)]] | + | | align="left" |[[Pentostatin (Nipent)]] |
|Low | |Low | ||
| | | | ||
Line 625: | Line 626: | ||
| | | | ||
|- | |- | ||
− | | align="left" | [[Pertuzumab (Perjeta)]] | + | | align="left" |[[Pertuzumab (Perjeta)]] |
|Minimal | |Minimal | ||
| | | | ||
Line 631: | Line 632: | ||
| | | | ||
|- | |- | ||
− | | align="left" | [[Pomalidomide (Pomalyst)]] (oral) | + | | align="left" |[[Pomalidomide (Pomalyst)]] (oral) |
|Low/Minimal | |Low/Minimal | ||
| | | | ||
Line 637: | Line 638: | ||
| | | | ||
|- | |- | ||
− | | align="left" | [[Ponatinib (Iclusig)]] (oral) | + | | align="left" |[[Ponatinib (Iclusig)]] (oral) |
|Low/Minimal | |Low/Minimal | ||
| | | | ||
Line 643: | Line 644: | ||
| | | | ||
|- | |- | ||
− | | align="left" | [[Pralatrexate (Folotyn)]] | + | | align="left" |[[Pralatrexate (Folotyn)]] |
|Low | |Low | ||
|Minimal | |Minimal | ||
Line 649: | Line 650: | ||
| | | | ||
|- | |- | ||
− | | 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 662: | ||
| | | | ||
|- | |- | ||
− | | align="left" | [[Rituximab (Rituxan)]] | + | | align="left" |[[Rituximab (Rituxan)]] |
|Minimal | |Minimal | ||
|Minimal | |Minimal | ||
Line 667: | Line 668: | ||
| | | | ||
|- | |- | ||
− | | align="left" | [[Romidepsin (Istodax)]] | + | | align="left" |[[Romidepsin (Istodax)]] |
|Low | |Low | ||
| | | | ||
Line 673: | Line 674: | ||
| | | | ||
|- | |- | ||
− | | align="left" | [[Ruxolitinib (Jakafi)]] (oral) | + | | align="left" |[[Ruxolitinib (Jakafi)]] (oral) |
|Low/Minimal | |Low/Minimal | ||
| | | | ||
Line 679: | Line 680: | ||
| | | | ||
|- | |- | ||
− | | align="left" | [[Sorafenib (Nexavar)]] (oral) | + | | 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 692: | ||
| | | | ||
|- | |- | ||
− | | 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 705: | ||
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 717: | ||
| | | | ||
|- | |- | ||
− | | 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 735: | ||
| | | | ||
|- | |- | ||
− | | align="left" | [[Topotecan (Hycamtin)]] | + | | align="left" |[[Topotecan (Hycamtin)]] |
|Low | |Low | ||
|Low | |Low | ||
Line 740: | Line 741: | ||
| | | | ||
|- | |- | ||
− | | 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" |[[Trametinib (Mekinist)]] (oral) |
|Low/Minimal | |Low/Minimal | ||
| | | | ||
Line 752: | Line 753: | ||
| | | | ||
|- | |- | ||
− | | align="left" | [[Trastuzumab (Herceptin)]] | + | | align="left" |[[Trastuzumab (Herceptin)]] |
|Minimal | |Minimal | ||
|Low | |Low | ||
Line 758: | Line 759: | ||
| | | | ||
|- | |- | ||
− | | align="left" | [[All-trans retinoic acid (ATRA)]] (oral) | + | | align="left" |[[All-trans retinoic acid (ATRA)]] (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" | [[Valrubicin (Valstar)]] | + | | align="left" |[[Valrubicin (Valstar)]] |
|Minimal | |Minimal | ||
| | | | ||
Line 770: | Line 771: | ||
| | | | ||
|- | |- | ||
− | | 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 783: | ||
| | | | ||
|- | |- | ||
− | | align="left" | [[Vinblastine (Velban)]] | + | | align="left" |[[Vinblastine (Velban)]] |
|Minimal | |Minimal | ||
|Minimal | |Minimal | ||
Line 788: | Line 789: | ||
| | | | ||
|- | |- | ||
− | | align="left" | [[Vincristine (Oncovin)]] | + | | align="left" |[[Vincristine (Oncovin)]] |
|Minimal | |Minimal | ||
|Minimal | |Minimal | ||
Line 794: | Line 795: | ||
| | | | ||
|- | |- | ||
− | | align="left" | [[Vincristine liposomal (Marqibo)]] | + | | align="left" |[[Vincristine liposomal (Marqibo)]] |
|Minimal | |Minimal | ||
| | | | ||
Line 800: | Line 801: | ||
| | | | ||
|- | |- | ||
− | | align="left" | [[Vinorelbine (Navelbine)]] | + | | align="left" |[[Vinorelbine (Navelbine)]] |
|Minimal | |Minimal | ||
|Minimal | |Minimal | ||
Line 812: | Line 813: | ||
| | | | ||
|- | |- | ||
− | | align="left" | [[Vismodegib (Erivedge)]] (oral) | + | | align="left" |[[Vismodegib (Erivedge)]] (oral) |
|High/Moderate | |High/Moderate | ||
| | | | ||
Line 818: | Line 819: | ||
| | | | ||
|- | |- | ||
− | | 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 | ||
| | | | ||
Line 835: | Line 836: | ||
| | | | ||
|'''Day 1 CINV prophylaxis''' | |'''Day 1 CINV prophylaxis''' | ||
− | |'''Day 2-4 CINV prophylaxis''' | + | |'''Day 2-4 CINV prophylaxis''' |
|- | |- | ||
|ASCO 2017 | |ASCO 2017 | ||
Line 861: | Line 862: | ||
==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 | ||
*[[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. [http://ascopubs.org/doi/full/10.1200/JCO.2010.31.7859 link to original article] [https://www.ncbi.nlm.nih.gov/pubmed/21383291 PubMed]</ref>'' | ''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. [http://ascopubs.org/doi/full/10.1200/JCO.2010.31.7859 link to original article] [https://www.ncbi.nlm.nih.gov/pubmed/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): | ||
Line 877: | Line 881: | ||
*[[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 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" | ''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" | ||
Line 886: | Line 891: | ||
===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 | ||
Line 899: | Line 905: | ||
==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 | ||
Line 904: | Line 911: | ||
==Olanzapine (OLN) containing regimen== | ==Olanzapine (OLN) containing regimen== | ||
''Note: a 4-drug regimen based on [https://www.nejm.org/doi/full/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://www.nejm.org/doi/full/10.1056/NEJMoa1515725 link to original article] [https://www.ncbi.nlm.nih.gov/pubmed/27410922 PubMed]</ref>'' | ''Note: a 4-drug regimen based on [https://www.nejm.org/doi/full/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://www.nejm.org/doi/full/10.1056/NEJMoa1515725 link to original article] [https://www.ncbi.nlm.nih.gov/pubmed/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 | ||
Line 937: | Line 945: | ||
===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): | ||
Line 949: | Line 958: | ||
===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 | ||
Line 955: | Line 965: | ||
*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" /> | ''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 | ||
Line 963: | Line 975: | ||
==Olanzapine (OLN) containing regimen== | ==Olanzapine (OLN) containing regimen== | ||
''Note: a 4-drug regimen based on [https://www.nejm.org/doi/full/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://www.nejm.org/doi/full/10.1056/NEJMoa1515725 link to original article] [https://www.ncbi.nlm.nih.gov/pubmed/27410922 PubMed]</ref>'' | ''Note: a 4-drug regimen based on [https://www.nejm.org/doi/full/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://www.nejm.org/doi/full/10.1056/NEJMoa1515725 link to original article] [https://www.ncbi.nlm.nih.gov/pubmed/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 | ||
Line 968: | Line 981: | ||
*[[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 emetic risk''' | |'''Guideline and emetic risk''' | ||
Line 977: | Line 990: | ||
AUC ≥ 4 | AUC ≥ 4 | ||
− | |NK1 + 5-HT3 + DEX | + | |NK1 + 5-HT3 + DEX |
|NONE | |NONE | ||
Line 1,006: | Line 1,019: | ||
</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://www.ncbi.nlm.nih.gov/pubmed/27176138</ref>. One of them for done in female patients with GYN malignancy only. <ref name=":2" /> 5-HT3 used in those trials was either granisetron or ondansetron. | </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://www.ncbi.nlm.nih.gov/pubmed/27176138</ref>. One of them for done 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 = | + | =Bone marrow transplant (BMT) conditioning regimens= |
− | == Allogeneic BMT conditioning regimens == | + | ==Allogeneic BMT conditioning regimens== |
{| class="wikitable" | {| class="wikitable" | ||
!Conditioning regimen | !Conditioning regimen | ||
Line 1,014: | Line 1,027: | ||
|- | |- | ||
|FMT (fludarabine, melphalan, thiotepa) | |FMT (fludarabine, melphalan, thiotepa) | ||
− | | | + | |<nowiki>- Fosaprepitant on day -7</nowiki> |
+ | |||
+ | - Ondansetron on days -7 to -1 | ||
|- | |- | ||
|Flu/Mel (fludarabine, melphalan) | |Flu/Mel (fludarabine, melphalan) | ||
+ | | - Fosaprepitant on day -2 | ||
+ | - Ondansetron on days -6 to -1 | ||
+ | |||
+ | - Dexamethasone on days -6 to -1 | ||
+ | |- | ||
+ | |Flu/Cy/TBI (fludarabine, cyclophosphamide, total body irradiation) | ||
| | | | ||
|- | |- | ||
|Cy/TBI (cyclophosphamide, total body irradiation) | |Cy/TBI (cyclophosphamide, total body irradiation) | ||
− | | | + | |<nowiki>- Fosaprepitant on day -6</nowiki> |
+ | |||
+ | - Ondansetron on days -6 to -1 | ||
+ | |||
+ | - Dexamethasone on days -6 to -4 | ||
|- | |- | ||
|Bu/Flu (bufulfan, fludarabine) | |Bu/Flu (bufulfan, fludarabine) | ||
Line 1,026: | Line 1,051: | ||
|- | |- | ||
|Bu/Cy (busulfan, cyclophosphamide) | |Bu/Cy (busulfan, cyclophosphamide) | ||
− | |||
− | |||
− | |||
| | | | ||
|} | |} | ||
− | == Autologous BMT conditioning == | + | ==Autologous BMT conditioning regimens== |
{| class="wikitable" | {| class="wikitable" | ||
!Conditioning regimen | !Conditioning regimen | ||
Line 1,051: | Line 1,073: | ||
Start before chemotherapy and continue once per day: | Start before chemotherapy and continue once per day: | ||
==Serotonin (5-HT3) antagonist== | ==Serotonin (5-HT3) antagonist== | ||
+ | |||
*[[Granisetron]] (choose one of the options below): | *[[Granisetron]] (choose one of the options below): | ||
**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]] | ||
Line 1,081: | Line 1,105: | ||
|} | |} | ||
'''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 | ||
Line 1,088: | Line 1,113: | ||
=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 single agent prophylactic antiemetic if patient had emesis with cycle 1. | + | |
+ | *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)]] 10mg IV or PO x1, then Q4-6H prn nausea | *[[Prochlorperazine (Compazine)]] 10mg 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: | ||
+ | |||
*[[Granisetron]] (choose one of the options below): | *[[Granisetron]] (choose one of the options below): | ||
**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= | ||
Line 1,118: | Line 1,148: | ||
-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,” Supportive Care in Cancer, vol. 21, no. 6, pp. 1655–1663, 2013</ref>. Use 5 mg if 10mg 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> | + | |
+ | *[[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 10mg 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 on days 1-3 if CINV develop in the first 24 hours after HEC <ref name=":0" />. | + | |
+ | *[[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 |
**10mg IV or PO Q4-6H prn nausea | **10mg 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 | ||
Line 1,143: | Line 1,178: | ||
==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 | ||
*Behavioral therapy | *Behavioral therapy |
Revision as of 18:17, 19 May 2019
Adapted from the NCCN[1], ASCO[2] and MASCC/ESMO[3]
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: <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 (2019) | ASCO emetogenic potential
(2017) |
MASCC/ESMO emetogenic potential (2016) | Comment |
---|---|---|---|---|
Ado-trastuzumab emtansine (Kadcyla) | 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) | High/Moderate | High | NCCN did not further delineate between degrees of emetic potential | |
Amifostine (Ethyol) | Moderate: >300 mg/m2 Low: ≤300 mg |
|||
Arsenic trioxide (Trisenox) | Moderate | |||
Asparaginase (Elspar) | Minimal | |||
Atezolizumab | Low | |||
Axitinib (Inlyta) (oral) | Low/Minimal | Low | ||
Azacitidine (Vidaza) | Moderate | Moderate | Moderate | |
Bendamustine | Moderate | Moderate | Moderate | |
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 | Low | |||
Bortezomib (Velcade) | Minimal | Low | Low | |
Bosutinib (Bosulif) (oral) | Low/Minimal | Moderate | Moderate | |
Brentuximab vedotin (Adcetris) | Low | Low | ||
Busulfan (Myleran) | High/Moderate: ≥4 mg/day Low/Minimal: <4 mg/day |
Minimal | Minimal | |
Busulfan (Myleran) (oral) | High/Moderate: ≥4 mg/day Low/Minimal: <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
Moderate: AUC <4 |
Moderate (but recommended triplet combination of NK1, 5-HT3, and Dex if AUC ≥4) | 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 | 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 |
Cladribine (Leustatin) | Minimal | Minimal | Minimal | |
Clofarabine (Clolar) | Moderate | Moderate | Moderate | |
Crizotinib (Xalkori) (oral) | High/Moderate | Moderate | Moderate | |
Cyclophosphamide (Cytoxan) | High: >1500 mg/m2 or when given with certain anthracyclines Moderate: ≤1500 mg/m2 |
High: ≥1500 mg/m2 or when given with anthracyclines Moderate: <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 Low/Minimal: <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: <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 | 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 when given at any dose with Cyclophosphamide (Cytoxan) Moderate: <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: ≥2 g/m2 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 Low: >5, <10 million international units/m2 Minimal: ≤5 million international units/m2 |
NCCN did not specify interferon alfa-2a vs. 2b | ||
Interferon alfa-2b (Intron-A) | Moderate: ≥10 million international units/m2 Low: >5, <10 million international units/m2 Minimal: ≤5 million international units/m2 |
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 | Moderate | |||
Lomustine (CCNU) (oral) | High/Moderate (single day) | single day; NCCN did not further delineate between degrees of emetic potential | ||
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 Low: >50, <250 mg/m2 Minimal: ≤50 mg/m2 |
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 | |
Ofatumumab (Arzzera) | Minimal | Minimal | ||
Omacetaxine (Synribo) | Low | |||
Oxaliplatin (Eloxatin) | Moderate | Moderate | Moderate | |
Paclitaxel (Taxol) | Low | Low | Low | |
Paclitaxel, nanoparticle albumin-bound (Abraxane) | Low | Low | ||
Panitumumab (Vectibix) | Minimal | |||
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 (PegIntron) | Minimal | NCCN did not specify interferon alfa-2a vs. 2b | ||
Pemetrexed (Alimta) | Low | Low | Low | |
Pentostatin (Nipent) | Low | |||
Pertuzumab (Perjeta) | Minimal | Low | ||
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 | ||
Ruxolitinib (Jakafi) (oral) | Low/Minimal | Minimal | ||
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 | ||
Trametinib (Mekinist) (oral) | Low/Minimal | |||
Trastuzumab (Herceptin) | Minimal | Low | Minimal | |
All-trans retinoic acid (ATRA) (oral) | Low/Minimal | NCCN did not further delineate between degrees of emetic potential | ||
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 | |||
Vinorelbine (Navelbine) | Minimal | Minimal | Minimal | |
Vinorelbine (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 |
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 2016 | NK1 + 5-HT3 + DEX | DEX
(if APR on day 1, then +APR days 2-3) |
NCCN 2019 | - NK1 + 5-HT3 + DEX + OLN | DEX + OLN |
- NK1 + 5-HT3 + DEX | DEX | |
- OLN + 5-HT3 + 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
- 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
Note: a 4-drug regimen based on Navari et al. 2016[8]
- 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
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 2019 | - 5-HT3 + DEX | DEX or 5-HT3 |
- NK1 + 5-HT3 + DEX
(for selected patients with additional risk factors or previous Rx failure) |
+/- DEX | |
- OLN + 5-HT3 + 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 |
NK1 + 5-HT3 + DEX | NONE
(if APR on day 1, then +APR days 2-3) |
MASCC 2016 (MEC)
(doesn’t specify AUC) |
NK1 + 5-HT3 + DEX | NONE
(if APR on day 1, then +APR days 2-3) |
NCCN 2019
AUC ≥ 4 (HEC) AUC < 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 for done 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
Allogeneic BMT conditioning regimens
Conditioning regimen | CINV prophylaxis |
---|---|
FMT (fludarabine, melphalan, thiotepa) | - Fosaprepitant on day -7
- Ondansetron on days -7 to -1 |
Flu/Mel (fludarabine, melphalan) | - Fosaprepitant on day -2
- Ondansetron on days -6 to -1 - Dexamethasone on days -6 to -1 |
Flu/Cy/TBI (fludarabine, cyclophosphamide, total body irradiation) | |
Cy/TBI (cyclophosphamide, total body irradiation) | - Fosaprepitant on day -6
- Ondansetron on days -6 to -1 - Dexamethasone on days -6 to -4 |
Bu/Flu (bufulfan, fludarabine) | |
Bu/Cy (busulfan, cyclophosphamide) |
Autologous BMT conditioning regimens
Conditioning regimen | CINV prophylaxis |
---|---|
High dose melphalan | |
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 2019 | 5-HT3 or DEX or Dopamine RA
5-HT3 other than palonosetrone |
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) 10mg 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) 10mg 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 [12]. Use 5 mg if 10mg is not well tolerated.[13]
Metoclopromide
- Metoclopramide (Reglan) 10 mg PO (IV) every 8 hours on days 1-3 if CINV develop in the first 24 hours after HEC [12].
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
- 10mg 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 2 mg PO the night before and the morning of treatment
Reference
- ↑ NCCN antiemesis guidelines
- ↑ Antiemetics: American Society of Clinical Oncology Clinical Practice Guideline Update
- ↑ 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://www.ncbi.nlm.nih.gov/pubmed/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://www.ncbi.nlm.nih.gov/pubmed/27176138
- ↑ 12.0 12.1 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