Emetogenic Potential of Antineoplastic Agents
| EMETOGENIC POTENTIAL OF ANTINEOPLASTIC AGENTS | |
|---|---|
| INTRAVENOUS/INJECTABLE AGENTS | |
| HIGH RISK (>90% frequency)† | |
|
AC combination: any regimen containing anthracycline + cyclophosphamide Carboplatin AUC ≥4 Carmustine (BiCNU) >250mg/m² Cyclophosphamide >1,500mg/m² |
Doxorubicin ≥60mg/m² Epirubicin (Ellence) >90mg/m² Ifosfamide (Ifex) ≥2g/m² per dose Mechlorethamine (Mustargen) Streptozocin (Zanosar) |
| MODERATE RISK (>30−90% frequency)† | |
|
Aldesleukin (Proleukin) >12−15 million IU/m² Amifostine (Ethyol) >300mg/m² Arsenic trioxide (Trisenox) Azacitidine (Vidaza) Bendamustine (Treanda) Busulfan (Busulfex) Carboplatin AUC <4* Carmustine (BiCNU) ≤250mg/m²* Clofarabine (Clolar) Cyclophosphamide ≤1,500mg/m² Cytarabine >200mg/m² Dactinomycin (Cosmegen)* Daunorubicin (Cerubidine)* |
Dual-drug liposomal cytarabine + daunorubicin (Vyxeos) Dinutuximab (Unituxin) Doxorubicin <60mg/m²* Epirubicin (Ellence) ≤90mg/m²* Idarubicin (Idamycin PFS) Ifosfamide (Ifex) <2g/m² per dose* Interferon alfa (Intron A) ≥10 million IU/m² Irinotecan (Camptosar)* Methotrexate ≥250 mg/m²* Oxaliplatin (Eloxatin)* Temozolomide (Temodar) Trabectedin (Yondelis)* |
| LOW RISK (10−30% frequency)† | |
|
Ado-trastuzumab emtansine (Kadcyla) Aldesleukin (Proleukin) ≤12 million IU/m² Amifostine (Ethyol) ≤300mg/m² Atezolizumab (Tecentriq) Belinostat (Beleodaq) Blinatumomab (Blincyto) Brentuximab vedotin(Adcetris) Cabazitaxel (Jevtana) Carfilzomib (Kyprolis) Cytarabine (low dose) 100−200mg/m² Docetaxel (Taxotere) Doxorubicin liposomal (Doxil) Eribulin (Halaven) Etoposide (Etopophos) Fluorouracil (5-FU) Gemcitabine (Gemzar) Interferon alfa (Intron A) >5−<10 million IU/m² |
Irinotecan liposomal (Onivyde) Ixabepilone (Ixempra) Methotrexate >50mg/m²−<250mg/m² Necitumumab (Portrazza) Olaratumab (Lartruvo) Omacetaxine (Synribo) Paclitaxel (Taxol) Paclitaxel albumin (Abraxane) Pemetrexed (Alimta) Pralatrexate (Folotyn) Romidepsin (Istodax) Talimogene laherparepvec (Imlygic) Thiotepa (Tepadina) Topotecan (Hycamtin) Ziv-aflibercept (Zaltrap) |
| MINIMAL RISK (<10% frequency)† | |
|
Alemtuzumab (Campath) Avelumab (Bavencio) Asparaginase (Erwinaze) Bevacizumab (Avastin) Bortezomib (Velcade) Cetuximab (Erbitux) Cytarabine <100mg/m² Daratumumab (Darzalex) Decitabine (Dacogen) Denileukin diftitox (Ontak) Dexrazoxane (Totect, Zinecard) Durvalumab (Imfinzi) Elotuzumab (Empliciti) Interferon alfa (Intron A) ≤5 million IU/m² Ipilimumab (Yervoy) Methotrexate ≤50mg/m² Nelarabine (Arranon) |
Nivolumab (Opdivo) Obinutuzumab (Gazyva) Ofatumumab (Arzerra) Panitumumab (Vectibix) Pegaspargase (Oncaspar) Peginterferon (Sylatron) Pembrolizumab (Keytruda) Pertuzumab (Perjeta) Ramucirumab (Cyramza) Rituximab (Rituxan) Rituximab + hyaluronidase (Rituxan Hycela) Siltuximab (Sylvant) Temsirolimus (Torisel) Trastuzumab (Herceptin) Valrubicin (Valstar) Vincristine liposomal (Marqibo) Vinorelbine (Navelbine) |
| ORAL AGENTS | |
| MODERATE TO HIGH RISK (≥30% frequency)† | |
|
Altretamine (Hexalen) Busulfan (Myleran) ≥4mg/day Ceritinib (Zykadia) Crizotinib (Xalkori) Cyclophosphamide ≥100mg/m²/day Enasidenib (Idhifa) Estramustine (Emcyt) Lenvatinib (Lenvima) Lomustine single day (Gleostine) |
Midostaurin (Rydapt) Mitotane (Lysodren) Niraparib (Zejula) Olaparib (Lynparza) Panobinostat (Farydak) Procarbazine (Matulane) Rucaparib (Rubraca) Temozolomide (Temodar) >75mg/m²/day Trifluridine/tipiracil (Lonsurf) |
| MINIMAL TO LOW RISK (<30% frequency)† | |
|
Abemaciclib (Verzenio) Afatinib (Gilotrif) Alectinib (Alecensa) Axitinib (Inlyta) Bexarotene (Targretin) Brigatinib (Alunbrig) Bosutinib (Bosulif) Busulfan (Myleran) <4mg/day Cabozantinib (Cabometyx, Cometriq) Capecitabine (Xeloda) Chlorambucil (Leukeran) Cobimetinib (Cotellic) Cyclophosphamide <100mg/m²/day Dasatinib (Sprycel) Dabrafenib (Tafinlar) Erlotinib (Tarceva) Everolimus (Afinitor) Gefitinib (Iressa) Hydroxyurea (Hydrea) Ibrutinib (Imbruvica) Idelalisib (Zydelig) Imatinib (Gleevec) Ixazomib (Ninlaro) Lapatinib (Tykerb) Lenalidomide (Revlimid) Melphalan (Alkeran) |
Methotrexate Neratinib (Nerlynx) Nilotinib (Tasigna) Osimertinib (Tagrisso) Palbociclib (Ibrance) Pazopanib (Votrient) Pomalidomide (Pomalyst) Ponatinib (Iclusig) Regorafenib (Stivarga) Ribociclib (Kisqali) Ruxolitinib (Jakafi) Sonidegib (Odomzo) Sorafenib (Nexavar) Sunitinib (Sutent) Temozolomide (Temodar) ≤75mg/m²/day Thalidomide (Thalomid) Topotecan (Hycamtin) Trametinib (Mekinist) Vandetanib (Caprelsa) Vemurafenib (Zelboraf) Venetoclax (Venclexta) Vismodegib (Erivedge) Vorinostat (Zolinza) |
| NOTES | |
|
† Frequency of emesis in the absence of effective antiemetic prophylaxis. |
|
| REFERENCES | |
|
National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Antiemesis. Version 1.2018 – March 14, 2018. http://www.nccn.org/professionals/physician_gls/PDF/antiemesis.pdf. Accessed March 27, 2018. (Rev. 9/2018) |
|
This article originally appeared on MPR
