How do the guidelines for antiemetic regimens compare?

Updated: May 31, 2018
  • Author: Winston W Tan, MD, FACP; more...
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Answer

Answer

Recommended antiemetic agents by emetic-risk categories are shown in the table below.

Table. Antiemetic Treatment Recommendations (Open Table in a new window)

Risk Level

National Comprehensive Cancer Network Recommendations

American Society of Clinical Oncology Recommendations

Multinational Association for Supportive Care in Cancer/European Society for Medical Oncology Recommendations

High

Day 1 (before chemotherapy): NK1 RA + 5-HT3 RA + DEX or

Olanzapine + palonosetron +DEX or

NK1 RA + 5-HT3 RA + DEX + olanzapine

Days 2-4: Varies according to day 1 regimen

Day 1 (before chemotherapy): NK1 RA + 5-HT3 RA + DEX + olanzapine

Days 2-4: continue olanzapine on days 2-4

Add DEX on days 2-4 for high-emetic risk (non-AC)

Acute: 5-HT3 RA + NK1 RA + DEX

Delayed (non-AC): DEX

Delayed (non-AC) if APR 125 mg for acute: metoclopramide (MCP) + DEX or APR+ DEX

Delayed (AC): None

Delayed (AC) if APR 125 mg for acute: DEX or APR

Moderate

Day 1 (before chemotherapy): 5-HT3 RA + DEX or  Olanzapine + palonosetron +DEX orNK1 RA + 5-HT3 RA + DEX

Days 2-3:  Varies according to day 1 regimen

Treated with carboplatin area under the curve (AUC) ≥ 4 mg/mL/min: NK1 RA + 5-HT3 RA + DEX

Other moderate-risk regimens: 5-HT3 RA + DEX on day 1

Delayed: DEX on days 2-3

Acute (carboplatin regimens): 5-HT3 RA + DEX+ NK1 RA

Acute (excluding carboplatin-based): 5-HT3 RA + DEX

Delayed (carboplatin regimens): None

Delayed (carboplatin regimens) if APR 125 mg for acute: APR

Low

Start before chemotherapy: DEX or  MCP PO/IV or  prochlorperazine or  oral 5-HT3 RA

Acute: 5-HT3 RA or DEX

Acute: DEX or 5-HT3 RA ordopamine receptor antagonist (DOP)

Delayed: No routine prophylaxis

Minimal

No routine prophylaxis

No routine prophylaxis

No routine prophylaxis


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