- Prophylactic therapy should be given prior to moderately to highly emetogenic agents or radiation
- They should be scheduled for after chemo to prevent delated N/V
- Lorazepam is useful for anticipatory nausea/vomiting, but can also just change routine
Chemo agents with high emetic risks:
- Day 1 = 3 agents
- neurokinin-1 antagonist (fosaprepitant)
- serotonin 3 antagonist (ondansetron)
- steroid
- Day 2-3 = 2 agents
- neurokinin-1
- steroid
Chemo agents with moderate emetic risks:
- Day 1 = 2 drugs only
- serotonin 3 antagonist (ondansetron)
- steroid
| IV | HIGHLY EMETOGENIC RISK (>90% FREQUENCY) | |
| AC (doxorubicin or epirubicin with cyclophosphamide)
Carmustine > 250mg/m2 Cisplatin Cyclophosphamide > 1500mg/m2 Dacarbazine |
Doxorubicin > 60mg/m2
Epirubicin > 90mg/m2 Ifosfamide ≥ 2g/m2/dose Mechlorethamine Streptozocin |
|
| MODERATELY EMETOGENIC RISK (30-90% FREQUENCY) | ||
| Carboplatin/Oxaliplatin
Carmustine ≤ 250mg/m2 Clofarabine Cyclophosphamide ≤ 1500mg/m2 Daunorubicin |
Doxorubicin < 60mg/m2
Epirubicin < 90 mg/m2 Idarubicin Ifosfamide < 2g/m2/dose Methotrexate ≥ 250 mg/m2 |
|
| PO | HIGH TO MODERATE EMETOGENIC RISK (PROPHYLAXIS RECOMMENDED) | |
| Altretamine
Busulfan ≥ 4mg/day Crisotinib Cyclophosphamide ≥100 mg/m2/day Estramustine Etoposide |
Lomustine (single day)
Mitotane Procarbazine Temozolomide > 75mg/m2/day Vismodegib |
|