Emetogenic Potential of Antineoplastic Agents

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         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

Cisplatin

Cyclophosphamide >1,500mg/m²

Dacarbazine

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)*

Melphalan (Alkeran, Evomela)

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)

Floxuridine

Fluorouracil (5-FU)

Gemcitabine (Gemzar)

Interferon alfa (Intron A) >5−<10 million IU/m²

Irinotecan liposomal (Onivyde)

Ixabepilone (Ixempra)

Methotrexate >50mg/m²−<250mg/m²

Mitomycin

Mitoxantrone

Necitumumab (Portrazza)

Olaratumab (Lartruvo)

Omacetaxine (Synribo)

Paclitaxel (Taxol)

Paclitaxel albumin (Abraxane)

Pemetrexed (Alimta)

Pentostatin

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)

Bleomycin

Bortezomib (Velcade)

Cetuximab (Erbitux)

Cladribine

Cytarabine <100mg/m²

Daratumumab (Darzalex)

Decitabine (Dacogen)

Denileukin diftitox (Ontak)

Dexrazoxane (Totect, Zinecard)

Durvalumab (Imfinzi)

Elotuzumab (Empliciti)

Fludarabine

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)

Vinblastine

Vincristine

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)

Etoposide

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)

Mercaptopurine

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)

Thioguanine

Topotecan (Hycamtin)

Trametinib (Mekinist)

Tretinoin

Vandetanib (Caprelsa)

Vemurafenib (Zelboraf)

Venetoclax (Venclexta)

Vismodegib (Erivedge)

Vorinostat (Zolinza)

NOTES

Frequency of emesis in the absence of effective antiemetic prophylaxis.
* May be highly emetogenic in certain patients.

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)

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