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

Cisplatin

Cyclophosphamide >1,500mg/m²

Dacarbazine

Doxorubicin ≥60mg/m²

Epirubicin (Ellence) >90mg/m²

Ifosfamide (Ifex) ≥2g/m² per dose

Mechlorethamine

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

Axicabtagene ciloleucel (Yescarta)

Belinostat (Beleodaq)

Brentuximab vedotin(Adcetris)

Cabazitaxel (Jevtana)

Carfilzomib (Kyprolis)

Copanlisib (Aliqopa)

Cytarabine (low dose) 100−200mg/m²

Docetaxel (Taxotere)

Doxorubicin liposomal (Doxil)

Eribulin (Halaven)

Etoposide (Etopophos)

Floxuridine

Fluorouracil (5-FU)

Gemcitabine (Gemzar)

Gemtuzumab ozogamicin

Inotuzumab ozogamicin (Besponsa)

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

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)

Tisagenlecleucel (Kymriah)

Topotecan (Hycamtin)

Ziv-aflibercept (Zaltrap)

MINIMAL RISK (<10% frequency)

Alemtuzumab (Campath)

Atezolizumab (Tecentriq)

Avelumab (Bavencio)

Asparaginase (Erwinaze)

Bevacizumab (Avastin)

Bleomycin

Blinatumomab (Blincyto)

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

Dabrafenib (Tafinlar)

Enasidenib (Idhifa)

Estramustine (Emcyt)

Etoposide

Lenvatinib (Lenvima)

Lomustine single day (Gleostine)

Midostaurin (Rydapt)

Mitotane (Lysodren)

Niraparib (Zejula)

Olaparib (Lynparza)

Procarbazine (Matulane)

Rucaparib (Rubraca)

Temozolomide (Temodar) >75mg/m²/day

Trifluridine/tipiracil (Lonsurf)

MINIMAL TO LOW RISK (<30% frequency)

Abemaciclib (Verzenio)

Acalabrutinib (Calquence)

Afatinib (Gilotrif)

Alectinib (Alecensa)

Axitinib (Inlyta)

Bexarotene (Targretin)

Binimetinib (Mektovi)

Brigatinib (Alunbrig)

Bosutinib (Bosulif)

Busulfan (Myleran) <4mg/day

Cabozantinib (Cabometyx, Cometriq)

Capecitabine (Xeloda)

Chlorambucil (Leukeran)

Cobimetinib (Cotellic)

Cyclophosphamide <100mg/m²/day

Dacomitinib (Vizimpro)

Dasatinib (Sprycel)

Duvelisib (Copiktra)

Encorafenib (Braftovi)

Erlotinib (Tarceva)

Everolimus (Afinitor)

Fludarabine

Gefitinib (Iressa)

Gilteritinib (Xospata)

Glasdegib (Daurismo)

Hydroxyurea (Hydrea)

Ibrutinib (Imbruvica)

Idelalisib (Zydelig)

Imatinib (Gleevec)

Ivosidenib (Tibsovo)

Ixazomib (Ninlaro)

Lapatinib (Tykerb)

Larotrectinib (Vitrakvi)

Lenalidomide (Revlimid)

Lorlatinib (Lorbrena)

Melphalan (Alkeran)

Mercaptopurine

Methotrexate

Neratinib (Nerlynx)

Nilotinib (Tasigna)

Osimertinib (Tagrisso)

Palbociclib (Ibrance)

Panobinostat (Farydak)

Pazopanib (Votrient)

Pomalidomide (Pomalyst)

Ponatinib (Iclusig)

Regorafenib (Stivarga)

Ribociclib (Kisqali)

Ruxolitinib (Jakafi)

Sonidegib (Odomzo)

Sorafenib (Nexavar)

Sunitinib (Sutent)

Talazoparib tosylate (Talzenna)

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 1.2019 – February 28, 2019. http://www.nccn.org/professionals/physician_gls/PDF/antiemesis.pdf. Accessed January 23, 2020.

(Rev. 2/2020)

This article originally appeared on MPR