2
Key Points
➤ The development of increasingly effective antiemetic regimens over
the last quarter century has greatly reduced the incidence of nausea
and vomiting due to chemotherapy.
➤ The recommended approach to preventing nausea and vomiting varies
by the emetic risk of the treatment regimen.
➤ Adherence to antiemetic guidelines has been linked with improved
control of nausea and vomiting.
Adult Patients
High-Emetic-Risk Antineoplastic Agents
➤ Adult patients treated with cisplatin and other high-emetic-risk single
agents should be offered a four-drug combination of an NK
1
receptor
antagonist, a serotonin (5-HT
3
) receptor antagonist, dexamethasone,
and olanzapine. Dexamethasone and olanzapine should be continued
on days 2–4 (Strong Recommendation; EB-H).
➤ Adult patients treated with an anthracycline combined with
cyclophosphamide should be offered a four-drug combination
of an NK
1
receptor antagonist, a 5-HT
3
receptor antagonist,
dexamethasone, and olanzapine. Olanzapine should be continued on
days 2–4 (Strong Recommendation; EB-H).
Moderate-Emetic-Risk Antineoplastic Agents
➤ Adult patients treated with carboplatin area under the curve (AUC)
≥4 mg/mL/min should be offered a three-drug combination of an NK
1
receptor antagonist, a 5-HT
3
receptor antagonist, and dexamethasone
(Strong Recommendation; EB-H).
➤ Adult patients treated with moderate-emetic-risk antineoplastic
agents (excluding carboplatin AUC ≥4 mg/mL/min) should be offered
a two-drug combination of a 5-HT
3
receptor antagonist (day 1) and
dexamethasone (day 1) (Strong Recommendation; EB-H).
➤ Adult patients treated with cyclophosphamide, doxorubicin,
oxaliplatin and other moderate-emetic-risk antineoplastic agents
known to cause delayed nausea and vomiting may be offered
dexamethasone on days 2–3 (Moderate Recommendation; IC-L).
Treatment
