Systematic Review-Based Recommendations
Chemotherapy-Induced Nausea and Vomiting (CINV) Highly Emetogenic Agents
ÎThe three-drug combination of an NK1 aprepitant; day 1 only for fosaprepitant), a 5-HT3
receptor antagonist (days 1-3 for receptor antagonist (day
1 only), and dexamethasone (days 1-3 or 1-4) is recommended for patients receiving highly emetogenic chemotherapy. The Update Committee also recommended reclassification of the combined anthracycline and cyclophosphamide (AC) regimen as highly emetogenic.
Moderately Emetogenic Agents
ÎThe two-drug combination of palonosetron (day 1 only) and dexamethasone (days 1-3) is recommended for patients receiving moderately emetogenic chemotherapy.
a first generation 5-HT3
If palonosetron is not available, clinicians may substitute serotonin receptor antagonist, preferably
granisetron or ondansetron. Limited evidence also supports adding aprepitant to the combination. Should clinicians opt to add aprepitant in patients receiving moderate-risk chemotherapy, any one of the 5-HT3 antagonists is appropriate.
Low Emetogenic Agents
ÎA single 8 mg dose of dexamethasone before chemotherapy is suggested. Minimally Emetogenic Agents
ÎNo antiemetic should be administered routinely before or after chemotherapy.
Combination Chemotherapy
ÎPatients should be administered antiemetics appropriate for the component chemotherapeutic (antineoplastic) agent of greatest emetic risk. AC combinations are now classified as highly emetogenic.
Adjunctive Drugs
ÎLorazepam and diphenhydramine are useful adjuncts to antiemetic drugs but are not recommended as single agent antiemetics.
Complementary Therapy
ÎNo published randomized controlled trial data that met inclusion criteria are currently available to support a recommendation about such therapies.
