EMETOGENIC POTENTIAL OF ANTINEOPLASTIC AGENTS High Risk (>90% frequency without antiemetics) • AC combination: Doxorubicin or Epirubicin (Ellence) ϩ • Doxorubicin IV: >60mg/m2 Cyclophosphamide (Cytoxan) IV • Epirubicin (Ellence) IV: >90mg/m 2 • Altretamine (HMM, Hexalen) oral • Ifosfamide (Ifex) IV: Ն2g/m 2 per dose • Carmustine (BCNU, BiCNU) IV: Ͼ250mg/m 2 • Mechlorethamine (Mustargen) IV • Cisplatin (CDDP) IV • Procarbazine (Matulane) oral • Cyclophosphamide (CTX, Cytoxan) IV: Ͼ1,500mg/m2 • Streptozocin (Zanosar) IV • Dacarbazine (DTIC, DTIC-Dome) IV Moderate Risk (30–90% frequency without antiemetics) • Aldesleukin (IL-2, Proleukin) IV: Ͼ12–15 million IU/m2 • Doxorubicin IV: Յ60mg/m2 • Amifostine (Ethyol) IV: Ͼ300mg/m2 • Epirubicin (Ellence) IV: Յ90mg/m 2
• Arsenic trioxide (As2 O3 , Trisenox) IV • Estramustine (Emcyt) oral • Azacitidine (Vidaza) IV • Etoposide (VP-16) oral • Bendamustine (Treanda) IV • Idarubicin (Idamycin) IV • Busulfan (Busulfex) IV ; oral: Ͼ4mg/day • Ifosfamide (Ifex) IV: Ͻ2g/m 2 • Carboplatin IV • Interferon alpha (IFN-alfa, Intron A) IV: Ն10 million IU/m2 • Carmustine (BCNU, BiCNU) IV: Յ250mg/m2 • Irinotecan (CPT-11, Camptosar) IV • Clofarabine (Clolar) IV • Lomustine (CCNU, CeeNU) oral • Cyclophosphamide (CTX, Cytoxan) IV: Յ1,500mg/m2 • Melphalan (L-PAM, Alkeran) I V • Cyclophosphamide (CTX) oral Ն100mg/m2 /day • Methotrexate (MTX) IV: Ն250mg/m 2 • Cytarabine (ARA-C) IV: Ͼ200mg/m2 • Oxaliplatin (Eloxatin) IV • Dactinomycin (Cosmegen) IV • Temozolomide (Temodar) IV; oral Ͼ75mg/m 2 /day • Daunorubicin (Cerubidine) IV Low Risk (10–30% frequency without antiemetics) • Aldesleukin (IL-2, Proleukin) IV: Յ12 million IU/m 2 • Gemcitabine (Gemzar) IV • Amifostine (Ethyol) IV: Յ300mg • Interferon alpha (IFN-alfa, Intron A) IV: Ͼ5–Ͻ10 million IU/m 2 • Bexarotene (Targretin) oral • Ixabepilone (Ixempra) IV • Cabazitaxel (Jevtana) IV • Methotrexate (MTX) IV: Ͼ50mg/m 2 to Ͻ250mg/m 2 • Capecitabine (Xeloda) oral • Mitomycin (MTC) IV • Cyclophosphamide (CTX) oral Ͻ100mg/m2 /day • Mitoxantrone (DHAD) IV • Cytarabine (ARA-C) IV: 100–200mg/m2 • Paclitaxel (Taxol) IV • Docetaxel (Taxotere) IV • Paclitaxel albumin (Abraxane) IV • Doxorubicin liposomal (Doxil) IV • Pemetrexed (Alimta) IV • Eribulin (Halaven) IV • Pentostatin IV • Etoposide (VP-16, Etopophos) IV • Pralatrexate (Folotyn) IV • Floxuridine IV • Romidepsin (Istodax) IV • Fludarabine (Fludara) oral • Thiotepa IV • Fluorouracil (5-FU) IV • Topotecan (Hycamtin) IV , oral Minimal Risk (<10% frequency without antiemetics) • Alemtuzumab (Campath) IV • Methotrexate (MTX) IV: Յ50mg/m 2 ; oral • Bevacizumab (Avastin) IV • Nelarabine (Arranon) IV • Bleomycin IV • Niltoinib (Tasigna) oral • Bortezomib (Velcade) IV • Ofatumumab (Arzerra) IV • Busulfan (Busulfex) oral: Ͻ4mg/day • Panitumumab (Vectibix) IV • Cetuximab (Erbitux) IV • Pazopanib (Votrient) oral • Chlorambucil (Leukeran) oral • Pegasparagase (Oncaspar) IV • Cladribine (2-CdA) IV • Peginterferon IV • Cytarabine (ARA-C) IV: Ͻ100mg/m 2 • Rituximab (Rituxan) IV • Dasatinib (Sprycel) oral • Sorafenib (Nexavar) oral • Decitabine (Dacogen) IV • Sunitinib (Sutent) oral • Denileukin diftitox (Ontak) IV • Temsirolimus (Torisel) IV • Dexrazoxane (Totect, Zinecard) IV • Temozolamide (Temodar) oral: Յ75mg/m2 /day • Erlotinib (Tarceva) oral • Thalidomide (Thalomid) oral • Everolimus (Afinitor, Zortress) oral • Thioguanine (6-TG,Tabloid) oral • Fludarabine (Fludara) IV • Trastuzumab (Herceptin) IV • Hydroxyurea (Hydrea) oral • Tretinoin (Vesanoid) oral • Imatinib (Gleevec) oral • Valrubicin (Valstar) IV • Interferon alpha (IFN-alfa, Intron A) IV: Յ5 million IU/m2 • Vandetanib (Caprelsa) oral • Ipilimumab (Yervoy) IV • Vinblastine (VLB) IV • Lapatinib (Tykerb) oral • Vincristine (VCR) IV • Lenalidomide (Revlimid) oral • Vinorelbine (Navelbine) IV • Melphalan (L-PAM, Alkeran) oral • Vorinostat (Zolinza) oral • Mercaptopurine (purinethol) oral NOTES Daily use of antiemetics is not recommended based on clinical experience. REFERENCES Adapted from: 1. Kris MG, Hesketh PJ, Somerfield MR, et al. American Society of Clinical Oncology Guideline for Antiemetics in Oncology: Update 2006. J Clin Oncol 2006;24:2932-2947. 2. National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology; v.1.2012: Antiemesis. Available at: http://www.nccn.org/professionals/physician_gls/PDF/antiemesis.pdf . Accessed August 8, 2012. (Rev. 6/2014)