Emetogenic Potential of Antineoplastic Agents

EMETOGENIC POTENTIAL OF ANTINEOPLASTIC AGENTS High Risk (>90% frequency without antiemetics) AC combination: Doxorubicin or Epirubicin (Ellence) + Doxorubicin IV: >60mg/m2 Cyclophosphamide (Cytoxan) IV Epirubicin (Ellence) IV: >90mg/m2 Altretamine (HMM, Hexalen) oral Ifosfamide (Ifex) IV: ≥2g/m2 per dose Carmustine (BCNU, BiCNU) IV: >250mg/m2 Mechlorethamine (Mustargen) IV Cisplatin (CDDP) IV Procarbazine (Matulane) oral Cyclophosphamide (CTX, Cytoxan) IV: >1,500mg/m2 Streptozocin (Zanosar) IV Dacarbazine (DTIC, DTIC-Dome) IV Moderate Risk (30–90% frequency without antiemetics) Aldesleukin (IL-2, Proleukin) IV: >12–15 million IU/m2 Doxorubicin IV: ≤60mg/m2 Amifostine (Ethyol) IV: >300mg/m2 Epirubicin (Ellence) IV: ≤90mg/m2 Arsenic trioxide (As2O3, Trisenox) IV Estramustine (Emcyt) oral Azacitidine (Vidaza) IV Etoposide (VP-16) oral Bendamustine (Treanda) IV Idarubicin (Idamycin) IV Busulfan (Busulfex) IV; oral: >4mg/day Ifosfamide (Ifex) IV: <2g/m2 Carboplatin IV Interferon alpha (IFN-alfa, Intron A) IV: ≥10 million IU/m2 Carmustine (BCNU, BiCNU) IV: ≤250mg/m2 Irinotecan (CPT-11, Camptosar) IV Clofarabine (Clolar) IV Lomustine (CCNU, CeeNU) oral Cyclophosphamide (CTX, Cytoxan) IV: ≤1,500mg/m2 Melphalan (L-PAM, Alkeran) IV Cyclophosphamide (CTX) oral ≥100mg/m2/day Methotrexate (MTX) IV: ≥250mg/m2 Cytarabine (ARA-C) IV: >200mg/m2 Oxaliplatin (Eloxatin) IV Dactinomycin (Cosmegen) IV Temozolomide (Temodar) IV; oral >75mg/m2/day Daunorubicin (Cerubidine) IV Low Risk (10–30% frequency without antiemetics) Aldesleukin (IL-2, Proleukin) IV: ≤12 million IU/m2 Gemcitabine (Gemzar) IV Amifostine (Ethyol) IV: ≤300mg Interferon alpha (IFN-alfa, Intron A) IV: >5–<10 million IU/m2 Bexarotene (Targretin) oral Ixabepilone (Ixempra) IV Cabazitaxel (Jevtana) IV Methotrexate (MTX) IV: >50mg/m2 to <250mg/m2 Capecitabine (Xeloda) oral Mitomycin (MTC) IV Cyclophosphamide (CTX) oral <100mg/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: ≤50mg/m2; oral Bevacizumab (Avastin) IV Nelarabine (Arranon) IV Bleomycin IV Niltoinib (Tasigna) oral Bortezomib (Velcade) IV Ofatumumab (Arzerra) IV Busulfan (Busulfex) oral: <4mg/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: <100mg/m2 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: ≤75mg/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: ≤5 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 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)