EMETOGENIC POTENTIAL OF ANTINEOPLASTIC AGENTS (Part 1 of 2) INTRAVENOUS/INJECTABLE AGENTS HIGH RISK (>90% frequency)† AC combination: any regimen containing anthracycline + Dacarbazine cyclophosphamide Doxorubicin ≥60mg/m² Carboplatin AUC ≥4 Epirubicin (Ellence) >90mg/m² Carmustine (BiCNU) >250mg/m² Ifosfamide (Ifex) ≥2g/m² per dose Cisplatin Mechlorethamine Cyclophosphamide >1,500mg/m² Streptozocin (Zanosar) MODERATE RISK (>30–90% frequency)† Aldesleukin (Proleukin) >12−15 million IU/m² Dual-drug liposomal cytarabine + daunorubicin (Vyxeos) Amifostine (Ethyol) >300mg/m² Dinutuximab (Unituxin) Arsenic trioxide (Trisenox) Doxorubicin <60mg/m²* Azacitidine (Vidaza) Epirubicin (Ellence) ≤90mg/m²* Bendamustine (Treanda) Idarubicin (Idamycin PFS) Busulfan (Busulfex) Ifosfamide (Ifex) <2g/m² per dose* Carboplatin AUC <4* Interferon alfa (Intron A) ≥10 million IU/m² Carmustine (BiCNU) ≤250mg/m²* Irinotecan (Camptosar)* Clofarabine (Clolar) Melphalan (Alkeran, Evomela) Cyclophosphamide ≤1,500mg/m² Methotrexate ≥250 mg/m²* Cytarabine >200mg/m² Oxaliplatin (Eloxatin)* Dactinomycin (Cosmegen)* Temozolomide (Temodar) Daunorubicin (Cerubidine)* Trabectedin (Yondelis)* LOW RISK (10–30% frequency)† Ado-trastuzumab emtansine (Kadcyla) Interferon alfa (Intron A) >5−<10 million IU/m² Aldesleukin (Proleukin) ≤12 million IU/m² Ixabepilone (Ixempra) Amifostine (Ethyol) ≤300mg/m² Methotrexate >50mg/m²−<250mg/m² Axicabtagene ciloleucel (Yescarta) Mitomycin Belinostat (Beleodaq) Mitoxantrone Brentuximab vedotin (Adcetris) Necitumumab (Portrazza) Cabazitaxel (Jevtana) Olaratumab (Lartruvo) Carfilzomib (Kyprolis) Omacetaxine (Synribo) Copanlisib (Aliqopa) Paclitaxel (Taxol) Cytarabine (low dose) 100−200mg/m² Paclitaxel-albumin (Abraxane) Docetaxel (Taxotere) Pemetrexed (Alimta) Doxorubicin liposomal (Doxil) Pentostatin Eribulin (Halaven) Pralatrexate (Folotyn) Etoposide (Etopophos) Romidepsin (Istodax) Floxuridine Talimogene laherparepvec (Imlygic) Fluorouracil (5-FU) Thiotepa (Tepadina) Gemcitabine (Gemzar) Tisagenlecleucel (Kymriah) Gemtuzumab ozogamicin Topotecan (Hycamtin) Inotuzumab ozogamicin (Besponsa) Ziv-aflibercept (Zaltrap) MINIMAL RISK (<10% frequency)† Alemtuzumab (Campath) Nelarabine (Arranon) Atezolizumab (Tecentriq) Nivolumab (Opdivo) Avelumab (Bavencio) Obinutuzumab (Gazyva) Asparaginase (Erwinaze) Ofatumumab (Arzerra) Bevacizumab (Avastin) Panitumumab (Vectibix) Bleomycin Pegasparagase (Oncaspar) Blinatumomab (Blincyto) Peginterferon (Sylatron) Bortezomib (Velcade) Pembrolizumab (Keytruda) Cetuximab (Erbitux) Pertuzumab (Perjeta) Cladribine Ramucirumab (Cyramza) Cytarabine <100mg/m² Rituximab (Rituxan) Daratumumab (Darzalex) Rituximab + hyaluronidase (Rituxan Hycela) Decitabine (Dacogen) Siltuximab (Sylvant) Denileukin diftitox (Ontak) Temsirolimus (Torisel) Dexrazoxane (Totect, Zinecard) Trastuzumab (Herceptin) Durvalumab (Imfinzi) Valrubicin (Valstar) Elotuzumab (Empliciti) Vinblastine Fludarabine Vincristine Interferon alfa (Intron A) ≤5 million IU/m² Vincristine liposomal (Marqibo) Ipilimumab (Yervoy) Vinorelbine (Navelbine) Methotrexate ≤50mg/m² (continued) EMETOGENIC POTENTIAL OF ANTINEOPLASTIC AGENTS (Part 2 of 2) ORAL AGENTS MODERATE TO HIGH RISK (≥30% frequency)† Altretamine (Hexalen) Lomustine single day (Gleostine) Busulfan (Myleran) ≥4mg/day Midostaurin (Rydapt) Ceritinib (Zykadia) Mitotane (Lysodren) Crizotinib (Xalkori) Niraparib (Zejula) Cyclophosphamide ≥100mg/m²/day Olaparib (Lynparza) Dabrafenib (Tafinlar) Procarbazine (Matulane) Enasidenib (Idhifa) Rucaparib (Rubraca) Estramustine (Emcyt) Temozolomide (Temodar) >75mg/m²/day Etoposide Trifluridine/tipiracil (Lonsurf) Lenvatinib (Lenvima) MINIMAL TO LOW RISK (<30% frequency)† Abemaciclib (Verzenio) Larotrectinib (Vitrakvi) Acalabrutinib (Calquence) Lenalidomide (Revlimid) Afatinib (Gilotrif) Lorlatinib (Lorbrena) Alectinib (Alecensa) Melphalan (Alkeran) Axitinib (Inlyta) Mercaptopurine Bexarotene (Targretin) Methotrexate Binimetinib (Mektovi) Neratinib (Nerlynx) Brigatinib (Alunbrig) Nilotinib (Tasigna) Bosutinib (Bosulif) Osimertinib (Tagrisso) Busulfan (Myleran) <4mg/day Palbociclib (Ibrance) Cabozantinib (Cabometyx, Cometriq) Panobinostat (Farydak) Capecitabine (Xeloda) Pazopanib (Votrient) Chlorambucil (Leukeran) Pomalidomide (Pomalyst) Cobimetinib (Cotellic) Ponatinib (Iclusig) Cyclophosphamide <100mg/m²/day Regorafenib (Stivarga) Dacomitinib (Vizimpro) Ribociclib (Kisqali) Dasatinib (Sprycel) Ruxolitinib (Jakafi) Duvelisib (Copiktra) Sonidegib (Odomzo) Encorafenib (Braftovi) Sorafenib (Nexavar) Erlotinib (Tarceva) Sunitinib (Sutent) Everolimus (Afinitor) Talazoparib tosylate (Talzenna) Fludarabine Temozolomide (Temodar) ≤75mg/m²/day Gefitinib (Iressa) Thalidomide (Thalomid) Gilteritinib (Xospata) Thioguanine Glasdegib (Daurismo) Topotecan (Hycamtin) Hydroxyurea (Hydrea) Trametinib (Mekinist) Ibrutinib (Imbruvica) Tretinoin Idelalisib (Zydelig) Vandetanib (Caprelsa) Imatinib (Gleevec) Vemurafenib (Zelboraf) Ivosidenib (Tibsovo) Venetoclax (Venclexta) Ixazomib (Ninlaro) Vismodegib (Erivedge) Lapatinib (Tykerb) 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. https://www.nccn.org/professionals/physician_gls/pdf/antiemesis.pdf. Accessed January 23, 2020. (Rev. 2/2020).