Chemotherapy-Induced Nausea and Vomiting Prophylaxis

Key: 5HT₃ = 5-hydroxytryptamine-3 (serotonin); AUC = area under the curve; CINV = chemotherapy induced nausea and vomiting; IV = intravenous; NK₁ = neurokinin 1; PO = oral; SC = subcutaneous

¹  For emetic risk category of chemotherapeutic agents, see “Emetogenic Potential of Antineoplastic Agent” chart.

²  Adults treated with antineoplastic combinations should receive the antiemetic regimen appropriate for the component antineoplastic agent of greatest emetic risk.

³  For adults treated with carboplatin AUC ≥4mg/mL (emetic risk is at the higher end of the moderate-emetic risk category), add NK₁ receptor antagonist for a 3-drug regimen. Dexamethasone dosing is Day 1 only: 20mg with rolapitant, and 12mg with aprepitant, fosaprepitant, or netupitant-palonosetron.

⁴  Give antiemetic regimen on the day of chemotherapy (single-day) before the dose of the antineoplastic agent. For multi-day chemotherapy, first determine the emetic risk of the agent(s) included in the regimen. Patients should receive the agent of the highest therapeutic index daily during chemotherapy and for 2 days thereafter. Granisetron transdermal patch or granisetron ext-rel inj, which deliver therapy over multiple days rather than a daily 5-HT₃ receptor antagonist, can be given.

⁵  If netupitant-palonosetron or fosnetupitant-palonosetron is used, no additional 5-HT₃ receptor antagonist is needed.

⁶  Dexamethasone dosing is for patients receiving the recommended 4-drug regimen for high-emetic risk. If NK₁ receptor antagonist was omitted, the dexamethasone dose should be adjusted to 20mg on Day 1 and 16mg on Days 2–4.

⁷  If rolapitant is used, give with dexamethasone 20mg PO or IV on Day 1, and 8mg PO or IV twice daily on Days 2–4.

⁸  For cisplatin and other high-emetic-risk single agents, dexamethasone and olanzapine should be continued on Days 2–4. For anthracycline + cyclophosphamide regimens, only continue olanzapine on Days 2–4.

⁹  If fosaprepitant is used, give with dexamethasone 8mg PO or IV on Day 2, and 8mg PO or IV twice daily on Days 3–4.

¹⁰ For moderate-emetic risk agents that are known to cause delayed nausea & vomiting (eg, cyclophosphamide, doxorubicin, oxaliplatin), may continue dexamethasone on Days 2–3.

(Rev 5/2023)