Emetogenic Potential of Antineoplastic Agents- MPR

Emetogenic Potential of Antineoplastic Agents

EMETOGENIC POTENTIAL OF ANTINEOPLASTIC AGENTS
INTRAVENOUS/INJECTABLE AGENTS
HIGH RISK (>90% frequency)^†
AC combination: any regimen containing anthracycline + cyclophosphamide Carboplatin AUC ≥4 Carmustine (BiCNU) >250mg/m² Cisplatin Cyclophosphamide >1,500mg/m² Dacarbazine	Doxorubicin ≥60mg/m² Epirubicin (Ellence) >90mg/m² Ifosfamide (Ifex) ≥2g/m² per dose Mechlorethamine Melphalan (Evomela) ≥140mg/m² Sacituzumab govitecan-hziy (Trodelvy) Streptozocin (Zanosar)
MODERATE RISK (>30−90% frequency)^†
Aldesleukin (Proleukin) >12−15 million IU/m² Amifostine (Ethyol) >300mg/m² Amivantamab-vmjw (Rybrevant) Azacitidine (Vidaza) Bendamustine (Treanda) Busulfan (Busulfex) Carboplatin AUC <4* Carmustine (BiCNU) ≤250mg/m²* Clofarabine (Clolar) Cyclophosphamide ≤1,500mg/m² Cytarabine >200mg/m² Dactinomycin (Cosmegen)* Daunorubicin (Cerubidine)* Dual-drug liposomal cytarabine + daunorubicin (Vyxeos) Dinutuximab (Unituxin)	Doxorubicin <60mg/m²* Epirubicin (Ellence) ≤90mg/m²* Fam-trastuzumab deruxtecan-nxki (Enhertu) Idarubicin (Idamycin PFS) Ifosfamide (Ifex) <2g/m² per dose* Irinotecan (Camptosar)* Irinotecan liposomal (Onivyde) Lurbinectedin (Zepzelca) Melphalan (Evomela) <140mg/m² Methotrexate ≥250 mg/m²* Naxitamab-gqgk (Danyelza) Oxaliplatin (Eloxatin)* Romidepsin (Istodax) Temozolomide (Temodar) Trabectedin (Yondelis)*
LOW RISK (10−30% frequency)^†
Ado-trastuzumab emtansine (Kadcyla) Aldesleukin (Proleukin) ≤12 million IU/m² Amifostine (Ethyol) ≤300mg/m² Arsenic trioxide (Trisenox) Axicabtagene ciloleucel (Yescarta) Belinostat (Beleodaq) Brentuximab vedotin(Adcetris) Brexucabtagene autoleucel (Tecartus) Cabazitaxel (Jevtana) Carfilzomib (Kyprolis) Copanlisib (Aliqopa) Cytarabine (low dose) 100−200mg/m² Docetaxel (Taxotere) Doxorubicin liposomal (Doxil) Enfortumab vedotin-ejfv (Padcev) Eribulin (Halaven) Etoposide (Etopophos) Floxuridine Fluorouracil (5-FU) Gemcitabine (Gemzar) Gemtuzumab ozogamicin Idecabtagene vicleucel (Abecma) Inotuzumab ozogamicin (Besponsa) Isatuximab-irfc (Sarclisa) Ixabepilone (Ixempra)	Lisocabtagene maraleucel (Breyanzi) Loncastuximab tesirine-lpyl (Zynlonta) Methotrexate >50mg/m²−<250mg/m² Mitomycin Mitomycin pyelocalyceal solution (Jelmyto) Mitoxantrone Mogamulizumab-kpkc (Poteligeo) Moxetumomab pasudotox-tdfk (Lumoxiti) Necitumumab (Portrazza) Omacetaxine (Synribo) Paclitaxel (Taxol) Paclitaxel albumin (Abraxane) Pemetrexed (Alimta) Pentostatin Polatuzumab vedotin-piig (Polivy) Pralatrexate (Folotyn) Tafasitamab-cxix (Monjuvi) Tagraxofusp-erzs (Elzonris) Talimogene laherparepvec (Imlygic) Thiotepa (Tepadina) Tisagenlecleucel (Kymriah) Tisotumab vedotin-tftv (Tivdak) Topotecan (Hycamtin) Ziv-aflibercept (Zaltrap)
MINIMAL RISK (<10% frequency)^†
Alemtuzumab (Campath) Atezolizumab (Tecentriq) Avelumab (Bavencio) Asparaginase (Erwinaze, Rylaze) Belantamab mafodotin-blmf (Blenrep) Bevacizumab (Avastin) Bleomycin Blinatumomab (Blincyto) Bortezomib (Velcade) Cemiplimab-rwlc (Libtayo) Cetuximab (Erbitux) Cladribine Cytarabine <100mg/m² Daratumumab (Darzalex) Daratumumab + hyaluronidase-fihj (Darzalex Faspro) Decitabine (Dacogen) Denileukin diftitox (Ontak) Dexrazoxane (Totect, Zinecard) Dostarlimab-gxly (Jemperli) Durvalumab (Imfinzi) Elotuzumab (Empliciti) Fludarabine Ipilimumab (Yervoy)	Luspatercept-aamt (Reblozyl) Margetuximab-cmkb (Margenza) Methotrexate ≤50mg/m² Nelarabine (Arranon) Nivolumab (Opdivo) Obinutuzumab (Gazyva) Ofatumumab (Arzerra) Panitumumab (Vectibix) Pembrolizumab (Keytruda) Pertuzumab (Perjeta) Pertuzumab/trastuzumab + hyaluronidase-zzxf (Phesgo) Ramucirumab (Cyramza) Rituximab (Rituxan) Rituximab + hyaluronidase (Rituxan Hycela) Siltuximab (Sylvant) Temsirolimus (Torisel) Trastuzumab (Herceptin) Trastuzumab + hyaluronidase-oysk (Herceptin Hylecta) Valrubicin (Valstar) Vinblastine Vincristine Vincristine liposomal (Marqibo) Vinorelbine (Navelbine)
ORAL AGENTS
MODERATE TO HIGH RISK (≥30% frequency)^†
Altretamine (Hexalen) Avapritinib (Ayvakit) Azacitidine (Onureg) Binimetinib (Mektovi) Bosutinib (Bosulif) >400mg/day Busulfan (Myleran) ≥4mg/day Cabozantinib (Cabometyx, Cometriq) Ceritinib (Zykadia) Crizotinib (Xalkori) Cyclophosphamide ≥100mg/m²/day Dabrafenib (Tafinlar) Enasidenib (Idhifa) Encorafenib (Braftovi) Estramustine (Emcyt)	Etoposide Fedratinib (Inrebic) Imatinib (Gleevec) >400mg/day Lenvatinib (Lenvima) >12mg/day Lomustine single day (Gleostine) Midostaurin (Rydapt) Mitotane (Lysodren) Mobocertinib (Exkivity) Niraparib (Zejula) Olaparib (Lynparza) Procarbazine (Matulane) Rucaparib (Rubraca) Selinexor (Xpovio) Temozolomide (Temodar) >75mg/m²/day
MINIMAL TO LOW RISK (<30% frequency)^†
Abemaciclib (Verzenio) Acalabrutinib (Calquence) Afatinib (Gilotrif) Alectinib (Alecensa) Alpelisib (Piqray), Vijoice) Asciminib (Scemblix) Axitinib (Inlyta) Belzutifan (Welireg) Bexarotene (Targretin) Brigatinib (Alunbrig) Bosutinib (Bosulif) ≤400mg/day Busulfan (Myleran) <4mg/day Capecitabine (Xeloda) Capmatinib (Tabrecta) Chlorambucil (Leukeran) Cobimetinib (Cotellic) Cyclophosphamide <100mg/m²/day Dacomitinib (Vizimpro) Dasatinib (Sprycel) Decitabine/cedazuridine (Inqovi) Duvelisib (Copiktra) Entrectinib (Rozlytrek) Erdafitinib (Balversa) Erlotinib (Tarceva) Everolimus (Afinitor) Fludarabine Gefitinib (Iressa) Gilteritinib (Xospata) Glasdegib (Daurismo) Hydroxyurea (Hydrea) Ibrutinib (Imbruvica) Idelalisib (Zydelig) Imatinib (Gleevec) ≤400mg/day Infigratinib (Truseltiq) Ivosidenib (Tibsovo) Ixazomib (Ninlaro) Lapatinib (Tykerb) Larotrectinib (Vitrakvi) Lenalidomide (Revlimid) Lenvatinib (Lenvima) ≤12mg/day Lorlatinib (Lorbrena)	Melphalan (Alkeran) Mercaptopurine Methotrexate Neratinib (Nerlynx) Nilotinib (Tasigna) Osimertinib (Tagrisso) Palbociclib (Ibrance) Pazopanib (Votrient) Pemigatinib (Pemazyre) Pexidartinib (Turalio) Pomalidomide (Pomalyst) Ponatinib (Iclusig) Pralsetinib (Gavreto) Regorafenib (Stivarga) Ribociclib (Kisqali) Ripretinib (Qinlock) Ruxolitinib (Jakafi) Selpercatinib (Retevmo) Sonidegib (Odomzo) Sorafenib (Nexavar) Sotorasib (Lumakras) Sunitinib (Sutent) Talazoparib tosylate (Talzenna) Tazemetostat (Tazverik) Temozolomide (Temodar) ≤75mg/m²/day Tepotinib (Tepmetko) Thalidomide (Thalomid) Thioguanine Tivozanib (Fotivda) Topotecan (Hycamtin) Trametinib (Mekinist) Tretinoin Trifluridine/tipiracil (Lonsurf) Tucatinib (Tukysa) Vandetanib (Caprelsa) Vemurafenib (Zelboraf) Venetoclax (Venclexta) Vismodegib (Erivedge) Vorinostat (Zolinza) Zanubrutinib (Brukinsa)
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 2.2022—March 23, 2022. https://www.nccn.org/professionals/physician_gls/pdf/antiemesis.pdf. Accessed May 23, 2022. (Rev. 5/2022)

EMETOGENIC POTENTIAL OF ANTINEOPLASTIC AGENTS

INTRAVENOUS/INJECTABLE AGENTS

HIGH RISK (>90% frequency)^†

AC combination: any regimen containing anthracycline + cyclophosphamide

Carboplatin AUC ≥4

Carmustine (BiCNU) >250mg/m²

Cisplatin

Cyclophosphamide >1,500mg/m²

Dacarbazine

Doxorubicin ≥60mg/m²

Epirubicin (Ellence) >90mg/m²

Ifosfamide (Ifex) ≥2g/m² per dose

Mechlorethamine

Melphalan (Evomela) ≥140mg/m²

Sacituzumab govitecan-hziy (Trodelvy)

Streptozocin (Zanosar)

MODERATE RISK (>30−90% frequency)^†

Aldesleukin (Proleukin) >12−15 million IU/m²

Amifostine (Ethyol) >300mg/m²

Amivantamab-vmjw (Rybrevant)

Azacitidine (Vidaza)

Bendamustine (Treanda)

Busulfan (Busulfex)

Carboplatin AUC <4*

Carmustine (BiCNU) ≤250mg/m²*

Clofarabine (Clolar)

Cyclophosphamide ≤1,500mg/m²

Cytarabine >200mg/m²

Dactinomycin (Cosmegen)*

Daunorubicin (Cerubidine)*

Dual-drug liposomal cytarabine + daunorubicin (Vyxeos)

Dinutuximab (Unituxin)

Doxorubicin <60mg/m²*

Epirubicin (Ellence) ≤90mg/m²*

Fam-trastuzumab deruxtecan-nxki (Enhertu)

Idarubicin (Idamycin PFS)

Ifosfamide (Ifex) <2g/m² per dose*

Irinotecan (Camptosar)*

Irinotecan liposomal (Onivyde)

Lurbinectedin (Zepzelca)

Melphalan (Evomela) <140mg/m²

Methotrexate ≥250 mg/m²*

Naxitamab-gqgk (Danyelza)

Oxaliplatin (Eloxatin)*

Romidepsin (Istodax)

Temozolomide (Temodar)

Trabectedin (Yondelis)*

LOW RISK (10−30% frequency)^†

Ado-trastuzumab emtansine (Kadcyla)

Aldesleukin (Proleukin) ≤12 million IU/m²

Amifostine (Ethyol) ≤300mg/m²

Arsenic trioxide (Trisenox)

Axicabtagene ciloleucel (Yescarta)

Belinostat (Beleodaq)

Brentuximab vedotin(Adcetris)

Brexucabtagene autoleucel (Tecartus)

Cabazitaxel (Jevtana)

Carfilzomib (Kyprolis)

Copanlisib (Aliqopa)

Cytarabine (low dose) 100−200mg/m²

Docetaxel (Taxotere)

Doxorubicin liposomal (Doxil)

Enfortumab vedotin-ejfv (Padcev)

Eribulin (Halaven)

Etoposide (Etopophos)

Floxuridine

Fluorouracil (5-FU)

Gemcitabine (Gemzar)

Gemtuzumab ozogamicin

Idecabtagene vicleucel (Abecma)

Inotuzumab ozogamicin (Besponsa)

Isatuximab-irfc (Sarclisa)

Ixabepilone (Ixempra)

Lisocabtagene maraleucel (Breyanzi)

Loncastuximab tesirine-lpyl (Zynlonta)

Methotrexate >50mg/m²−<250mg/m²

Mitomycin

Mitomycin pyelocalyceal solution (Jelmyto)

Mitoxantrone

Mogamulizumab-kpkc (Poteligeo)

Moxetumomab pasudotox-tdfk (Lumoxiti)

Necitumumab (Portrazza)

Omacetaxine (Synribo)

Paclitaxel (Taxol)

Paclitaxel albumin (Abraxane)

Pemetrexed (Alimta)

Pentostatin

Polatuzumab vedotin-piig (Polivy)

Pralatrexate (Folotyn)

Tafasitamab-cxix (Monjuvi)

Tagraxofusp-erzs (Elzonris)

Talimogene laherparepvec (Imlygic)

Thiotepa (Tepadina)

Tisagenlecleucel (Kymriah)

Tisotumab vedotin-tftv (Tivdak)

Topotecan (Hycamtin)

Ziv-aflibercept (Zaltrap)

MINIMAL RISK (<10% frequency)^†

Alemtuzumab (Campath)

Atezolizumab (Tecentriq)

Avelumab (Bavencio)

Asparaginase (Erwinaze, Rylaze)

Belantamab mafodotin-blmf (Blenrep)

Bevacizumab (Avastin)

Bleomycin

Blinatumomab (Blincyto)

Bortezomib (Velcade)

Cemiplimab-rwlc (Libtayo)

Cetuximab (Erbitux)

Cladribine

Cytarabine <100mg/m²

Daratumumab (Darzalex)

Daratumumab + hyaluronidase-fihj (Darzalex Faspro)

Decitabine (Dacogen)

Denileukin diftitox (Ontak)

Dexrazoxane (Totect, Zinecard)

Dostarlimab-gxly (Jemperli)

Durvalumab (Imfinzi)

Elotuzumab (Empliciti)

Fludarabine

Ipilimumab (Yervoy)

Luspatercept-aamt (Reblozyl)

Margetuximab-cmkb (Margenza)

Methotrexate ≤50mg/m²

Nelarabine (Arranon)

Nivolumab (Opdivo)

Obinutuzumab (Gazyva)

Ofatumumab (Arzerra)

Panitumumab (Vectibix)

Pembrolizumab (Keytruda)

Pertuzumab (Perjeta)

Pertuzumab/trastuzumab + hyaluronidase-zzxf (Phesgo)

Ramucirumab (Cyramza)

Rituximab (Rituxan)

Rituximab + hyaluronidase (Rituxan Hycela)

Siltuximab (Sylvant)

Temsirolimus (Torisel)

Trastuzumab (Herceptin)

Trastuzumab + hyaluronidase-oysk (Herceptin Hylecta)

Valrubicin (Valstar)

Vinblastine

Vincristine

Vincristine liposomal (Marqibo)

Vinorelbine (Navelbine)

ORAL AGENTS

MODERATE TO HIGH RISK (≥30% frequency)^†

Altretamine (Hexalen)

Avapritinib (Ayvakit)

Azacitidine (Onureg)

Binimetinib (Mektovi)

Bosutinib (Bosulif) >400mg/day

Busulfan (Myleran) ≥4mg/day

Cabozantinib (Cabometyx, Cometriq)

Ceritinib (Zykadia)

Crizotinib (Xalkori)

Cyclophosphamide ≥100mg/m²/day

Dabrafenib (Tafinlar)

Enasidenib (Idhifa)

Encorafenib (Braftovi)

Estramustine (Emcyt)

Etoposide

Fedratinib (Inrebic)

Imatinib (Gleevec) >400mg/day

Lenvatinib (Lenvima) >12mg/day

Lomustine single day (Gleostine)

Midostaurin (Rydapt)

Mitotane (Lysodren)

Mobocertinib (Exkivity)

Niraparib (Zejula)

Olaparib (Lynparza)

Procarbazine (Matulane)

Rucaparib (Rubraca)

Selinexor (Xpovio)

Temozolomide (Temodar) >75mg/m²/day

MINIMAL TO LOW RISK (<30% frequency)^†

Abemaciclib (Verzenio)

Acalabrutinib (Calquence)

Afatinib (Gilotrif)

Alectinib (Alecensa)

Alpelisib (Piqray), Vijoice)

Asciminib (Scemblix)

Axitinib (Inlyta)

Belzutifan (Welireg)

Bexarotene (Targretin)

Brigatinib (Alunbrig)

Bosutinib (Bosulif) ≤400mg/day

Busulfan (Myleran) <4mg/day

Capecitabine (Xeloda)

Capmatinib (Tabrecta)

Chlorambucil (Leukeran)

Cobimetinib (Cotellic)

Cyclophosphamide <100mg/m²/day

Dacomitinib (Vizimpro)

Dasatinib (Sprycel)

Decitabine/cedazuridine (Inqovi)

Duvelisib (Copiktra)

Entrectinib (Rozlytrek)

Erdafitinib (Balversa)

Erlotinib (Tarceva)

Everolimus (Afinitor)

Fludarabine

Gefitinib (Iressa)

Gilteritinib (Xospata)

Glasdegib (Daurismo)

Hydroxyurea (Hydrea)

Ibrutinib (Imbruvica)

Idelalisib (Zydelig)

Imatinib (Gleevec) ≤400mg/day

Infigratinib (Truseltiq)

Ivosidenib (Tibsovo)

Ixazomib (Ninlaro)

Lapatinib (Tykerb)

Larotrectinib (Vitrakvi)

Lenalidomide (Revlimid)

Lenvatinib (Lenvima) ≤12mg/day

Lorlatinib (Lorbrena)

Melphalan (Alkeran)

Mercaptopurine

Methotrexate

Neratinib (Nerlynx)

Nilotinib (Tasigna)

Osimertinib (Tagrisso)

Palbociclib (Ibrance)

Pazopanib (Votrient)

Pemigatinib (Pemazyre)

Pexidartinib (Turalio)

Pomalidomide (Pomalyst)

Ponatinib (Iclusig)

Pralsetinib (Gavreto)

Regorafenib (Stivarga)

Ribociclib (Kisqali)

Ripretinib (Qinlock)

Ruxolitinib (Jakafi)

Selpercatinib (Retevmo)

Sonidegib (Odomzo)

Sorafenib (Nexavar)

Sotorasib (Lumakras)

Sunitinib (Sutent)

Talazoparib tosylate (Talzenna)

Tazemetostat (Tazverik)

Temozolomide (Temodar) ≤75mg/m²/day

Tepotinib (Tepmetko)

Thalidomide (Thalomid)

Thioguanine

Tivozanib (Fotivda)

Topotecan (Hycamtin)

Trametinib (Mekinist)

Tretinoin

Trifluridine/tipiracil (Lonsurf)

Tucatinib (Tukysa)

Vandetanib (Caprelsa)

Vemurafenib (Zelboraf)

Venetoclax (Venclexta)

Vismodegib (Erivedge)

Vorinostat (Zolinza)

Zanubrutinib (Brukinsa)

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 2.2022—March 23, 2022. https://www.nccn.org/professionals/physician_gls/pdf/antiemesis.pdf. Accessed May 23, 2022.

(Rev. 5/2022)

Want to read more?