39 / 50
Emetic risk groups
Antiemetics
High (non-AC)
High: anthracycline +
cyclophosphamide (AC)
a
Carboplatin
b
Moderate
c
Low
Overview of NCCN / ASCO / MASCC-ESMO guidelines
for acute nausea and vomiting
* The addition of OLA is recommended in HEC by ASCO, is one possible option in HEC and MEC by NCCN and only when nausea is an issue by MASCC/ESMO
a
If an NK1 RA is not available for AC chemotherapy, palonosetron is the preferred 5-HT3 RA for MASCC/ESMO.
b
Carboplatin is considered as “high-MEC” by ASCO and MASCC/ESMO
,
and reclassified as HEC by NCCN an NK1 RA should be added in all cases.
c
An NK1 RA is recommended as option in MEC for selected patients with additional risk factors or who have failed previous therapy with 5-HT3 antagonist plus
steroid by NCCN.
d
Palonosetron and granisetron extended-release injection formulation are the preferred 5-HT3 RAs in MEC regimens without an NK1 RA by NCCN.
e
Not for ASCO.
5-HT
3
RA =
serotonin receptor
antagonist
DEX =
dexamethasone
NK
1
RA= neurokinin 1
receptor antagonist
PALO =
palonosetron
DRA =
dopamine receptor
antagonist
5-HT
3
RA
DEX
NK
1
RA
5-HT
3
RA
DEX
NK
1
RA
DEX
DEX
5-HT
3
RA
DRA
e
+
+
OR
+
+
OR
+
±
±
OLA*
OLA*
±
OLA*
5-HT
3
RA
DEX
NK
1
RA
+
+
OLA =
Olanzapina
5-HT
3
RA
d
1. Roila F. et al. Ann Oncol. 2016 Sep;27(suppl 5):v119-v133. MASCC/ESMO Antiemetic Guideline 2016 V.1.2. Available at:
http://www.mascc.org/; 2.
NCCN: National Comprehensive Cancer Network; NCCN
Clinical Practice Guidelines in Oncology; Version 3.2018. Available at:
www.nccn.org; 3.
Hesketh P. J. et al. J Clin Oncol. 2017 Oct 1;35(28):3240-3261. doi: 10.1200/JCO.2017.74.4789. Epub 2017 Jul 31.