Emetogenicity Tool PDF
Emetogenicity Tool PDF
Emetogenicity Tool PDF
Emetogenic Risk of NCCN Levels of Emetogenicity:
Level 5 – High Emetic Risk: 90% frequency of emesis
Chemotherapy and Level 3/4 – Moderate Emetic Risk: 30‐90% frequency of emesis
Level 2 – Low Emetic Risk: 10‐30% frequency of emesis
Biotherapy Agents Level 1 – Minimal Emetic Risk: <10% frequency of emesis
Emetogenicity Agents (alphabetically) Emetogenicity Agents (alphabetically)
5 AC combo: doxorubicin or epirubicin + cyclophosphamide 2 Gemcitabine
1 Alemtuzumab 1 Gemtuzumab ozogamicin
1 Alpha Interferon < 5000 IU/m2 1 Gefitinib (oral)
2 Amifostine < 300 mg 3 Hexamethylmelamine (oral)
4 Amifostine > 300 ‐ 500 mg/m2 1 Hydroxyurea (oral)
1 Androgens 1 Ibritumomab tiuxetan
3 Arsenic trioxide 3 Ifosfamide
1 Asparaginase 1 Imatinib mesylate (oral)
3 Azacitadine 3 Interleukin‐2 > 12‐15 million units/m2
3 Bendamustine 3 Irinotecan
1 Bevacizumab 1 Ixabepilone
2 Bexarotene (oral) 1 Lapatinib (oral)
1 Bleomycin 2 Lenalidomide
1 Bortezomib 3 Lomustine (oral)
4 Busulfan > 4 mg/d 5 Mechlorethamine
2 Capecitabine (oral) 1 Melphalan (oral low‐dose)
4 Carboplatin 4 Melphalan > 50 mg/m2
4 Carmustine ≤ 250 mg/m2 1 Methotrexate ≤ 50 mg/m2
5 Carmustine > 250 mg/m2 2 Methotrexate > 50 mg/m2 < 250 mg/m2
1 Cetuximab 3 Methotrexate 250‐1,000 mg/m2
1 Chlorambucil (oral) 4 Methotrexate > 1,000 mg/m2
5 Cisplatin ≥50 mg/m2 2 Mitomycin
4 Cisplatin < 50 mg/m2 2 Mitoxantrone < 15 mg/m2
1 Cladribine 1 Nelarabine
3 Clofarabine 3 Oxaliplatin > 75 mg/m2
1 Corticosteroids 2 Paclitaxel/Paclitaxel albumin‐bound
3 Cyclophosphamide (oral) 1 Panitumumab
3 Cyclophosphamide ≤ 750 mg/m2 2 Pemetrexed
4 Cyclophosphamide > 750 mg/m2 to ≤ 1,500 mg/m2 1 Pentostatin
5 Cyclophosphamide > 1,500 mg/m2 5 Procarbazine (oral)
2 Cytarabine (low dose) 100‐200 mg/m2 1 Rituximab
4 Cytarabine > 1 g/m2 2 Sorafenib (oral)
5 Dacarbazine 5 Streptozocin
4 Dactinomycin 2 Sunitinib (oral)
1 Dasatinib (oral) 3 Temozolomide (oral)
3 Daunorubicin 1 Temsirolimus
1 Denileukin diftitox 2 Teniposide
1 Dexrazoxane 1 Thioguanine (oral)
2 Docetaxel 2 Topotecan
2 Doxorubicin (liposomal) 1 Tositumomab
3 Doxorubicin < 60 mg/m2 1 Trastuzumab
4 Doxorubicin >60mg/m2 1 Tretinoin (oral)
3 Epirubicin ≤ 90 mg/m2 1 Vinblastine
4 Epirubicin > 90 mg/m2 1 Vincristine
1 Erlotinib (oral) 1 Vinorelbine
2 Etoposide 3 Vinorelbine (oral)
2 Fluorouracil 2 Vorinostat (oral)
1/2 Fludarabine
Calculating the Emetogenicity of Multiple Agent Chemotherapy/Biotherapy Regimens
Steps and Guidelines:
1. List each agent contained within the multiple agent regimen.
2. Identify the agent with the highest emetogenic level
3. Determine the contribution of the remaining agents using the following guidelines:
a. Level 1 agents do not contribute to emetogenicity in combination regimens.
Examples: Level 1+1=0 2+1=2 3+1=3 4+1=4
b. Adding one or more level 2 agents increases the highest level by 1 in combination regimens.
Examples: Level 2+2=3 3+2=4 2+2+2=3 3+2+2=4
c. Adding level 3 or 4 agents increases the highest level by 1 per each agent in combination regimens.
Examples: Level 3+3=4 3+3+3=5 4+3=5
Worksheet:
1. For each agent in the combination regimen, list its name, dose, and emetogenicity:
Agent and Dose Emetogenicity
2. Identify the most emetogenic agent in the combination:
Agent and dose ______________________________ Emetogenicity: _________
Example Regimen:
1. List each agent in the combination regimen: Cyclophosphamide 400 mg/m2; Methotrexate 30 mg/m2; Fluorouracil 400 mg/m2
2. Identify the most emetogenic agent in the combination: Cyclophosphamide 400 mg/m2 Emetic Risk: 3
References
Grunberg, S.M., Osoba, D., Hesketh, P.J., Gralla, R.J., Borjeson, S., Rapoport, B.L., duBois, A., & Tonato, M. (2004). Evaluation of new
antiemetic agents and definition of antineoplastic agent emetogenicity: An update. Support Care Cancer, 13, 80–84.
Hesketh P.J. (1999). Defining the emetogenicity of cancer chemotherapy regimens: Relevance to clinical practice. The Oncologist, 4,
191‐196.
National Comprehensive Cancer Network. (2010). NCCN clinical practice guidelines in oncology™: Antiemesis. Version 2.2010.
Jenkintown, PA: Authors.
Polovich, M., Whitford, J.M., & Olsen, M. (Eds.). (2009). Chemotherapy and biotherapy guidelines and recommendations for practice
(3rd ed.). Pittsburgh, PA: Oncology Nursing Society.