emetic control, although, with
anxiety being a contributory
factor, it can occur in patients even
before initial therapy. Sensory
and environmental factors are
also associated with anticipatory
CINV and patients have reported
that just the thought of coming
for treatment, or the smell of the
clinic as they walk in the door, can
induce severe nausea.
Situations where patients
continue to have CINV, despite
appropriate prophylactic
measures, or continue to have
CINV that is unresponsive despite
appropriate interventions, are
referred to as breakthrough and
refractory.
One of the main aims of CINV
prophylaxis is to provide patients
with appropriate and adequate
table 3
Classification of IV chemotherapy drugs
by emetogenic risk 11
High risk
Anthracycline/cyclophosphamide combination, cisplatin,
(>90% of
carmustine, cyclophosphamide ≥1500mg/m 2 ,
patients at risk) dacarbazine, streptozocin, mechlorethamine
Moderate risk
(30–90%
of patients
at risk)
Azacitidine, alemtuzumab, bendamustine, carboplatin,
clofarabine, cyclophosphamide <1500mg/m 2 , cytarabine
>1000mg/m 2 , daunorubicin, doxorubicin, epirubicin,
idarubicin, ifosfamide, irinotecan, oxalipatin, romidepsin,
temozolomide, thiotepa, trabectedin
Low risk
Aflibercept, belinostat, blinatumumab, bortezomib,
(10–30% of
brentuxumab, cabazitaxel, carfilzomib, catumaxumab,
patients at
cetuxumab, cytarabine ≤1000mg/m 2 , docetaxel,
risk)
PEG liposomal doxorubicin, eribulin, etoposide,
5-fluorouracil, gemcitabine, ipulimumab, ixabepilone,
methotrexate, mitomycin, mitoxantrone, Nab-paclitaxel,
paclitaxel, panitumumab, pemetrexed, pertuzumab,
temsirolimus, topotecan, trastuzumab, vinflunine
Minimal risk
(<10% of
patients at risk)
2-Chlorodeoxyadenosine, bevacizumab, bleomycin,
busulfan, cladribine, fludarabine, rituximab, vinblastine
vincristine, vinorelbine, nivolumab, ofatumumab,
pembrolizumab, pixantrone, pralatrexate
hospitalpharmacyeurope.com | 2018 | 11