of chemotherapeutics according
to their likelihood of emesis
following treatment with
particular agents. 1,3,4
The Perugia Antiemetic
Consensus Guideline meeting 4
divided chemotherapy agents
into four categories based on
the percentage of patients
with acute emesis caused by
single agents in the absence of
antiemetic prophylaxis (including
parenteral and oral therapy). This
classification is still used and many
chemotherapeutics have been
added:
• Highly emetic (HEC): >90% risk
of emesis (for example, cisplatin,
dacarbazine)
• Moderately emetic (MEC):
>30–90% risk of emesis
(for example, oxaliplatin,
temozolomide)
52 | 2018 | hospitalpharmacyeurope.com
• Low emetic (LEC): 10–30% risk
of emesis (for example, topotecan,
mitoxantrone)
• Minimally emetic (MiEC):
0<10% risk of emesis (for example,
vincristine, dasatinib).
This four-level classification
schedule is used in international
antiemetic guidelines for
both intravenous and oral
chemotherapeutics. 5–9 When
using combination regimens, the
emetogenic level is determined
by identifying the most emetic
agent in the combination and then
assessing the relative contribution
of the other agents.
Prevention and treatment
Prevention of nausea and
vomiting is considered to be
the key to effective control of
CINV. Antiemetics are most
effective when they are used
prophylactically. Once nausea and
vomiting occur, it becomes more
difficult to suppress and it might
increase the spectrum of other
antiemetics required in future
chemotherapy cycles.
Classes wit the highest
therapeutic index for
management of CINV include
5-hydroxytryptamine-3 (5-HT3
receptor antagonists (RAs),
neurokinin-1 (NK1) RAs and
corticosteroids. In addition, a
wide variety of other antiemetic
agents are available, which can
all be classified according to
the therapeutic index of their