of schedules classifying
chemotherapeutics according
to their likelihood of emesis
following treatment with
particular agents. 1,3,4
Chemotherapy agents are
divided into four categories based
on the percentage of patients with
the risk of emesis caused by single
agents in the absence of antiemetic
prophylaxis. 2
Many chemotherapeutic agents
(including parenteral and oral
therapy) have been added over
time: 7
• Highly emetic (HEC): >90% risk
of emesis (for example, cisplatin,
dacarbazine, epirubicine >90mg/
m²)
• Moderately emetic (MEC):
>30–90% risk of emesis (for
example, busulfan, dinutuximab,
temozolomide)
• Low emetic (LEC): 10–30% risk
of emesis (for example, thiotepa,
mitoxantrone, tisagenlecleucel)
• Minimally emetic (MiEC):
0<10% risk of emesis (for example,
vincristine, daratumumab,
bevacizumab).
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 identification
of the most emetogenic agent
in the combination followed
by assessment of the relative
contribution of the other agents.
As an example, doxorubicin
<60mg/m² and cyclophosphamide
≤1500mg/m² are both defined
as moderate emetogenic
agents. 7 However, when used in
combination, their regimen is
defined as highly emetogenic.
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, they become more
difficult to suppress and it might
increase the spectrum of other
antiemetics required in future
chemotherapy cycles.
The three drug classes with
the highest therapeutic index
52 | 2019 | hospitalpharmacyeurope.com