Recommendations for Preventing Vomiting Caused by Chemotherapy
Some chemotherapy is more likely to cause nausea and vomiting than other chemotherapy. The table (Table 1) below lists the likelihood that a certain intravenous (IV; given in a vein) chemotherapy will cause nausea and vomiting.
Table 1. The Risk of Nausea and Vomiting From Intravenous Chemotherapy
|
Nearly Always Causes Nausea and Vomiting |
Usually Causes Nausea and Vomiting |
Sometimes Causes Nausea and Vomiting |
Rarely Causes Nausea and Vomiting |
| Carmustine (Becenum, BiCNU, Carmubris) | Azacitadine (Mylosar, Vidaza) | Bortezomib (Velcade) | Bevacizumab (Avastin) |
| Cisplatin (Platinol) | Alemtuzumab (Campath) | Cabazitaxel (Jevtana) | Bleomycin (Blenoxane) |
| Cyclophosphamide (Cytoxan, Clafen, Neosar) at higher doses | Bendamustine (Treanda) | Catumaxumab (Removab) | Busulfan (Busulfex, Mitosan, Myleran) |
| Dacarbazine (DTIC-Dome) | Carboplatin (Paraplat, Paraplatin) | Cytarabine at lower doses | Cetuximab (Erbitux) |
| Dactinomycin (Cosmegen, Lyovac Cosmegen) | Clofarabine (Clofarex, Clolar) | Docetaxel (Taxotere) | 2-Chlorodeoxyadenosine (cladribine, Leustatin) |
| Daunorubicin (Cerubidine, Rubidomycin) when combined with cyclophosphamide | Cyclophosphamide at lower doses | Doxorubicin HCL liposome injection (Doxil, Dox-SL, Evacet, LipoDox) | Fludarabine (Fludara) |
| Doxorubicin (Adriamycin) when combined with cyclophosphamide | Cytarabine (Cytosar-U, Tarabine PFS) at higher doses | Etoposide (Etopophus, Toposar, VePesid) | Pralatrexate (Folotyn) |
| Epirubicin (Ellence) when combined with cyclophosphamide | Daunorubicin | Fluorouracil (5-FU, Adrucil, Efudex, Fluoroplex) | Rituximab (Rituxan) |
| Idarubicin (Idamycin) when combined with cyclophosphamide | Doxorubicin | Gemcitabine (Gemzar) | Vinblastine (Velban, Velsar) |
| Mechlorethamine (Mustargen) | Epirubicin | Ixabepilone (Ixempra) | Vincristine (Vincasar PFS, Oncovin) |
| Streptozotocin (Zanosar) | Idarubicin | Methotrexate (multiple brand names) | Vinorelbine (Navelbine, Alocrest) |
| Ifosfamide (Cyfos, Ifex, Ifosfamidum) | Mitomycin (Mitozytrex, Mutamycin) | ||
| Irinotecan (Camptosar) | Mitoxantrone (Novantrone) | ||
| Oxaliplatin (Eloxatin) | Paclitaxel (Taxol, Abraxane) | ||
| Panitumumab (Vectibix) | |||
| Pemetrexed (Alimta) | |||
| Temsirolimus (Torisel) | |||
| Topotecan (Hycamtin, Brakiva) | |||
| Trastuzumab (Herceptin) |
The recommended treatments for preventing nausea and vomiting are listed in Table 2.
Table 2. Recommendations for Preventing Vomiting Caused by Chemotherapy
|
Likelihood of Chemotherapy to Cause Nausea and Vomiting |
Nearly Always Causes Nausea and Vomiting (High Risk) |
Usually Causes Nausea and Vomiting (Moderate Risk) |
Sometimes Causes Nausea and Vomiting (Low Risk) |
Rarely Causes Nausea and Vomiting (Minimal Risk) |
| Recommended Treatment |
A three-drug combination of the following: 1. Aprepitant (Emend) on days 2 and 3 or fosaprepitant on day 1 2. Dolasetron (Anzemet; oral [by mouth] form only), granisetron (Kytril, Sancuso), ondansetron (Zofran), palonosetron (Aloxi), tropisetron (Navoban), or ramosetron (Nasea) 3. Dexamethasone (multiple brand names) on days 2 through 4 |
A two-drug combination of the following: 1. Palonosetron (this is the preferred treatment, but granisetron or ondansetron may also be used) 2.Dexamethasone on days 2 and 3 |
Dexamethasone | No treatment required unless the patient has previously experienced vomiting with this treatment. |