Originally published as JCO Early Release 10.1200/JCO.2006.06.9591 on May 22 2006

This Article Full Text Full Text (PDF) Publisher's Note Erratum (v24,p5341) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Kris, M. G. Articles by Grunberg, S. M. Search for Related Content PubMed PubMed Citation Articles by Kris, M. G. Articles by Grunberg, S. M. Related Articles Related Correspondence

American Society of Clinical Oncology Guideline for Antiemetics in Oncology: Update 2006

Mark G. Kris, Paul J. Hesketh, Mark R. Somerfield, Petra Feyer, Rebecca Clark-Snow, James M. Koeller, Gary R. Morrow, Lawrence W. Chinnery, Maurice J. Chesney, Richard J. Gralla, Steven M. Grunberg

From the American Society of Clinical Oncology, Alexandria, VA

Address reprint requests to American Society of Clinical Oncology, Cancer Policy and Clinical Affairs, 1900 Duke St, Suite 200, Alexandria, VA 22314; e-mail: guidelines{at}asco.org

PURPOSE: To update the 1999 American Society of Clinical Oncology guideline for antiemetics in oncology.

UPDATE METHODOLOGY: The Update Committee completed a review and analysis of data published from 1998 thru February 2006. The literature review focused on published randomized controlled trials, and systematic reviews and meta-analyses of published phase II and phase III randomized controlled trials.

RECOMMENDATIONS: The three-drug combination of a 5-hydroxytryptamine-3 (5-HT₃) serotonin receptor antagonist, dexamethasone, and aprepitant is recommended before chemotherapy of high emetic risk. For persons receiving chemotherapy of high emetic risk, there is no group of patients for whom agents of lower therapeutic index are appropriate first-choice antiemetics. These agents should be reserved for patients intolerant of or refractory to 5-HT₃ serotonin receptor antagonists, neurokinin-1 receptor antagonists, and dexamethasone. The three-drug combination of a 5-HT₃ receptor serotonin antagonist, dexamethasone, and aprepitant is recommended for patients receiving an anthracycline and cyclophosphamide. For patients receiving other chemotherapy of moderate emetic risk, the Update Committee continues to recommend the two-drug combination of a 5-HT₃ receptor serotonin antagonist and dexamethasone. In all patients receiving cisplatin and all other agents of high emetic risk, the two-drug combination of dexamethasone and aprepitant is recommended for the prevention of delayed emesis. The Update Committee no longer recommends the combination of a 5-HT₃ serotonin receptor antagonist and dexamethasone for the prevention of delayed emesis after chemotherapeutic agents of high emetic risk.

CONCLUSION: The Update Committee recommends that clinicians administer antiemetics while considering patients' emetic risk categories and other characteristics.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

Related Correspondence

• Controlling Emesis: What Is It Worth?
  Stephen C. Fox
  JCO 2006 24: 5617 [Full Text]

This article has been cited by other articles:

				L. N. Shulman, R. S. Miller, E. P. Ambinder, P. P. Yu, and J. V. Cox Principles of Safe Practice Using an Oncology EHR System for Chemotherapy Ordering, Preparation, and Administration, Part 2 of 2 J. Oncol. Pract, September 1, 2008; 4(5): 254 - 257. [Full Text] [PDF]

				R. B Ibrahim, M. H Abidi, L. J Ayash, S. M Cronin, C. Cadotte, J. Mulawa, P. A Jacobson, D. W Smith, J. P Uberti, and D. J Edwards Effect of aprepitant on intravenous tacrolimus disposition in reduced intensity hematopoietic stem cell transplantation Journal of Oncology Pharmacy Practice, September 1, 2008; 14(3): 113 - 121. [Abstract] [PDF]

				A. Naeim, S. M. Dy, K. A. Lorenz, H. Sanati, A. Walling, and S. M. Asch Evidence-Based Recommendations for Cancer Nausea and Vomiting J. Clin. Oncol., August 10, 2008; 26(23): 3903 - 3910. [Abstract] [Full Text] [PDF]

				P. J. Hesketh Chemotherapy-Induced Nausea and Vomiting N. Engl. J. Med., June 5, 2008; 358(23): 2482 - 2494. [Full Text] [PDF]

				L. Yang, J. C. Panetta, X. Cai, W. Yang, D. Pei, C. Cheng, N. Kornegay, C.-H. Pui, and M. V. Relling Asparaginase May Influence Dexamethasone Pharmacokinetics in Acute Lymphoblastic Leukemia J. Clin. Oncol., April 20, 2008; 26(12): 1932 - 1939. [Abstract] [Full Text] [PDF]

				A. Chan, V. Shih, and L. Chew Evolving roles of oncology pharmacists in Singapore: A survey on prescribing patterns of antiemetics for chemotherapy induced nausea and vomiting (CINV) at a cancer centre{dagger} Journal of Oncology Pharmacy Practice, March 1, 2008; 14(1): 23 - 29. [Abstract] [PDF]

				B. C. De Jonghe and C. C. Horn Chemotherapy-induced pica and anorexia are reduced by common hepatic branch vagotomy in the rat Am J Physiol Regulatory Integrative Comp Physiol, March 1, 2008; 294(3): R756 - R765. [Abstract] [Full Text] [PDF]

				A. Georgy, J. Neceskas, and S. Goodin Antiemetic care for patients with breast cancer: Focus on drug interactions and safety concerns Am. J. Health Syst. Pharm., November 1, 2007; 64(21): 2227 - 2236. [Abstract] [Full Text] [PDF]

				G. J. Wood, J. W. Shega, B. Lynch, and J. H. Von Roenn Management of Intractable Nausea and Vomiting in Patients at the End of Life: "I Was Feeling Nauseous All of the Time . . . Nothing Was Working" JAMA, September 12, 2007; 298(10): 1196 - 1207. [Abstract] [Full Text] [PDF]

				K. Jordan, C. Sippel, and H.-J. Schmoll Guidelines for Antiemetic Treatment of Chemotherapy-Induced Nausea and Vomiting: Past, Present, and Future Recommendations Oncologist, September 1, 2007; 12(9): 1143 - 1150. [Abstract] [Full Text] [PDF]

				A. Gurpide, B. Sadaba, S. Martin-Algarra, J. R. Azanza, J. M. Lopez-Picazo, M. A. Campanero, J. P. Cabello, I. Gil-Aldea, S. de la Cruz, V. F. Gallego, et al. Randomized Crossover Pharmacokinetic Evaluation of Subcutaneous Versus Intravenous Granisetron in Cancer Patients Treated with Platinum-Based Chemotherapy Oncologist, September 1, 2007; 12(9): 1151 - 1155. [Abstract] [Full Text] [PDF]

				C. G. Azzoli, M. G. Kris, and D. G. Pfister Cisplatin Versus Carboplatin for Patients With Metastatic Non-Small-Cell Lung Cancer--An Old Rivalry Renewed J Natl Cancer Inst, June 6, 2007; 99(11): 828 - 829. [Full Text] [PDF]

				A. Ardizzoni, L. Boni, M. Tiseo, F. V. Fossella, J. H. Schiller, M. Paesmans, D. Radosavljevic, A. Paccagnella, P. Zatloukal, P. Mazzanti, et al. Cisplatin- Versus Carboplatin-Based Chemotherapy in First-Line Treatment of Advanced Non-Small-Cell Lung Cancer: An Individual Patient Data Meta-analysis J Natl Cancer Inst, June 6, 2007; 99(11): 847 - 857. [Abstract] [Full Text] [PDF]

				S. Grunberg Antiemetic activity of corticosteroids in patients receiving cancer chemotherapy: dosing, efficacy, and tolerability analysis Ann. Onc., February 1, 2007; 18(2): 233 - 240. [Abstract] [Full Text] [PDF]

				S. C. Fox Controlling Emesis: What Is It Worth? J. Clin. Oncol., December 10, 2006; 24(35): 5617 - 5617. [Full Text] [PDF]

				J. M. Koeller, S. M. Grunberg, P. J. Hesketh, and M. G. Kris In Reply J. Clin. Oncol., December 10, 2006; 24(35): 5616 - 5617. [Full Text] [PDF]

				B. Bloechl-Daum, R. R. Deuson, P. Mavros, M. Hansen, and J. Herrstedt Delayed Nausea and Vomiting Continue to Reduce Patients' Quality of Life After Highly and Moderately Emetogenic Chemotherapy Despite Antiemetic Treatment J. Clin. Oncol., September 20, 2006; 24(27): 4472 - 4478. [Abstract] [Full Text] [PDF]