Table 1.
Changes to the Cancer Care Ontario antiemetic guidelines during the COVID-19 Pandemic. Changes from the general CCO guidelines are emphasized in bold
| Regimen | General CCO Guidelines [14] | COVID-19 modifications |
|---|---|---|
| Single-day IV | ||
| Highly emetogenic chemotherapy |
Steroid Day 1 Dexamethasone 12 mg PO or 10 mg IV Day 2 to 3–4 Dexamethasone 8 mg PO or 10 mg IV. Note only day 1 is required for anthracycline and cyclophosphamide regimens for breast cancer. 5-HT3 Day 1 Granisetron 2 mg PO or 1 mg IV OR Ondansetron 8 mg PO BID or 8 mg IV OR Palonosetron 0.25 mg IV or 0.5 mg PO NK1 Day 1 Aprepitant 125 mg PO OR Fosaprepitant 150 mg IV OR NEPA (netupitant 300 mg + palonosetron 0.5 mg) PO Day 2–3 Aprepitant 80 mg PO daily (days 2–3) if started on Day 1 Thiobenzodiazepine Day 1 Olanzapine 5 mg PO daily Day 2–4 Olanzapine 5 mg PO daily or 2.5 mg BID |
If highly emetogenic, excluding high-dose cisplatin: Steroid Day 1 Dexamethasone 12 mg PO or IV No dexamethasone after day 1. 5-HT3 Day 1 NEPA (netupitant 300 mg + palonosetron 0.5 mg) (preferred with single-day dexamethasone as NEPA in combination with netupitant) OR Granisetron 2 mg PO or 1 mg IV OR Ondansetron 8 mg PO BID or 8 mg IV NK1 Day 1 NEPA (netupitant 300 mg + palonosetron 0.5 mg) (preferred with single-day dexamethasone as NEPA in combination with netupitant) OR Aprepitant 125 mg PO OR Fosaprepitant 150 mg IV Day 2–3 Aprepitant 80 mg PO daily (days 2–3) if started on Day 1 Thiobenzodiazepine Day 1 Olanzapine 5 mg PO daily Day 2–4 Olanzapine 5 mg PO daily or 2.5 mg BID |
| Moderately emetogenic chemotherapy |
Steroid Day 1 Dexamethasone 8 mg PO or 10 mg IV Note, for taxanes, prefer 20 mg IV × 1 30 min before for hypersensitivity or infusion reactions 5-HT3 Day 1 Granisetron 2 mg PO or 1 mg IV OR Ondansetron 8 mg PO BID or 8 mg IV OR Palonosetron 0.25 mg IV or 0.5 mg PO |
Unchanged. |
| Low-emetogenic risk chemotherapy |
Steroid Dexamethasone 8 mg PO or 10 mg IV |
5-HT3 Day 1 Granisetron 2 mg PO or 1 mg IV OR Ondansetron 8 mg PO BID or 8 mg IV OR Palonosetron 0.25 mg IV or 0.5 mg PO |
| Minimal emetogenic risk chemotherapy | No antiemetics recommended | Unchanged |
| Multiple-day IV | ||
| Highly emetogenic chemotherapy |
Steroid Dexamethasone 12 mg PO or 10 mg IV on day 1 and then 8 mg PO or 10 mg IV (up to two days after the last dose of therapy) 5-HT3 Granisetron 2 mg PO or 1 mg IV OR Ondansetron 8 mg PO BID or 8 mg IV NK1 Aprepitant 125 mg PO on Day 1 then 80 mg PO daily (up to 2 days after last dose of chemotherapy) Thiobenzodiazepine Olanzapine 5 mg PO and then 5 mg PO daily or 2.5 mg PO BID (up to 2 days after last dose of chemotherapy) |
Steroid Dexamethasone 12 mg PO or 10 mg IV on the days of chemotherapy 5-HT3 Granisetron 2 mg PO or 1 mg IV OR Ondansetron 8 mg PO BID or 8 mg IV NK1 Aprepitant 125 mg PO on Day 1 then 80 mg PO daily (up to 2 days after last dose of chemotherapy) Thiobenzodiazepine Olanzapine 5 mg PO and then 5 mg PO daily or 2.5 mg PO BID (up to 2 days after last dose of chemotherapy) |
| Moderately emetogenic chemotherapy |
Steroid Day 1 Dexamethasone 8 mg PO or 10 mg IV 5-HT3 Day 1 Granisetron 2 mg PO or 1 mg IV OR Ondansetron 8 mg PO BID or 8 mg IV |
Unchanged |
| Oral chemotherapy | ||
| Moderate to high |
5-HT3 Granisetron 2 mg PO or ondansetron 8 mg PO BID |
Unchanged |
| Minimal to low | No routine prophylaxis; PRN recommended | Unchanged |
| Breakthrough nausea and vomiting | Prefer olanzapine 2.5 mg PO BID PRN, max 10 mg daily if given in combination with prophylaxis | Unchanged |