TABLE 4.
Classification of chemotherapeutic agents according to their emetogenicity.
| Risk level | Chemotherapeutic agent | |
|---|---|---|
| High (>90%) | Cytotoxic agents | AC combination |
| Non-AC agents: carmustine, cisplatin, CP (≥1,500 mg/m2), dacarbazine, mechlorethamine, streptozotocin | ||
| Moderate (30–90%) | Cytotoxic agents | Arsenic trioxide, azacytidine, bendamustine, busulfan, carboplatin, clofarabine, CP (<1,500 mg/m2), cytarabine (>1,000 mg/m2), daunorubicin, daunorubicin + cytarabine liposome, doxorubicin, epirubicin, idarubicin, ifosfamide, irinotecan, irinotecan liposomal injection, oxaliplatin, romidepsin, temozolomide (*), thioTEPA (#), trabectedin |
| Non-cytotoxic agents | Alemtuzumab, fam-trastuzumab deruxtecan-nxki | |
| Low (10–30%) | Cytotoxic agents | 5-FU, belinostat, cabazitaxel, cytarabine (up to 1,000 mg/m2), decitabine, DCTX, eribulin, etoposide, gemcitabine, ixabepilone, MTX, mitomycin, mitoxantrone, nab-PCTX, nelarabine, PCTX, pegylated liposomal doxorubicin, pemetrexed, topotecan, vinflunine |
| Non-cytotoxic agents | Aflibercept, axicabtagene ciloleucel, blinatumomab, bortezomib, brentuximab, carfilzomib, copanlisib, catumaxumab, cetuximab, elotuzumab, enfortumab vedotin-ejfv, gemtuzumab ozogamicin, inotuzumab ozogamicin, moxetumomab pasudotox, necitumumab, panitumumab, tagraxofusp-rzs, tisagenlecleucel, temsirolimus, trastuzumab-emtansine | |
| Minimal (<10%) | Cytotoxic agents | Bleomycin, 2-chlorodeoxyadenosine, cladribine, fludarabine, pixantrone, pralatrexate, vinblastine, vincristine, vinorelbine |
| Non-cytotoxic agents | Atezolizumab, avelumab, bevacizumab, cemiplimab, daratumumab, durvalumab, emapalumab, ipilimumab, nivolumab, obinutuzumab, ofatumumab, pembrolizumab, polatuzumab vedotin, ramuciumab, rituximab, trastuzumab | |
Both cytotoxic and non-cytotoxic (antibodies, protein kinase inhibitors, etc) are classified according to their emetogenic risk after intravenous administration to adults (exceptions: * indicates oral administration; # indicates pediatric patients). Cisplatin is highlighted in bold, since it is the emetogenic drug of reference used in the development of new antiemetics. Adapted from Hesketh et al., 2020. Abbreviations: 5-FU, 5-fluorouracil; AC, anthracycline +cyclophosphamide; CP, cyclophosphamide; DCTX, docetaxel; MTX, methotrexate; PCTX, paclitaxel.