Emetogenic Potential of Antineoplastic Agents
EMETOGENIC POTENTIAL OF ANTINEOPLASTIC AGENTS
INTRAVENOUS/INJECTABLE AGENTS
HIGH RISK (>90% frequency)

AC combination: any regimen containing anthracycline + cyclophosphamide

Carboplatin AUC ≥4

Carmustine (BiCNU) >250mg/m²

Cisplatin

Cyclophosphamide >1,500mg/m²

Dacarbazine

Doxorubicin ≥60mg/m²

Epirubicin (Ellence) >90mg/m²

Ifosfamide (Ifex) ≥2g/m² per dose

Mechlorethamine

Melphalan (Evomela) ≥140mg/m²

Sacituzumab govitecan-hziy (Trodelvy)

Streptozocin (Zanosar)

MODERATE RISK (>30−90% frequency)

Aldesleukin (Proleukin) >12−15 million IU/m²

Amifostine (Ethyol) >300mg/m²

Amivantamab-vmjw (Rybrevant)

Azacitidine (Vidaza)

Bendamustine (Treanda)

Busulfan (Busulfex)

Carboplatin AUC <4*

Carmustine (BiCNU) ≤250mg/m²*

Clofarabine (Clolar)

Cyclophosphamide ≤1,500mg/m²

Cytarabine >200mg/m²

Dactinomycin (Cosmegen)*

Daunorubicin (Cerubidine)*

Dual-drug liposomal cytarabine + daunorubicin (Vyxeos)

Dinutuximab (Unituxin)

Doxorubicin <60mg/m²*

Epirubicin (Ellence) ≤90mg/m²*

Fam-trastuzumab deruxtecan-nxki (Enhertu)

Idarubicin (Idamycin PFS)

Ifosfamide (Ifex) <2g/m² per dose*

Irinotecan (Camptosar)*

Irinotecan liposomal (Onivyde)

Lurbinectedin (Zepzelca)

Melphalan (Evomela) <140mg/m²

Methotrexate ≥250 mg/m²*

Naxitamab-gqgk (Danyelza)

Oxaliplatin (Eloxatin)*

Romidepsin (Istodax)

Temozolomide (Temodar)

Trabectedin (Yondelis)*

LOW RISK (10−30% frequency)

Ado-trastuzumab emtansine (Kadcyla)

Aldesleukin (Proleukin) ≤12 million IU/m²

Amifostine (Ethyol) ≤300mg/m²

Arsenic trioxide (Trisenox)

Axicabtagene ciloleucel (Yescarta)

Belinostat (Beleodaq)

Brentuximab vedotin(Adcetris)

Brexucabtagene autoleucel (Tecartus)

Cabazitaxel (Jevtana)

Carfilzomib (Kyprolis)

Copanlisib (Aliqopa)

Cytarabine (low dose) 100−200mg/m²

Docetaxel (Taxotere)

Doxorubicin liposomal (Doxil)

Enfortumab vedotin-ejfv (Padcev)

Eribulin (Halaven)

Etoposide (Etopophos)

Floxuridine

Fluorouracil (5-FU)

Gemcitabine (Gemzar)

Gemtuzumab ozogamicin

Idecabtagene vicleucel (Abecma)

Inotuzumab ozogamicin (Besponsa)

Isatuximab-irfc (Sarclisa)

Ixabepilone (Ixempra)

Lisocabtagene maraleucel (Breyanzi)

Loncastuximab tesirine-lpyl (Zynlonta)

Methotrexate >50mg/m²−<250mg/m²

Mitomycin

Mitomycin pyelocalyceal solution (Jelmyto)

Mitoxantrone

Mogamulizumab-kpkc (Poteligeo)

Moxetumomab pasudotox-tdfk (Lumoxiti)

Necitumumab (Portrazza)

Omacetaxine (Synribo)

Paclitaxel (Taxol)

Paclitaxel albumin (Abraxane)

Pemetrexed (Alimta)

Pentostatin

Polatuzumab vedotin-piig (Polivy)

Pralatrexate (Folotyn)

Tafasitamab-cxix (Monjuvi)

Tagraxofusp-erzs (Elzonris)

Talimogene laherparepvec (Imlygic)

Thiotepa (Tepadina)

Tisagenlecleucel (Kymriah)

Tisotumab vedotin-tftv (Tivdak)

Topotecan (Hycamtin)

Ziv-aflibercept (Zaltrap)

MINIMAL RISK (<10% frequency)

Alemtuzumab (Campath)

Atezolizumab (Tecentriq)

Avelumab (Bavencio)

Asparaginase (Erwinaze, Rylaze)

Belantamab mafodotin-blmf (Blenrep)

Bevacizumab (Avastin)

Bleomycin

Blinatumomab (Blincyto)

Bortezomib (Velcade)

Cemiplimab-rwlc (Libtayo)

Cetuximab (Erbitux)

Cladribine

Cytarabine <100mg/m²

Daratumumab (Darzalex)

Daratumumab + hyaluronidase-fihj (Darzalex Faspro)

Decitabine (Dacogen)

Denileukin diftitox (Ontak)

Dexrazoxane (Totect, Zinecard)

Dostarlimab-gxly (Jemperli)

Durvalumab (Imfinzi)

Elotuzumab (Empliciti)

Fludarabine

Ipilimumab (Yervoy)

Luspatercept-aamt (Reblozyl)

Margetuximab-cmkb (Margenza)

Methotrexate ≤50mg/m²

Nelarabine (Arranon)

Nivolumab (Opdivo)

Obinutuzumab (Gazyva)

Ofatumumab (Arzerra)

Panitumumab (Vectibix)

Pembrolizumab (Keytruda)

Pertuzumab (Perjeta)

Pertuzumab/trastuzumab + hyaluronidase-zzxf (Phesgo)

Ramucirumab (Cyramza)

Rituximab (Rituxan)

Rituximab + hyaluronidase (Rituxan Hycela)

Siltuximab (Sylvant)

Temsirolimus (Torisel)

Trastuzumab (Herceptin)

Trastuzumab + hyaluronidase-oysk (Herceptin Hylecta)

Valrubicin (Valstar)

Vinblastine

Vincristine

Vincristine liposomal (Marqibo)

Vinorelbine (Navelbine)

ORAL AGENTS
MODERATE TO HIGH RISK (≥30% frequency)

Altretamine (Hexalen)

Avapritinib (Ayvakit)

Azacitidine (Onureg)

Binimetinib (Mektovi)

Bosutinib (Bosulif) >400mg/day

Busulfan (Myleran) ≥4mg/day

Cabozantinib (Cabometyx, Cometriq)

Ceritinib (Zykadia)

Crizotinib (Xalkori)

Cyclophosphamide ≥100mg/m²/day

Dabrafenib (Tafinlar)

Enasidenib (Idhifa)

Encorafenib (Braftovi)

Estramustine (Emcyt)

Etoposide

Fedratinib (Inrebic)

Imatinib (Gleevec) >400mg/day

Lenvatinib (Lenvima) >12mg/day

Lomustine single day (Gleostine)

Midostaurin (Rydapt)

Mitotane (Lysodren)

Mobocertinib (Exkivity)

Niraparib (Zejula)

Olaparib (Lynparza)

Procarbazine (Matulane)

Rucaparib (Rubraca)

Selinexor (Xpovio)

Temozolomide (Temodar) >75mg/m²/day

MINIMAL TO LOW RISK (<30% frequency)

Abemaciclib (Verzenio)

Acalabrutinib (Calquence)

Afatinib (Gilotrif)

Alectinib (Alecensa)

Alpelisib (Piqray), Vijoice)

Asciminib (Scemblix)

Axitinib (Inlyta)

Belzutifan (Welireg)

Bexarotene (Targretin)

Brigatinib (Alunbrig)

Bosutinib (Bosulif) ≤400mg/day

Busulfan (Myleran) <4mg/day

Capecitabine (Xeloda)

Capmatinib (Tabrecta)

Chlorambucil (Leukeran)

Cobimetinib (Cotellic)

Cyclophosphamide <100mg/m²/day

Dacomitinib (Vizimpro)

Dasatinib (Sprycel)

Decitabine/cedazuridine (Inqovi)

Duvelisib (Copiktra)

Entrectinib (Rozlytrek)

Erdafitinib (Balversa)

Erlotinib (Tarceva)

Everolimus (Afinitor)

Fludarabine

Gefitinib (Iressa)

Gilteritinib (Xospata)

Glasdegib (Daurismo)

Hydroxyurea (Hydrea)

Ibrutinib (Imbruvica)

Idelalisib (Zydelig)

Imatinib (Gleevec) ≤400mg/day

Infigratinib (Truseltiq)

Ivosidenib (Tibsovo)

Ixazomib (Ninlaro)

Lapatinib (Tykerb)

Larotrectinib (Vitrakvi)

Lenalidomide (Revlimid)

Lenvatinib (Lenvima) ≤12mg/day

Lorlatinib (Lorbrena)

Melphalan (Alkeran)

Mercaptopurine

Methotrexate

Neratinib (Nerlynx)

Nilotinib (Tasigna)

Osimertinib (Tagrisso)

Palbociclib (Ibrance)

Pazopanib (Votrient)

Pemigatinib (Pemazyre)

Pexidartinib (Turalio)

Pomalidomide (Pomalyst)

Ponatinib (Iclusig)

Pralsetinib (Gavreto)

Regorafenib (Stivarga)

Ribociclib (Kisqali)

Ripretinib (Qinlock)

Ruxolitinib (Jakafi)

Selpercatinib (Retevmo)

Sonidegib (Odomzo)

Sorafenib (Nexavar)

Sotorasib (Lumakras)

Sunitinib (Sutent)

Talazoparib tosylate (Talzenna)

Tazemetostat (Tazverik)

Temozolomide (Temodar) ≤75mg/m²/day

Tepotinib (Tepmetko)

Thalidomide (Thalomid)

Thioguanine

Tivozanib (Fotivda)

Topotecan (Hycamtin)

Trametinib (Mekinist)

Tretinoin

Trifluridine/tipiracil (Lonsurf)

Tucatinib (Tukysa)

Vandetanib (Caprelsa)

Vemurafenib (Zelboraf)

Venetoclax (Venclexta)

Vismodegib (Erivedge)

Vorinostat (Zolinza)

Zanubrutinib (Brukinsa)

NOTES

Frequency of emesis in the absence of effective antiemetic prophylaxis. * May be highly emetogenic in certain patients.

REFERENCES

National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Antiemesis. Version 2.2022—March 23, 2022. https://www.nccn.org/professionals/physician_gls/pdf/antiemesis.pdf. Accessed May 23, 2022.

(Rev. 5/2022)