Chemotherapy can cause nausea and vomiting, with the risk varying with the agents and doses used. Knowledge of the emetic potential for a drug regimen can help determine if prophylaxis might help prevent or reduce patient discomfort.
|
Level of Emetic Potential for Each Agent |
Frequency of Emesis |
|
1 |
< 10% |
|
2 |
10 – 30% |
|
3 |
30 – 60% |
|
4 |
60 – 90% |
|
5 |
> 90% |
|
Dose Dependent |
Level 1 |
Level 2 |
Level 3 |
Level 4 |
Level 5 |
|
busulfan (mg/kg po per day) |
< 4 |
|
|
|
|
|
carmustine (mg per square meter) |
|
|
|
<= 250 |
> 250 |
|
cisplatin (mg per square meter) |
|
|
|
< 50 |
>= 50 |
|
cyclophosphamide (mg per sq m IV) |
|
|
< 750 |
750 - 1500 |
> 1500 |
|
cytarabine (g per square meter) |
|
<= 1 |
|
> 1 |
|
|
dacarbazine (mg per square meter) |
|
|
|
|
> 500 |
|
dactinomycin (in mg per sq meter) |
|
|
< 1.5 |
>= 1.5 |
|
|
doxorubicin HCl (mg per square meter) |
|
< 20 |
20 - 60 |
> 60 |
|
|
epirubicin HCl (in mg per sq m) |
|
|
< 90 |
|
|
|
fluorouracil (mg per square meter) |
|
< 1000 |
|
|
|
|
lomustine (mg per square meter) |
|
|
|
|
60 |
|
methotrexate (in mg per square meter) |
< 50 |
50 - < 250 |
250 - 1000 |
> 1000 |
|
|
mitoxantrone (in mg per sq meter) |
|
|
< 15 |
>= 15 |
|
where:
• Only a single level was given for: busulfan, dacarbazine, epirubicin, fluorouracil and lomustine. In the implementation I used only a single value, although moving to 1 higher level might be an alternative.
|
Level 1 Agents |
Level 2 Agents |
Level 3 Agents |
|
androgens bleomycin chlorambucil cladribine corticosteroids fludarabine hydroxyurea interferon melphalan (oral) mercaptopurine thioguanine (oral) tretinoin vinblastine vincristine vinorelbine |
asparaginase docetaxel etoposide gemcitabine mitomycin paclitaxel teniposide thiotepa topotecan |
aldesleukin hycamtin idarubicin ifosfamide methenamine (oral) |
|
Level 4 Agents |
Level 5 Agents |
|
carboplatin irinotecan melphalan (IV) procarbazine (oral) |
mechlorethamine pentostatin streptozocin |
Algorithm for combining emetogenicity with combination chemotherapy (Hesketh):
(1) Identify most emetogenic agent in regimen.
(2) Increase this level by 1 for each Level 4 agent (up to 5).
(3) Increase this level by 1 for each Level 3 agent (up to 5).
(4) Increase the level by 1 for >= 1 Level 2 agent(s).
(5) Level 1 agents do not increase the level.
Purpose: To determine the emetogenic potential of a chemotherapy regimen.
Specialty: Hematology Oncology
Objective: adverse effects, prevention
ICD-10: T45.1,
