Herrstedt, J. (2008). Antiemetics: An update and the MASCC guidelines applied in clinical practice. Nature Clinical Practice.Oncology, 5, 32–43.

To review the pathophysiology of cancer-related nausea and vomiting and the research regarding various medications for management of this symptom, as well as similarities and differences among guidelines of various professional groups

Multinational Association of Supportive Care in Cancer (MASCC) guidelines are based on consensus via surveys and a consensus conference.

High emetic risk (e.g., cisplatin, dacarbazine, high-dose cyclophosphamide)

• Acute: Serotonin antagonist plus dexamethasone plus aprepitant
• Delayed: Aprepitant days 2–3 plus dexamethasone day 2–3 or 2–4

Moderate emetic risk (e.g., cyclophosphamide at more than 100 mg/m², anthracyclines, oxaliplatin, carboplatin)

• Acute: Serotonin antagonist plus dexamethasone
• Delayed: Dexamethasone days 2–3
• Patients receiving cyclophosphamide plus an anthracycline should receive acute protection for high emetic risk and delayed emesis protection with aprepitant or dexamethasone days 2–3.

Low emetic risk (e.g., topotecan, gemcitabine, taxanes, capecitabine, trastuzumab)

• Acute: Low-dose dexamethasone
• Delayed: No routine prophylaxis

Minimal emetic risk (e.g., bleomycin, vinca-alkaloids, bevacizumab): No routine prophylaxis

No approach to anticipatory nausea was provided.

New medications are highly effective in prophylaxis of emesis, but prevention of nausea remains challenging.