Kris, M.G., Hesketh, P.J., Somerfield, M.R., Feyer, P., Clark-Snow, R., … Grunberg, S.M. (2006). American Society of Clinical Oncology guideline for antiemetics in oncology: Update 2006. Journal of Clinical Oncology, 24(18), 2932–2947.

Purpose & Patient Population

To update the 1999 American Society of Clinical Oncology (ASCO) guideline for antiemetics in oncology 

Type of Resource/Evidence-Based Process

The update committee reviewed studies identified through a literature search.

Databases searched were MEDLINE, the National Library of Medicine, and the Cochrane Collaboration Library (1998-Feb. 2006).

Studies were included if they were phase II and III randomized, controlled trials.

The search identified the following studies.

  • Systematic reviews and meta-analysis on neurokinin 1 (NK1) receptor antagonists in the prevention of chemotherapy-induced nausea and vomiting (CINV) related to high-dose chemotherapy
  • A meta-analysis of randomized trials assessing the efficacy of dexamethasone in controlling CINV
  • Three systematic reviews and meta-analyses of 5-hydroxytryptamine 3 (5-HT3) receptor antagonists

Additional materials provided to the committee were

  • Two additional systematic reviews available prepublication from the Cancer Care Ontario Program in Evidence-Based Care
  • Consensus statements and guidelines from Multinational Association of Supportive Care in Cancer (MASCC).

Guidelines & Recommendations

  • The combination of 5-HT3 receptor antagonist, dexamethasone, and aprepitant is recommended before highly emetogenic chemotherapy (HEC). This combination is recommended for patients receiving an anthracycline and cychlophosphamide. At equivalent doses for the prevention of acute emesis, 5-HT3 receptor antagonists have equivalent safety and efficacy. 
  • For patients receiving HEC, antiemetic agents of lower therapeutic index are not an appropriate first choice. Agents with lower therapeutic index should be used in patients who are unable to take to a 5-HT3 receptor antagonist, dexamethasone, and aprepitant because of allergy or side effects or for whom these agents have been ineffective.
  • For patients receiving moderately emetogenic chemotherapy (MEC), a combination of a 5-HT3 receptor antagonist and dexamethasone is recommended.
  • In patients receiving cisplatin and all other agents of high emetic risk, the combination of aprepitant and dexamethasone is recommended for the prevention of delayed emesis.
  • The combination of a 5-HT3 receptor antagonist and dexamethasone is no longer a recommendation for the prevention of delayed emesis after HEC.
  • The recommendation to lower the dose of dexamethasone when administered as an antiemetic with aprepitant does not apply to corticosteroids for anticancer therapy.