Latest Cancer TreatmentsDr. Mohammadreza Dabiri
Dr. Mohammadreza Dabiriفارسی
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Preventing Chemotherapy-Induced Nausea and Vomiting: Choosing the Antiemetic Regimen

Based on the emetogenic risk of the regimen; ASCO 2020 and MASCC/ESMO 2023

Updated: 27 October 20261 min read4 references

Suggests antiemetic prophylaxis based on the emetogenicity of the chemotherapy (ASCO and MASCC/ESMO guidelines).

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An aid for clinicians; it does not replace clinical judgement, local protocols or the drug label. Double-check every result before prescribing.

Principles

  • High emetic risk (cisplatin, AC and others): four drugs — an NK1 antagonist, a 5-HT3 antagonist, dexamethasone and olanzapine [1, 2]. Olanzapine 10 mg reduced nausea over the five days after chemotherapy [3], and 5 mg was also effective with less sedation [4].
  • Carboplatin AUC 4 or more: three drugs including an NK1 antagonist [1, 2].
  • Moderate risk: a 5-HT3 antagonist plus dexamethasone on day 1 [1].
  • Low risk: a single drug; minimal risk: no routine prophylaxis [1].
Spare dexamethasone

With AC regimens, dexamethasone on day 1 only is sufficient and days 2–4 can be omitted [1, 2]. Immunotherapy given with chemotherapy is not a reason to omit antiemetic dexamethasone [1].

Common questions

What if nausea occurs despite prophylaxis?

For breakthrough nausea, give olanzapine if not already used, or a drug from another class, and step up prophylaxis by one level in the next cycle [1].

What is anticipatory nausea?

Nausea that starts before chemotherapy after a bad earlier experience; the best prevention is complete control from the first cycle, and lorazepam or behavioural therapy can help [1].

References

4 references
Show all references, 3 with a study cardClose the reference list

Numbers in the text, such as [1], refer to these sources. Sources with a “Study card” button are summarised in the site’s evidence library.

  1. 1
    Antiemetics: ASCO Guideline UpdateHesketh PJ, Kris MG, Basch E, et al · J Clin Oncol · 2020;38:2782-2797
    Study cardDOIPubMed Back to text: 1 2 3 4 5 6 7 8
  2. 2
    2023 MASCC and ESMO guideline update for the prevention of chemotherapy- and radiotherapy-induced nausea and vomitingHerrstedt J, Clark-Snow R, Ruhlmann CH, et al · ESMO Open · 2024;9:102195
    Study cardDOIPubMed Back to text: 1 2 3
  3. 3
    Olanzapine for the Prevention of Chemotherapy-Induced Nausea and VomitingNavari RM, Qin R, Ruddy KJ, et al · N Engl J Med · 2016;375:134-42
    Study cardDOIPubMed Back to text
  4. 4
    Olanzapine 5 mg plus standard antiemetic therapy for the prevention of chemotherapy-induced nausea and vomiting (J-FORCE): a multicentre, randomised, double-blind, placebo-controlled, phase 3 trialHashimoto H, Abe M, Tokuyama O, et al · Lancet Oncol · 2020;21:242-249
    DOIPubMed Back to text

This page is based on reputable scientific sources and was last updated on 27 October 2026. The content of this website is for educational and informational purposes only and does not replace consultation, diagnosis or treatment by a specialist physician. Consult your treating physician about any treatment decision.

Printed from the website; the full and up-to-date version: https://drdabiri.com/en/tools/antiemetic-regimen-cinv/

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