MASCC 2016 ASCO NCCN 2017

Day 1 Day 2-4 Day 1 Day 2-5 Day 1 Day 2-4

High Emetic - single doses of a 5- - dexamethasone 5-HT3 receptor 5-HT3 receptor - 5-HT3 receptor antagonist -Dexamethasone
Risk HT3 receptor (breast cancer) antagonist+dexamethas antagonist before + dexamethasone (If use aprepitant combind
antagonist+ - For triplet thrapy in one, +neurokinin 1 (NK1) each fraction and +neurokinin 1 (NK1) Dexamethasone with aprepitant
dexamethasone, + use in prevention NK1 receptor antagonist for 24 hours after receptor antagonist on day 2-3 )
(aprepitant, receptor antagonist or treatment and
fosaprepitant, dexamethasone should may receive a 5- Olanzapine+Palonosetron+ Olanzapine
netupitant*,** or be used on days 2 and day course of dexamethasone
rolapitant 3 or none dexamethasone Olanzapine+Aprepitant + Olanzapine+Aprepitant +
-same in breast during fractions 1 dexamethasone dexamethasone
cancer to 5
Moderately - 5-HT3 receptor - known potential for Palonosetron+ 5-day course of - 5-HT3 receptor antagonist - 5-HT3 receptor antagonist +
Emetogenic antagonist delayed nausea and dexamethasone dexamethasone + dexamethasone dexamethasone on day 2-3
Chemother - NK1 receptor vomiting (e.g., Olanzapine+Aprepitant + Aprepitant + dexamethasone on
apy antagonist+5-HT3 oxaliplatin, dexamethasone day 2-3
receptor antagonist+ anthracycline, Fosapripretant or Rolapitant Dexamethasone on day 2-3
dexamethasone cyclophosphamide), + dexamethasone
(carboplatin-based the use of NEPA + dexamethasone Dexamethasone on day 2-3
chemotherapy) dexamethasone for Olanzapine+Palonosetron+ Olanzapine
days 2 to 3 can be dexamethasone
considered.*
- No routine
prophylaxis
 If aprepitant 125 mg aprepitant 80 mg on
is used days 2 to 3 is
recommended for the
prevention of delayed
nausea and vomiting
Low dexamethasone, or dexamethasone Dexamethasone or
Emetogenic 5-HT3 receptor Metroclopamide or
Chemother antagonist, or a Prochlorperazine or 5HT3
apy dopamine receptor RA
antagonist, such as
metoclopramide
* Netupitant is administered with palonosetron as part of the fixed-dose oral combination agent NEPA If a NK1 receptor antagonist is not available for AC
chemotherapy, palonosetron is the preferred 5-HT3 receptor antagonist.
**Olanzapine may be considered with a 5-HT3 receptor antagonist plus dexamethasone, particularly when nausea is an issue