Proposal for classifying the acute emetogenicity of cancer chemotherapy

P. J. Hesketh, M. G. Kris, S. M. Grunberg, T. Beck, J. D. Hainsworth, G. Harker, M. S. Aapro, David R Gandara, C. M. Lindley

Research output: Contribution to journalArticlepeer-review

534 Scopus citations


Purpose: To propose a classification of the acute emetogenicity of antineoplastic chemotherapy agents, and to develop an algorithm to define the emetogenicity of combination chemotherapy regimens. Methods: A Medline search was conducted to identify (1) clinical trials that used chemotherapy as single-agent therapy, and (2) major reviews of antiemetic therapy. The search was limited to patients who received commonly used doses of chemotherapy agents, primarily by short (< 3 hours) intravenous infusions. Based on review of this information and our collective clinical experience, we assigned chemotherapy agents to one of five emetogenic levels by consensus. A preliminary algorithm to determine the emetogenicity of combination chemotherapy regimens was then designed by consensus. A final algorithm was developed after we analyzed a data base composed of patients treated an the placebo arms of four randomized antiemetic trials. Results: Chemotherapy agents were divided into five levels: level 1 (< 10% of patients experience acute [≤24 hours after chemotherapy] emesis without antiemetic prophylaxis); level 2 (10% to 30%); level 3 (30% to 60%); level 4 (60% to 90%); and level 5 (> 90%). For combinations, the emetogenic level was determined by identifying the most emetogenic agent in the combination and then assessing the relative contribution of the other agents. The following rules apply: (1) level 1 agents do not contribute to the emetogenic level of a combination; (2) adding ≤ one level 2 agent increases the emetogenicity of the combination by one level greater than the most emetogenic agent in the combination; and (3) adding level 3 or 4 agents increases the emetogenicity of the combination by one level per agent. Conclusion: The proposed classification schema provides a practical means to determine the emetogenic potential of individual chemotherapy agents and combination regimens during the 24 hours after administration. This system can serve as a framework for the development of antiemetic guidelines.

Original languageEnglish (US)
Pages (from-to)103-109
Number of pages7
JournalJournal of Clinical Oncology
Issue number1
StatePublished - Jan 1997
Externally publishedYes

ASJC Scopus subject areas

  • Cancer Research
  • Oncology


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