Proposal for classifying the acute emetogenicity of cancer chemotherapy.
OBJECTIVE
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 on the placebo arms of four randomized antiemetic trials.


RESULTS
Chemotherapy agents were divided into five levels: level 1 (< 10% of patients experience acute [< or = 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 > or = 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.


CONCLUSIONS
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.
Hesketh
P J
PJ
St Elizabeth's Medical Center, Boston, MA 02135, USA. PhesKeth@aol.com
Kris
M G
MG
Grunberg
S M
SM
Beck
T
T
Hainsworth
J D
JD
Harker
G
G
Aapro
M S
MS
Gandara
D
D
Lindley
C M
CM
D000208:Acute Disease; D000465:Algorithms; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000145:classification*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects / Q000145:classification; D002986:Clinical Trials as Topic; D005260:Female; D006801:Humans; D008297:Male; D009325:Nausea / Q000139:chemically induced*; D016032:Randomized Controlled Trials as Topic; D014839:Vomiting / Q000139:chemically induced*
D000970:Antineoplastic Agents