Emetogenic Risk Of Chemotherapy And Biotherapy Agents Page 2
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1
2Calculating the Emetogenicity of Multiple Agent Chemotherapy/Biotherapy Regimens
Steps and Guidelines:
1. List each agent contained within the multiple agent regimen.
2. Identify the agent with the highest emetogenic level
3. Determine the contribution of the remaining agents using the following guidelines:
a.
Level 1 agents do not contribute to emetogenicity in combination regimens.
Examples: Level 1+1=0
2+1=2
3+1=3
4+1=4
b. Adding one or more level 2 agents increases the highest level by 1 in combination regimens.
Examples:
Level 2+2=3
3+2=4
2+2+2=3
3+2+2=4
c.
Adding level 3 or 4 agents increases the highest level by 1 per each agent in combination regimens.
Examples:
Level 3+3=4
3+3+3=5
4+3=5
Worksheet:
1. For each agent in the combination regimen, list its name, dose, and emetogenicity:
Agent and Dose
Emetogenicity
2.
most emetogenic agent
Identify the
in the combination:
Agent and dose ______________________________
Emetogenicity: _________
3.
each
For
Level 3 or Level 4 drug, add 1 level of emetogenicity
add: _________
For 1 or more level 2 drugs, add 1 level of emetogenicity
add: _________
4. Add to obtain the expected total emetogenicity level of the combination regimen:
Total: _________
Example Regimen:
1.
List each agent in the combination regimen: Cyclophosphamide 400 mg/m2; Methotrexate 30 mg/m2; Fluorouracil 400 mg/m2
2.
Identify the most emetogenic agent in the combination: Cyclophosphamide 400 mg/m2
Emetic Risk: 3
3.
For each Level 3 or Level 4 drug, add 1 level of emetogenicity
Add: 0
For 1 or more level 2 drugs, add 1 level of emetogenicity
Add: 1
4.
Add to obtain the expected total emetogenicity level of the combination regimen:
Total: 4
References
Grunberg, S.M., Osoba, D., Hesketh, P.J., Gralla, R.J., Borjeson, S., Rapoport, B.L., duBois, A., & Tonato, M. (2004). Evaluation of new
antiemetic agents and definition of antineoplastic agent emetogenicity: An update. Support Care Cancer, 13, 80–84.
Hesketh P.J. (1999). Defining the emetogenicity of cancer chemotherapy regimens: Relevance to clinical practice. The Oncologist, 4,
191‐196.
National Comprehensive Cancer Network. (2010). NCCN clinical practice guidelines in oncology™: Antiemesis. Version 2.2010.
Jenkintown, PA: Authors.
Polovich, M., Whitford, J.M., & Olsen, M. (Eds.). (2009). Chemotherapy and biotherapy guidelines and recommendations for practice
(3rd ed.). Pittsburgh, PA: Oncology Nursing Society.
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