Consensus recommendations for the prevention of vomiting and nausea following high-emetic-risk chemotherapy

Mark G. Kris, Maurizio Tonato, Emilio Bria, Enzo Ballatori, Birgitte Espersen, Jørn Herrstedt, Cynthia Rittenberg, Lawrence H. Einhorn, Steven Grunberg, Mitsue Saito, Gary Morrow, Paul Hesketh

Research output: Contribution to journalReview articlepeer-review

32 Scopus citations


In this update of our 2005 document, we used an evidence-based approach whenever possible to formulate recommendations, emphasizing the results of controlled trials concerning the best use of antiemetic agents for the prevention of emesis and nausea following anticancer chemotherapies of high emetic risk. A three-drug combination of a 5-hydroxytryptamine type 3 receptor (5-HT3) receptor antagonist, dexamethasone, and aprepitant beginning before chemotherapy and continuing for up to 4 days remains the standard of care. We address issues of dose, schedule, and route of administration of five selective 5-HT3 receptor antagonists. We conclude that, for each of these five drugs, there is a plateau in therapeutic efficacy above which further dose escalation does not improve outcome. In trials designed to prove the equivalence of palonosetron to ondansetron and granisetron, palonosetron proved superior in emesis prevention, while adverse effects were comparable. Furthermore, for all classes of antiemetic agents, a single dose is as effective as multiple doses or a continuous infusion. The oral route is as efficacious as the intravenous route of administration.

Original languageEnglish (US)
Pages (from-to)S25-S32
JournalSupportive Care in Cancer
Issue numberSUPPL. 1
StatePublished - Mar 2011


  • Antiemetic agents
  • High-emetic-risk chemotherapy
  • Nausea

ASJC Scopus subject areas

  • Oncology

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