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2016 Updated MASCC/ESMO Consensus Recommendations: Controlling nausea and vomiting with chemotherapy of low or minimal emetic potential



The purpose of this review is to update the MASCC (Multinational Association of Supportive Care in Cancer) guidelines for controlling nausea and vomiting with chemotherapy of low or minimal emetic potential.


The antiemetic study group of MASCC met in Copenhagen in 2015 to review the MASCC antiemetic guidelines. A subgroup performed a systematic literature review on antiemetics for low emetogenic chemotherapy (LEC) and chemotherapy of minimal emetic potential and the chair presented the update recommendation to the whole group for discussion. They then voted with an aim of achieving 67 % or greater consensus.


For patients receiving low emetogenic chemotherapy, a single antiemetic such as dexamethasone, a 5HT3 receptor antagonist, or a dopamine receptor antagonist may be considered for prophylaxis of acute emesis. For patients receiving chemotherapy of minimal emetogenicity, no antiemetic should be routinely administered. If patients vomit, they should be treated as for chemotherapy of low emetic potential. No antiemetic should be administered for prevention of delayed nausea and vomiting induced by low or minimally emetogenic chemotherapy.


More research is needed to determine the incidence of emesis, particularly delayed emesis, in the LEC group. Prospective studies are required to evaluate antiemetic strategies. The risk of emesis within LEC may be more accurately determined by adding the patient risk factors for emesis to those of the chemotherapy drugs. Improved strategies for promoting adherence to guidelines are required.

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  1. Hesketh PJ, Kris KG, Grunberg SM, et al. (1997) Proposal for classifying the acute emetogenicity of cancer chemotherapy. J Clin Oncol 15:103–109

    CAS  PubMed  Google Scholar 

  2. Grunberg SM, Osaba D, Hesketh PJ et al (2005) Evaluation of new antiemetic agents and definition of antineoplastic emetogenicity—an update. Support Care Cancer 13:80–84

  3. Last accessed 27th Feb 2016

  4. Perry CM, Wiseman LR (1999) Trastuzumab. BioDrugs 12(2):129–135

    CAS  Article  PubMed  Google Scholar 

  5. Al-Dasooqi N, Boen JM, Gibson RJ, et al. (2009) Trastuzumab induces gastrointestinal side effects in HER2-overexpresssing breast cancer patients. Investig New Drugs 27:173–178

    CAS  Article  Google Scholar 

  6. Last accessed 27th February 2016

  7. Robert C, Schachter J, Long GV, et al. (2015) Pembrolizumab versus ipilimumab in advanced melanoma. New Engl J Med 372:2521–2532

    CAS  Article  PubMed  Google Scholar 

  8. Einhorn LH, Brames MJ (2006) Emetic potential of daily oral etoposide. Support Care Cancer 14:1262–1265

    Article  PubMed  Google Scholar 

  9. Tonato M, Clark-Snow RA, Osoba D, et al. (2005) Emesis induced by low or minimal emetogenic risk chemotherapy. Support Care Cancer 13:109–111

    Article  PubMed  Google Scholar 

  10. Basch E, Hesketh PJ, Kris MJ, et al. (2011) Antiemetics: American Society of Clinical Oncology clinical practice guideline update. J Oncol Practice 7:395–398

    Article  Google Scholar 

  11. Last accessed 17th Feb 2016

  12. Vardy J, Chiew KS, Galica J, et al. (2006) Side effects associated with the use of dexamethasone for prophylaxis of delayed emesis after moderately emetogenic chemotherapy. Br J Cancer 94:1011–1015

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  13. Italian group for antiemetic research (2004) Randomised double-blind, dose-finding study of dexamethasone in preventing acute emesis induced by anthracyclines, carboplatin, or cyclophosphamide. J Clin Oncol 22:752–729

    Article  Google Scholar 

  14. Costa AL, Abreu C, Pacheo TR et al (2015) Prevention of nausea and vomiting in patients undergoing oral anticancer therapies for solid tumours. Biomed Res Int. Article ID 309601. doi: 10.1155/2015/309601

  15. Hayashi T, Ikesue H, Esaki T, et al. (2010) Implementation of institutional antiemetic guidelines for low emetic risk chemotherapy with docetaxel: a clinical and cost evaluation. Support Care Cancer 20:1805–1810

    Article  Google Scholar 

  16. Keat CH, Phua G, Kassim MSA, et al. (2013) Can granisetron injection used as a primary prophylaxis improve the control of nausea and vomiting with low-emetogenic chemotherapy? Asia Pacific J Cancer Prev 14:469–473

    Article  Google Scholar 

  17. Fabi A, Barduagni M, Lauro S, et al. (2011) Is delayed chemotherapy-induced emesis well managed in oncological clinical practice? An observational study. Support Care Cancer 11:156–161

    Google Scholar 

  18. Molassiotis A, Saunders MP, Valle J, et al. (2008) A prospective observational study of chemotherapy-related nausea and vomiting in routine practice in a UK cancer centre. Support Care Cancer 16:201–208

    CAS  Article  PubMed  Google Scholar 

  19. Gralla R, Lichinitser M, Van Der Vegt S, et al. (2003) Palonosetron improves prevention of chemotherapy-induced nausea and vomiting following moderately emetogenic chemotherapy: results of a double-blind randomized phase III trial comparing single doses of palonosetron with ondansetron. Ann Oncol 14:1570–1577

    CAS  Article  PubMed  Google Scholar 

  20. Saito M, Aogi K, Sekine I, et al. (2009) Palonosetron plus dexamethasone versus granisetron plus dexamethasone for prevention of nausea and vomiting during chemotherapy: a double-blind, double-dummy, randomised, comparative phase III trial. Lancet Oncol 10:115–124

    CAS  Article  PubMed  Google Scholar 

  21. Aapro MS, Grunberg SM, Manikhas GM, et al. (2006) A phase III, double-blind, randomized trial of palonosetron compared with ondansetron in preventing chemotherapy-induced nausea and vomiting following highly emetogenic chemotherapy. Ann Oncol 17:1441–1449

    CAS  Article  PubMed  Google Scholar 

  22. Schwartzberg L, Morrow G, Balu S, et al. (2011) Chemotherapy-induced nausea and vomiting and antiemetic prophylaxis with palonosetron versus other 5HT3 receptor antagonists in patients with cancer treated with low emetogenic chemotherapy in a hospital outpatient setting in the United States. Curr Med Res Opin 27:1613–1622

    CAS  Article  PubMed  Google Scholar 

  23. Hesketh PJ, Morrow G, Komorowski AW, Ahmed R, Cox D (2012) Efficacy and safety of palonosetron as salvage treatment in the prevention of chemotherapy-induced nausea and vomiting in patients receiving low emetogenic chemotherapy (LEC). Support Care Cancer 20:2633–2637

    Article  PubMed  Google Scholar 

  24. Navari RM, Gray SE, Kerr AC (2011) Olanzapine versus aprepitant for the prevention of chemotherapy-induced nausea and vomiting: a randomised phase II trial. J Support Oncol 9:188–195

    CAS  Article  PubMed  Google Scholar 

  25. Jordan K, Jahn F, Aapro M (2015) Recent developments in the prevention of chemotherapy-induced nausea and vomiting (CINV): a comprehensive review. Ann Oncol 26:1091–1090

    Article  Google Scholar 

  26. Warr DG, Street JC, Carides AD (2011) Evaluation of risk factors predictive of nausea and vomiting with current standard-of-care antiemetic treatment: analysis of phase 3 trial of aprepitant in patients receiving adriamycin-cyclophosphamide-based chemotherapy. Support Care Cancer 19:807–813

    Article  PubMed  Google Scholar 

  27. D’Acqusito RW, Tyson LB, Gralla RJ, et al. (1986) The influence of chromic high alcohol intake on chemotherapy-induced nausea and vomiting. Proc Am Soc Clin Oncol 5:257

    Google Scholar 

  28. Morrow GR (1985) The effect of susceptibility to motion sickness on the side effects of cancer chemotherapy. Cancer 55:2766–2770

    CAS  Article  PubMed  Google Scholar 

  29. Olver IN, Taylor AE, Whitford H (2005) Relationships between patients’ pre-treatment expectations of toxicities and post chemotherapy experiences. Psycho-Oncology 14:25–33

    Article  PubMed  Google Scholar 

  30. Aapro M, Molassiotis A, Dicato M, et al. (2012) The effect of guideline-consistent antiemetic therapy on chemotherapy-induced nausea and vomiting (CINV): the Pan European Emesis Registry (PEER). Ann Oncol 23:1986–1992

    CAS  Article  PubMed  Google Scholar 

  31. Yu S, Burke TA, Chan A, et al. (2014) Antiemetic therapy in Asia Pacific countries for patients receiving moderately and highly emetogenic chemotherapy—a descriptive analysis of practice patterns, antiemetic quality of care, and use of antiemetic guidelines. Support Care Cancer 23:273–282

    Article  PubMed  Google Scholar 

  32. Olver I, von Dincklage J, Nicholson J, Shaw T (2016) Improving uptake of wiki-based guidelines with Qstream education. Med Educ 50:590–591

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Correspondence to Ian Olver.

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Conflicts of interest

The authors received remuneration, research funding, and consultancies as follows:

I Olver: Tesaro; C Ruhlmann: Swedish Orphan Biovitrum; F Jahn: MSD, Merck, Helsinn, Tesaro; L Schwartzberg: Eisai, Merck, Helsinn, Tesaro; B Rapoport: Merck, Helsinn, MSD Tesaro; C Rittenberg: none; R Clark-Snow: none.

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Olver, I., Ruhlmann, C.H., Jahn, F. et al. 2016 Updated MASCC/ESMO Consensus Recommendations: Controlling nausea and vomiting with chemotherapy of low or minimal emetic potential. Support Care Cancer 25, 297–301 (2017).

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  • Antiemetic
  • Nausea
  • Vomiting
  • Low emetogenic chemotherapy (LEC)
  • Minimal emetogenicity
  • Minimal emetogenic chemotherapy