The Multinational Association of Supportive Care in Cancer (MASCC) had their first antiemetic guideline consensus conference in Perugia in 1997 [1, 2] and updated the guidelines in 2004 [3, 4]. The European Society for Medical Oncology (ESMO) published their first antiemetic guideline in 2001 [5] with annual updates in subsequent years. In 2009 the two societies joined forces and published mutual antiemetic guidelines based on consensus meetings in 2009 (Perugia) and 2015 (Copenhagen). An Expert Committee was appointed by the two societies with 10 working groups identified to update specific antiemetic recommendations. The guidelines were published in Annals of Oncology in 2010 [6] and 2016 [7] as one review paper of all recommendations and in 10 papers in Supportive Care in Cancer in 2011 and 2017 as extended reviews of the recommendations from each of the 10 working groups.

For this update, members of the 2015 Consensus Committee were asked to join the current Consensus Committee. The societies also advertised for new members with documented experience (publications) in nausea and vomiting induced by antineoplastic therapy. The Consensus Committee for the 2023 update consisted of 34 multidisciplinary, health care professionals with expertise in antiemetic research (physicians, nurses, pharmacists, and pharmacologists) and three patient advocates (Fig. 1) representing a total of 5 continents and 18 countries (Fig. 2). As previously noted, the work was organised in 10 working groups including 6–10 members of the Consensus Committee. Some became members of up to three working groups, but a member could only chair one working group (Fig. 3).

Fig. 1
figure 1

Members of the 2023 MASCC/ESMO antiemetic guideline update committee

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Fig. 2
figure 2

Countries and continents represented in the MASCC/ESMO 2023 antiemetic guideline update committee

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Fig. 3
figure 3

Overview of working groups

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The methodology for the guideline process has previously been described [6, 8]. In brief, the reporting of the literature search followed the PRISMA criteria for systematic reviews [9]. The current update of the recommendations include studies published from June 1, 2015 to January 31, 2023 (for details of the literature search and reporting are referred to the publications from each of the working groups). To change a 2015 recommendation or for a new guideline recommendation to be accepted, a consensus of at least 67% of the expert panellists was needed. The panel considered changes of ≥ 10% to be sufficient to warrant a change of a 2015 recommendation. Levels of evidence (I-V) and grades of recommendation (A-E) were given according to the adapted version of the grading of the Infectious Diseases Society of America [10].

In Supportive Care in Cancer, we report updated recommendations (Fig. 3). Two of these guidelines are included for the first time. Working group VIII developed guidelines for “Resource limited settings”, and working group IX developed “Guidelines for patients”. A condensed version of the updated guidelines from working groups I-VII was recently published [11]. The articles in Supportive Care in Cancer are to be considered as more detailed (extended) reviews.

There is a need for more research in nausea and vomiting induced by antineoplastic agents. For example we know very little about the emetic risk potential of the antibody drug conjugates and of most of the oral agents.

Furthermore, although recommendations are based on evidence-based data, it should be emphasized that not all patients have outcomes as we expect them to according to the guidelines. Therefore, recommendations concern the first course of antineoplastic therapy; modifications may be necessary in subsequent courses.

Only updated guidelines can make an impact. Therefore, each working group will make a new literature search every 6 months and if relevant update the current version of the guideline.