Blood & Cancer

Blood & Cancer: A hematology-oncology podcast from MDedge


In the first episode of Blood & Cancer, David Henry, MD (, welcomes Richard J. Gralla, MD (, or the Albert Einstein College of Medicine in New York. The topic today centers around antiemetics and ways to use them. And later, Ilana Yurkiewicz, MD (, debuts her segment Clinical Correlations all about hematology care.
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Show Notes

By Emily Bryer, DO

  • Highly emetic chemotherapy regimens include cisplatin, dacarbazine, anthracycline, and cyclophosphamide combinations
    • Treatment should include an NK1 receptor antagonist, dexamethasone, and a 5HT3 antagonist
    • All 5HT3 antagonists should be given only once (no evidence that prn or delayed administration is helpful)
    • Olanzapine is an effective antiemetic, although its precise role and dose are undergoing investigation
    • An all-oral regimen for highly emetic could include Netupitant (NK1) and palonosetron (long-acting 5HT3) (NEPA) + Oral Dex + Olanzapine
  • Moderately emetic chemotherapy regimens include irinotecan and taxotere
    • Treatment should include 5HT3 antagonist and dexamethasone
  • Carboplatin causes more emesis than initially thought
    • Improvement with NK1 antagonist yields a 15% decreased risk of emesis
    • Guidelines now recommending NK1 with carboplatin
  • Low emetic chemotherapy regimens include gemcitabine, pemetrexed as single agent
    • Single drug: one dose of corticosteroid or one dose of 5HT3 antagonist
  • Minimal emetic chemotherapy regimens include vincristine or bleomycin
    • No drugs are recommended for acute or delayed nausea/emesis
  • 20 mg Dexamethasone IV (or 12 mg PO 12 mg) should be administered only on day 1 of chemotherapy. Dexamethasone can be spared after that unless cisplatin (would require 2 days of steroids)
  • Marijuana and THC have some antiemetic properties, but are about one quarter as effective as 5HT3 antagonists
  • Lorazepam may be used in anticipatory emesis started a few days prior to chemotherapy


Ann Oncol. 2014 Jul;25(7):1333-9.

JCSO 2015;13(4):128-30.

JCSO 2016;4(1):11-20.

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Dr. Ilana Yurkiewicz on Twitter: @ilanayurkiewicz

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