2016 Updated MASCC/ESMO consensus recommendations: Emetic risk classification and evaluation of the emetogenicity of antineoplastic agents

Purpose: Employing the same framework as in previous guideline updates, antineoplastic agents were classified into four emetic risk categories. The classification of the emetogenic level of new antineoplastic agents, especially for the oral drugs, represents an increasing challenge. Accurate reporting of emetogenicity of new antineoplastic agents in the absence of preventive antiemetic treatment is rarely available. Methods: A systematic search was conducted for drugs approved after 2009 until June 2015 using EMBASE and PubMed. The search term was “drug name.” The restrictions were language (English records only), date (2009 to 2015), and level of evidence (“clinical trial”). Results: From January 2009 to June 2015, 42 new antineoplastic agents were identified and a systematic search was conducted to identify relevant studies to help define emetic risk levels. The reported incidence of vomiting varied across studies for many agents, but there was adequate evidence to allow 41 of the 42 new antineoplastic agents to be classified according to emetogenic risk. No highly emetogenic agents were identified. Seven moderately emetogenic agents, 26 low emetogenic, agents and eight minimal emetogenic agents were identified and classified accordingly. The MASCC/ESMO update committee also recommended reclassification of the combination of an anthracycline and cyclophosphamide (AC) as highly emetogenic. Conclusion: Despite several limitations, we have attempted to provide a reasonable approximation of the emetic risk associated with new antineoplastic agents through a comprehensive search of the available literature. Hopefully by the next update, more precise information on emetic risk will have been collected during new agent development process.