National Comprehensive Cancer Network

About NCCN

UPDATES: NCCN Guidelines® and NCCN Compendium®

NCCN has published updates to the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) and the NCCN Drugs & Biologics Compendium (NCCN Compendium®) for Antiemesis. These NCCN Guidelines are currently available as Version 1.2014.

    • High emetic risk intravenous chemotherapy - acute and delayed emesis prevention (AE-2)
      • Added "daily" to the recommendation for granisetron 2 mg PO.
      • Removed "max 32 mg/day" IV dose for ondansetron.
      • Added olanzapine-containing regimen:
        • Olanzapine 10 mg PO days 1-4
        • Palonosetron 0.25 mg IV day 1
        • Dexamethasone 20 mg IV day 1
    • Added the following reference; Navari RM, Gray SE, Kerr AC. Olanzapine versus aprepitant for the prevention of chemotherapy-induced nausea and vomiting: a randomized phase III trial. J Support Oncol 2011;9:188-195.

    • Moderate emetic risk intravenous chemotherapy - emesis prevention (AE-3)
      • Added "daily" to the recommendation for granisetron 2 mg PO.
      • Removed "max 32 mg/day" IV dose for ondansetron.
      • Added olanzapine-containing regimen:
        • Olanzapine 10 mg PO  days 1-4
        • Palonosetron 0.25 mg IV day 1
        • Dexamethasone 20 mg IV day 1
      • Added the following reference; Navari RM, Gray SE, Kerr AC. Olanzapine versus aprepitant for the prevention of chemotherapy-induced nausea and vomiting: a randomized phase III trial. J Support Oncol 2011;9:188-195.
      • Under days 2 and 3 added: "Fosaprepitant used day 1: ± dexamethasone 8 mg PO or IV (days 2 and 3)."

  • Low and minimal emetic risk intravenous chemotherapy - emesis prevention (AE-4)
  • Following Low, added "Serotonin (5-HT3) antagonist (Choose one):"
    • Dolasetron 100 mg PO daily 
    • Granisetron 2 mg PO daily or 1 mg PO BID
    • Ondansetron 16-24 mg PO daily
  • Added footnote e: "Order of listed antiemetics is alphabetical."
  • Removed the IV administration of prochlorperazine

    • Oral chemotherapy - emesis prevention (AE-5)
      • Following Low to minimal emetic risk, added "Serotonin (5-HT3) antagonist (Choose one):"
        • Dolasetron 100 mg PO daily 
        • Granisetron 2 mg PO daily or 1 mg PO BID
        • Ondansetron 16-24 mg PO daily
      • Removed the IV administration of prochlorperazine

    • Breakthrough treatment for chemotherapy-induced nausea/vomiting  (AE-6)
      • Removed the IV administration of prochlorperazine
      • Removed the following footnote: See blackbox warning/label indication regarding type II diabetes, hyperglycemia, and death in elderly dementia patients.

    • Emetic potential of intravenous antineoplastic agents (AE-8)
      • Added the following agents to low emetic risk:
        • Ado-trastuzumab ematansine
        • Omacetaxine
        • Ziv-aflibercept

    • Emetic potential of oral antineoplastic agents (AE-9)
      • Added the following agents to minimal to low emetic risk:
        • Cabozantinib
        • Dabrafenib
        • Pomalidomide
        • Ponatinib
        • Trametinib
      • Added a footnote to temozolomide stating; "Temozolomide ≤ 75 mg/m2 should be considered moderately emetogenic with concurrent radiotherapy."

  • Principles of managing multiday emetogenic chemotherapy regimens (AE-A)
    • Under neurokinin antagonists: added a new bullet, "Data from a small phase III randomized study support the use of aprepitant (125 mg day 3, 80 mg days 4-7) with 5-HT3 antagonist (days 1-5) and dexamethasone (20 mg days 1, 2) in patients with germ line cancers treated with 5-day cisplatin-based chemotherapy."
    • Added the reference: Albany C, Brames MJ, Fausel C, et al. Randomized, double-blind, placebo-controlled, phase III cross-over study evaluating the oral neurokinin-1 antagonist aprepitant in combination with a 5HT3 receptor antagonist and dexamethasone in patients with germ cell tumors receiving 5-day cisplatin combination chemotherapy regimens: a hoosier oncology group study. J Clin Oncol 2012;30:3998-4003.

  • The Discussion section has been updated to reflect the changes in the algorithm (MS-1).

For the complete updated versions of the NCCN Guidelines®, the NCCN Drugs & Biologics Compendium (NCCN Compendium®), and the NCCN Chemotherapy Order Templates (NCCN Templates®), please visit NCCN.org.

To access the NCCN Biomarkers Compendium™, please visit NCCN.org/biomarkers.

To view the NCCN Guidelines for Patients®, please visit NCCN.com.

Free NCCN Guidelines mobile apps for iPad and Android are now available! Visit NCCN.org/apps