Guideline sources The following summarized guidelines for the evaluation and management of chemotherapy- and radiotherapy-induced nausea and vomiting are prepared by our editorial team based on guidelines from the Pediatric Oncology Group of Ontario (POGO 2023; 2022; 2021; 2019), the Multinational Association of Supportive Care in Cancer (MASCC 2022), the European Society of Medical Oncology (ESMO 2021), the American Society of Clinical Oncology (ASCO 2020), and the Multinational Association of Supportive Care in Cancer (MASCC/ESMO 2016). 1 2 3 4 5 6 7 8 9 Calculator Calculator Eastern Cooperative Oncology G Karnofsky performance status s Guidelines 1. Diagnostic investigations Clinical assessment: re-evaluate emetic risk, disease status, concurrent illnesses, and medications in patients with breakthrough nausea or vomiting. Ascertain that the best regimen is https://web.pathway.md/diseases/rec5SOTVt8G9FKSJW 1/11 6/29/23, 3:50 AM Chemotherapy- and radiotherapy-induced nausea and vomiting Pathway being administered for the emetic risk. B 2. Medical management Management of breakthrough NV, first-line therapy: As per ASCO 2020 guidelines, administer olanzapine (if not administered prophylactically) in addition to the standard antiemetic regimen in adult patients experiencing nausea or vomiting despite optimal prophylaxis. B As per ESMO/MASCC 2016 guidelines, administer an antiemetic with a different mechanism of action than used for prophylaxis for the management of breakthrough nausea and vomiting. Consider administering olanzapine 10 mg/day PO for 3 days in patients with breakthrough nausea and vomiting, recognizing that mild-to-moderate sedation in these patients, especially elderly patients, is a potential issue with olanzapine. B Management of breakthrough NV (second-line therapy): Consider administering a drug of a different class, such as an NK1 receptor antagonist, lorazepam or alprazolam, a dopamine receptor antagonist, C dronabinol, or nabilone, C in addition to the standard antiemetic regimen in adult patients experiencing nausea or vomiting despite optimal prophylaxis if olanzapine has already been administered. C Insufficient evidence to support the use of medical marijuana in place of dronabinol and nabilone for the treatment of chemotherapy- or radiotherapy-induced nausea and vomiting. I Management of breakthrough NV (cannabinoids): consider administering cannabinoids for the treatment of chemotherapy-induced nausea and vomiting in refractory cases with persisting symptoms despite optimized conventional antiemetic regimens. C Avoid using cannabinoids in patients receiving immune checkpoint inhibitors. C Management of anticipatory NV, prevention: As per ASCO 2020 guidelines, administer the most active antiemetic regimen appropriate for the antineoplastic agents being administered in all patients. Administer such regimens with initial antineoplastic treatment instead assessing the emetic response with less effective antiemetic treatment. B As per ESMO/MASCC 2016 guidelines, control acute and delayed nausea and vomiting as the best approach to prevent anticipatory nausea and vomiting, as anticipatory nausea and vomiting is difficult to control by pharmacological treatment once it develops. B Management of anticipatory NV (benzodiazepines): administer benzodiazepines for the prevention of anticipatory nausea and vomiting. B Management of anticipatory NV, behavioral therapy: As per ASCO 2020 guidelines, consider offering behavioral therapy with systematic desensitization in patients with anticipatory emesis. C As per ESMO/MASCC 2016 guidelines, consider offering behavioral therapies, particularly progressive muscle relaxation training, systematic desensitization, and hypnosis, in patients with anticipatory nausea and vomiting. C https://web.pathway.md/diseases/rec5SOTVt8G9FKSJW 2/11 6/29/23, 3:50 AM Chemotherapy- and radiotherapy-induced nausea and vomiting Pathway 3. Specific circumstances Pediatric patients (classification of emetogenicity): Recognize that the following chemotherapy regimens are classified as follows: Situation Guidance Asparaginase erwinia IV 20,000 IU/m /dose Highly emetogenic Busulfan IV 0.8 mg/kg/dose Busulfan PO 1 mg/kg/dose Carboplatin IV 175 mg/m /dose Cisplatin IV 12 mg/m /dose Cyclophosphamide IV 1,200 mg/m /dose Cytarabine IV 3 g/m /day Dactinomycin IV 1.35 mg/m /dose Doxorubicin IV 30 mg/m /dose Idarubicin PO 30 mg/m /dose Melphalan IV Methotrexate IV 12 g/m /dose Cyclophosphamide 600 mg/m /dose + dactinomycin 1 mg/m /dose Cyclophosphamide 400 mg/m /dose + doxorubicin 40 mg/m /dose Cytarabine 90 mg/m /dose IV + methotrexate IV 150 mg/m /dose Cytarabine IV + teniposide IV Dacarbazine 250 mg/m /dose IV + doxorubicin IV 60 mg/m /dose Sactinomycin 900 g/m /dose IV + ifosfamide 3 g/m /dose Etoposide IV 60 mg/m /dose + ifosfamide IV 1.2 g/m /dose Etoposide IV 250 mg/m /dose + thiotepa IV 300 mg/m /dose Cyclophosphamide IV 1,000 mg/m /dose Moderately emetogenic Cytarabine IV 75 mg/m /dose Dactinomycin IV 10 g/kg/dose Doxorubicin IV 25 mg/m /dose Gemtuzumab IV 3-9 mg/m /dose https://web.pathway.md/diseases/rec5SOTVt8G9FKSJW 3/11 6/29/23, 3:50 AM Chemotherapy- and radiotherapy-induced nausea and vomiting Pathway Imatinib PO > 260 mg/m /day Interferon alpha IV 15-30 million U/m /day Ixabepilone IV 3-10 mg/m /dose Methotrexate IV 5 g/m /dose Methotrexate intrathecal Topotecan orallt 0.4-2.3 mg/m /day Cytarabine IV 100 mg/m /dose + daunorubicin IV 45 mg/m /dose + etoposide IV 100 mg/m /dose + prednisolone PO + thioguanine PO 80 mg/m /dose Cytarabine 60 or 90 mg/m /dose + methotrexate 120 mg/m /dose Liposomal doxorubicin IV 20-50 mg/m /dose + topotecan PO 0.6 mg/m /day Cyclophosphamide IV 500 mg/m /dose Low emetogenic Cyclophosphamide PO 2-3 mg/kg/dose Dasatinib PO 60-120 mg/m /dose Erlotinib PO 35-150 mg/m /day Everolimus PO 0.8-9 mg/m /day Gefitinib PO 150-500 mg/m /day Imatinib PO 260 mg/m /day Mafosfamide intrathecal 1-6.5 mg/dose Melphalan PO 0.2 mg/kg/dose Mercaptopurine PO 4.2 mg/kg/dose Methotrexate IV 38-83 mg/m /dose Mitoxantrone IV 33 mg/m /dose Procarbazine PO 50-100 mg/m /day Ruxolitinib PO 15-21 mg/m /dose Selumetinib PO 20-30 mg/m /dose Sorafenib PO 150-325 mg/m /dose Temozolomide PO 200 mg/m /dose Cytarabine IV 60 mg/m /dose + methotrexate IV 90 mg/m /dose Asparaginase (E. coli) IM 6,000 IU/m /dose Minimally emetogenic Asparaginase erwinia IM 25,000 IU/m /dose Chlorambucil PO 0.2 mg/kg/day Doxorubicin IV 10 mg/m /dose https://web.pathway.md/diseases/rec5SOTVt8G9FKSJW 4/11 6/29/23, 3:50 AM Chemotherapy- and radiotherapy-induced nausea and vomiting Pathway Liposomal doxorubicin IV 50 mg/m /dose Mercaptopurine PO 4.2 mg/kg/dose Methotrexate PO/SC 10 mg/m /dose Pracinostat 25-45 mg/m /dose PO Vincristine IV 1.5 mg/m /dose Cisplatin 60 mg/m /dose intra-arterially + doxorubicin 30 mg/m /dose intra-arterially Cisplatin 60 mg/m /dose intra-arterially + pirarubicin 30 mg/m /dose intra-arterially Mercaptopurine PO 2.5 mg/kg/dose + methotrexate orallt 0.1 mg/kg/day. A Pediatric patients, prophylactic antiemetics, highly emetogenic chemotherapy: As per POGO 2022 guidelines: Administer a 3-drug combination of a 5-HT receptor antagonist, dexamethasone, and aprepitant/fosaprepitant for the prevention of acute-phase chemotherapy-induced nausea and vomiting in pediatric patients receiving highly emetogenic chemotherapy. A Administer palonosetron and dexamethasone in patients unable to receive aprepitant/fosaprepitant, B palonosetron and aprepitant/fosaprepitant in patients unable to receive dexamethasone, B and palonosetron in patients unable to receive dexamethasone and aprepitant/fosaprepitant. B Consider adding olanzapine to other clinical practice guideline-consistent antiemetics. B Follow the following strategies for the prevention of delayed-phase chemotherapy-induced nausea and vomiting in pediatric patients receiving highly emetogenic chemotherapy: administer palonosetron in the acute phase as the preferred 5-HT receptor antagonist in patients at high risk of delayed-phase chemotherapy-induced nausea and vomiting. B administer oral aprepitant in the delayed phase if aprepitant/fosaprepitant started in the acute phase. A add dexamethasone in the delayed phase in patients received granisetron or ondansetron in the acute phase. B consider adding dexamethasone in the delayed phase in patients received palonosetron in the acute phase B administer dexamethasone in the delayed phase in patients unable to receive oral aprepitant B continue olanzapine in the delayed phase if started in the acute phase B do not use 5-HT receptor antagonists in the delayed phase. B As per ASCO 2020 guidelines, administer a 3-drug combination of a 5-HT receptor antagonist, dexamethasone, and aprepitant in pediatric patients treated with highly emetogenic antineoplastic agents. Administer a 5-HT receptor antagonist and dexamethasone in patients unable to receive aprepitant, and palonosetron and aprepitant in patients unable to receive dexamethasone. B https://web.pathway.md/diseases/rec5SOTVt8G9FKSJW 5/11 6/29/23, 3:50 AM Chemotherapy- and radiotherapy-induced nausea and vomiting Pathway As per ESMO/MASCC 2016 guidelines, administer a 3-drug combination of a 5-HT receptor antagonist (granisetron, ondansetron, tropisetron, or palonosetron), dexamethasone, and aprepitant in pediatric patients receiving highly emetogenic chemotherapy. Administer a 5-HT receptor antagonist in pediatric patients unable to receive dexamethasone, as dexamethasone use is prohibited in many pediatric oncology protocols (such as leukemia and brain tumors) due to concerns regarding potential interference with apoptosis, fungal infection, and distribution of chemotherapy across the blood-brain barrier. Administer a 5-HT receptor antagonist and dexamethasone when aprepitant administration is not feasible or desirable, recognizing that aprepitant may not be an option for all pediatric patients. B Pediatric patients, prophylactic antiemetics, moderately emetogenic chemotherapy: As per POGO 2022 guidelines: Administer a 2-drug combination of a 5-HT receptor antagonist and dexamethasone for the prevention of acute-phase chemotherapy-induced nausea and vomiting in pediatric patients receiving moderately emetogenic chemotherapy. B Administer a 5-HT receptor antagonist and aprepitant/fosaprepitant in patients unable to receive dexamethasone B and a 5-HT receptor antagonist in patients unable to receive dexamethasone aprepitant/fosaprepitant. B Consider administering palonosetron as the preferred 5-HT receptor antagonist in patients unable to receive dexamethasone and aprepitant/fosaprepitant. B Consider adding olanzapine to other clinical practice guideline-consistent antiemetics in patients unable to receive dexamethasone and aprepitant/fosaprepitant. B Follow the following strategies for the prevention of delayed-phase chemotherapy-induced nausea and vomiting in pediatric patients receiving moderately emetogenic chemotherapy: consider administering dexamethasone in the delayed phase B continue oral aprepitant in the delayed phase in patients receiving single-day chemotherapy received aprepitant/fosaprepitant in the acute phase B avoid using oral aprepitant in the delayed phase in patients receiving multiday chemotherapy received aprepitant/fosaprepitant in the acute phase B continue olanzapine in the delayed phase if started in the acute phase. B As per ASCO 2020 guidelines, administer a 2-drug combination of a 5-HT receptor antagonist and dexamethasone in pediatric patients treated with moderately emetogenic antineoplastic agents. B Administer a 5-HT receptor antagonist and aprepitant in patients unable to receive dexamethasone. B As per ESMO/MASCC 2016 guidelines, administer a 2-drug combination of a 5-HT receptor antagonist and dexamethasone in pediatric patients receiving moderately emetogenic chemotherapy. Administer a 5-HT receptor antagonist and aprepitant in patients unable to receive dexamethasone. B Pediatric patients, prophylactic antiemetics, low/minimally emetogenic chemotherapy: As per POGO 2022 guidelines, administer a 5-HT receptor antagonist for the prevention of acute-phase chemotherapy-induced nausea and vomiting in pediatric patients receiving low emetogenic chemotherapy. B Show 2 more https://web.pathway.md/diseases/rec5SOTVt8G9FKSJW 6/11 6/29/23, 3:50 AM Chemotherapy- and radiotherapy-induced nausea and vomiting Pathway As per ASCO 2020 guidelines: Administer ondansetron or granisetron in pediatric patients treated with low emetogenic antineoplastic agents. B Do not administer routine antiemetic prophylaxis in pediatric patients treated with minimally emetogenic antineoplastic agents. D As per ESMO/MASCC 2016 guidelines: Administer antiemetic prophylaxis with a 5-HT receptor antagonist in pediatric patients receiving low emetogenic chemotherapy. B Do not administer antiemetic prophylaxis in pediatric patients receiving minimally emetogenic chemotherapy. D Pediatric patients (management of breakthrough nausea and vomiting): escalate the antiemetic agents provided in the current chemotherapy block (defined as consecutive days of chemotherapy) to those recommended for chemotherapy-induced nausea and vomiting prophylaxis for chemotherapy of the next higher level of emetogenic risk in pediatric patients with breakthrough chemotherapy-induced nausea and vomiting receiving acute and delayed chemotherapy-induced nausea and vomiting prophylaxis recommended for minimally, low, or moderately emetogenic chemotherapy. B Show 7 more Pediatric patients (management of anticipatory nausea and vomiting): optimize control of acute and delayed chemotherapy-induced nausea and vomiting to minimize the risk of developing anticipatory chemotherapy-induced nausea and vomiting. B Show 4 more Patients with advanced cancer: As per ESMO 2021 guidelines: Administer metoclopramide titrated to effect as the antiemetic drug of choice in patients with advanced cancer. B Administer haloperidol, levomepromazine or olanzapine as alternative options. B Insufficient evidence to support the use of cyclizine and 5-HT receptor antagonists in patients with advanced cancer. I As per MASCC 2016 guidelines, administer metoclopramide as the antiemetic agent of choice in patients with advanced cancer. B Administer haloperidol, levomepromazine, or olanzapine as alternative options. B Patients with malignant bowel obstruction: As per MASCC 2022 guidelines, consider administering octreotide to reduce vomiting in patients with malignant bowel obstruction. C Show 7 more As per ESMO 2021 guidelines: Administer octreotide or haloperidol for nausea and vomiting in patients with malignant bowel obstruction. B https://web.pathway.md/diseases/rec5SOTVt8G9FKSJW 7/11 6/29/23, 3:50 AM Chemotherapy- and radiotherapy-induced nausea and vomiting Pathway Administer metoclopramide with caution in patients with partial bowel obstruction. B Do not use metoclopramide in patients with complete bowel obstruction. B As per ESMO 2016 guidelines, administer octreotide, dosed around the clock, in addition to a conventional antiemetic in patients with bowel obstruction. B Show 2 more 4. Preventative measures Prophylactic antiemetics, highly emetogenic chemotherapy: As per ASCO 2020 guidelines: Administer a 4-drug combination of an NK1 receptor antagonist, a 5-HT receptor antagonist, dexamethasone, and olanzapine (day 1) in adult patients treated with cisplatin and other highly emetogenic single agents. Continue dexamethasone and olanzapine on days 2 to 4. A Administer a 4-drug combination of an NK1 receptor antagonist, a 5-HT receptor antagonist, dexamethasone, and olanzapine (day 1) in adult patients treated with an anthracycline combined with cyclophosphamide. Continue olanzapine on days 2 to 4. A As per ESMO/MASCC 2016 guidelines, administer a 3-drug combination of single doses of a 5- HT receptor antagonist, dexamethasone, and an NK1 receptor antagonist (aprepitant, fosaprepitant, netupitant, or rolapitant) before non-anthracycline-cyclophosphamide highly emetogenic chemotherapy. A Show 3 more Prophylactic antiemetics, moderately emetogenic chemotherapy: As per ASCO 2020 guidelines, administer a 3-drug combination of a NK1 receptor antagonist, a 5-HT receptor antagonist, and dexamethasone (day 1) in adult patients treated with carboplatin AUC 4 mg/mL/min. A Show 2 more As per ESMO/MASCC 2016 guidelines, administer a 2-drug combination of a 5-HT receptor antagonist and dexamethasone to prevent acute emesis in patients treated with moderately emetogenic chemotherapy. B Show 2 more Prophylactic antiemetics, low/minimally emetogenic chemotherapy: As per ASCO 2020 guidelines: Administer a single dose of a 5-HT receptor antagonist or a single dose of dexamethasone (8 mg) before antineoplastic treatment in adult patients treated with low emetogenic antineoplastic agents. B Do not administer routine antiemetic prophylaxis in adult patients treated with minimally emetogenic antineoplastic agents. D As per ESMO/MASCC 2016 guidelines, consider administering a single antiemetic agent, such as dexamethasone, a 5-HT receptor antagonist, or a dopamine-receptor antagonist (such as metoclopramide), for prophylaxis in patients receiving low emetogenic chemotherapy. C https://web.pathway.md/diseases/rec5SOTVt8G9FKSJW 8/11 6/29/23, 3:50 AM Chemotherapy- and radiotherapy-induced nausea and vomiting Pathway Show 2 more Prophylactic antiemetics (combination chemotherapy): administer antiemetics appropriate for the component antineoplastic agent of greatest emetic risk in adult patients treated with antineoplastic combinations. B Prophylactic antiemetics, multiday chemotherapy: As per ASCO 2020 guidelines: Administer antiemetics pre-treatment appropriate for the emetic risk of the antineoplastic agent on each day of the antineoplastic treatment and for 2 days after completion of the antineoplastic regimen in adult patients treated with multiday antineoplastic agents. B Administer a 3-drug combination of an NK1 receptor antagonist, a 5-HT receptor antagonist, and dexamethasone in adult patients treated with 4- or 5-day cisplatin regimens. A As per ESMO/MASCC 2016 guidelines, administer a 3-drug combination of a 5-HT receptor antagonist, dexamethasone, and aprepitant for the prevention of acute nausea and vomiting in patients with metastatic germ cell tumors receiving multiday cisplatin. Administer dexamethasone for the prevention of delayed nausea and vomiting. B Prophylactic antiemetics, chemotherapy and stem-cell/bone marrow transplantation: As per ASCO 2020 guidelines: Administer a 3-drug combination of an NK1 receptor antagonist, a 5-HT receptor antagonist, and dexamethasone in adult patients treated with high-dose chemotherapy and stem-cell or BMT. A Consider administering a 4-drug combination of an NK1 receptor antagonist, a 5-HT receptor antagonist, dexamethasone, and olanzapine in adult patients treated with high-dose chemotherapy and stem-cell or BMT. C As per ESMO/MASCC 2016 guidelines, administer a 3-drug combination of a 5-HT receptor antagonist, dexamethasone, and aprepitant (125 mg PO on day 1 and 80 mg on days 2-4) before chemotherapy in patients receiving high-dose chemotherapy for stem cell transplantation. A Prophylactic antiemetics (chemotherapy and radiotherapy): administer antiemetic therapy appropriate for the emetic risk level of the antineoplastic agents, unless the risk level of the radiotherapy is higher, in adult patients treated with concurrent radiotherapy and antineoplastic agents. Administer prophylactic therapy appropriate for the emetic risk of the radiotherapy until the next period of antineoplastic therapy when prophylactic antiemetic therapy for the antineoplastic agents has ended and ongoing radiotherapy would normally be managed with its own prophylactic therapy. B Prophylactic antiemetics (highly emetogenic radiotherapy): administer a 2-drug combination of a 5-HT receptor antagonist and dexamethasone before each fraction and on the day after each fraction (if radiotherapy is not planned for that day) in adult patients treated with highly emetogenic radiotherapy. A Prophylactic antiemetics (moderately emetogenic radiotherapy): administer a 5-HT receptor antagonist before each fraction, with or without dexamethasone, before the first 5 fractions in adult https://web.pathway.md/diseases/rec5SOTVt8G9FKSJW 9/11 6/29/23, 3:50 AM Chemotherapy- and radiotherapy-induced nausea and vomiting Pathway patients treated with moderately emetogenic radiotherapy. B Prophylactic antiemetics (low/minimally emetogenic radiotherapy): Administer breakthrough dexamethasone therapy in adult patients treated with radiotherapy to the brain. Administer breakthrough therapy with a 5-HT receptor antagonist, dexamethasone, or a dopamine-receptor antagonist in patients treated with radiotherapy to the head and neck, chest, or pelvis. B Administer breakthrough therapy with a 5-HT receptor antagonist, dexamethasone, or a dopamine-receptor antagonist in adult patients treated with minimally emetogenic radiotherapy. B Prophylactic antiemetics (opioids): insufficient evidence to recommend antiemetic prophylaxis for opioid-induced nausea and vomiting. I Prophylactic benzodiazepines: As per ASCO 2020 guidelines, consider administering lorazepam as an adjunct to antiemetic drugs but not as a single-agent antiemetic. C As per ESMO 2016 guidelines, consider administering olanzapine with a 5-HT receptor antagonist plus dexamethasone in patients receiving highly emetogenic chemotherapy, particularly when nausea is an issue, recognizing that patient sedation may be a concern when using a 10 mg dose. C Prophylactic cannabinoids: As per MASCC 2022 guidelines, avoid using cannabinoids as first-line therapy for the prevention of chemotherapy-induced nausea and vomiting. D As per ASCO 2020 guidelines, insufficient evidence to support the use of medical marijuana for the prevention of chemotherapy- or radiotherapy-induced nausea and vomiting. I Alternative and complementary therapies: insufficient evidence to recommend for or against the use of ginger, acupuncture/acupressure, and other complementary or alternative therapies for the prevention of nausea and vomiting in patients with cancer. I References 1. F Roila, A Molassiotis, J Herrstedt et al. 2016 MASCC and ESMO guideline update for the prevention of chemotherapy- and radiotherapy-induced nausea and vomiting and of nausea and vomiting in advanced cancer patients. Ann Oncol. 2016 Sep;27(suppl 5):v119-v133. Open 2. Paul J Hesketh, Mark G Kris, Ethan Basch et al. Antiemetics: ASCO Guideline Update. J Clin Oncol. 2020 Aug 20;38 24 2782 2797. Open 3. Bryony Alderman, David Hui, Sandip Mukhopadhyay et al. Multinational Association of Supportive Care in Cancer MASCC expert opinion/consensus guidance on the use of cannabinoids for gastrointestinal symptoms in patients with cancer. Support Care Cancer. 2022 Dec 16;31 1 39. Open 4. Priya Patel, Paula D Robinson, Katie A Devine et al. Prevention and treatment of anticipatory chemotherapy-induced nausea and vomiting in pediatric cancer patients and hematopoietic stem cell https://web.pathway.md/diseases/rec5SOTVt8G9FKSJW 10/11 6/29/23, 3:50 AM Chemotherapy- and radiotherapy-induced nausea and vomiting Pathway recipients: Clinical practice guideline update. Pediatr Blood Cancer. 2021 May;68 5):e28947. Open 5. Priya Patel, Paula D Robinson, Robert Phillips et al. Treatment of breakthrough and prevention of refractory chemotherapy-induced nausea and vomiting in pediatric cancer patients: Clinical practice guideline update. Pediatr Blood Cancer. 2023 May 13;e30395. Open 6. G B Crawford, T Dzier anowski, K Hauser et al. Care of the adult cancer patient at the end of life: ESMO Clinical Practice Guidelines. ESMO Open. 2021 Aug;6 4 100225. Open 7. Ainhoa Madariaga, Jenny Lau, Arunangshu Ghoshal et al. MASCC multidisciplinary evidence-based recommendations for the management of malignant bowel obstruction in advanced cancer. Support Care Cancer. 2022 Mar 10. Open 8. Edric Paw Cho Sing, Paula D Robinson, Jacqueline Flank et al. Classification of the acute emetogenicity of chemotherapy in pediatric patients: A clinical practice guideline. Pediatr Blood Cancer. 2019 May;66 5):e27646. Open 9. Priya Patel, Paula D Robinson, Marie Cohen et al. Prevention of acute and delayed chemotherapy- induced nausea and vomiting in pediatric cancer patients: A clinical practice guideline. Pediatr Blood Cancer. 2022 Dec;69 12):e30001. Open 10. Bell GC, Caudle KE, Whirl-Carrillo M et al. Clinical Pharmacogenetics Implementation Consortium CPIC guideline for CYP2D6 genotype and use of ondansetron and tropisetron. Clin Pharmacol Ther. 2017 Aug;102 2 213 218. Open 11. Margarita Majem, Ramon de Las Pe as, Juan Antonio Virizuela et al. SEOM clinical guideline emesis 2021 . Clin Transl Oncol. 2022 Mar 26. 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