Treatment of breakthrough and prevention of refractory chemotherapy-induced nausea and vomiting in pediatric cancer patients: Clinical practice guideline update

Pediatr Blood Cancer. 2023 Aug;70(8):e30395. doi: 10.1002/pbc.30395. Epub 2023 May 13.


This clinical practice guideline update provides recommendations for treating breakthrough chemotherapy-induced nausea and vomiting (CINV) and preventing refractory CINV in pediatric patients. Two systematic reviews of randomized controlled trials in adult and pediatric patients informed the recommendations. In patients with breakthrough CINV, escalation of antiemetic agents to those recommended for chemotherapy of the next higher level of emetogenic risk is strongly recommended. A similar recommendation to escalate therapy is made to prevent refractory CINV in patients who did not experience complete breakthrough CINV control and are receiving minimally or low emetogenic chemotherapy. A strong recommendation to use antiemetic agents that controlled breakthrough CINV for the prevention of refractory CINV is also made.

Keywords: chemotherapy-induced nausea and vomiting; guideline; pediatric oncology; supportive care.

Publication types

  • Practice Guideline

MeSH terms

  • Adult
  • Antiemetics* / adverse effects
  • Antineoplastic Agents* / adverse effects
  • Child
  • Humans
  • Nausea / chemically induced
  • Nausea / drug therapy
  • Nausea / prevention & control
  • Neoplasms* / complications
  • Neoplasms* / drug therapy
  • Vomiting / chemically induced
  • Vomiting / drug therapy
  • Vomiting / prevention & control


  • Antiemetics
  • Antineoplastic Agents