Practical management of antineoplastic-induced nausea and vomiting from antibody–drug conjugates: Insights from a Canadian expert panel

ObjectiveTrastuzumab deruxtecan (T-DXd) and sacituzumab govitecan (SG) are antibody-drug conjugates (ADCs) that are associated with clinically significant antineoplastic-induced nausea and vomiting (AINV), for which prophylaxis and management strategies vary in clinical practice. Integration of available evidence, guideline recommendations, and expert clinical experience is required to develop practical, expert-informed strategies and approaches for the prevention and management of AINV in patients receiving these agents.Data SourcesA systematized literature review of PubMed publications from 2020 to 2024 was conducted to identify evidence regarding AINV management in patients receiving T-DXd or SG. Search terms were developed in consultation with a multidisciplinary Canadian expert panel, including medical oncologists and oncology pharmacists from academic and tertiary cancer centers, and included terms related to nausea, vomiting, emesis, and supportive care, as well as specific ADC agents and antiemetic therapies. Findings were contextualized using local and international guidelines. Expert clinical consensus was achieved through two virtual meetings and two rounds of structured group discussions using a modified Nominal Group Technique.Data SummaryThe search identified 1229 records, with 32 articles relevant to ADCs. The Canadian expert panel used this evidence, supplemented with non-ADC chemotherapy studies where ADC-specific data were limited, to inform practical clinical strategies. These included prophylactic, combination-based antiemetic strategies tailored to emetogenic risk; steroid-sparing and individualized approaches based on patient response and tolerability; early escalation or modification of therapy for persistent symptoms; structured patient education on symptom recognition, medication adherence and tools for symptom monitoring for acute and delayed AINV.ConclusionsWe provide expert consensus recommendations for practical approaches for the management of AINV in patients receiving T-DXd or SG, including an antiemetic algorithm and tools for structured symptom monitoring. These approaches are intended to support consistent implementation of AINV management strategies in diverse oncology settings.