Prevalence of antibody drug conjugated-induced nausea and vomiting (ADCINV) in patients with cancer

Clinical Snapshot

Key Findings

• P Value: Type I error set at 0.05

• Effect Size: Substantial prevalence comparable to chemotherapy-induced nausea and vomiting

• Primary Outcome: Prevalence of any nausea: 39% (95%CI 36-42%); any vomiting: 26% (95%CI 23-29%)

• Nnt Or Sensitivity: Age effect: 12% decrease in nausea rates per 10-year age increase

• Confidence Interval: Narrow confidence intervals suggest precise estimates

Clinical Application

Results support development of antiemetic prophylaxis protocols for ADC therapy Relevant to Australian oncology practice as ADCs become increasingly available through PBS and clinical trials. Findings support TGA safety monitoring and COSA guideline development for supportive care Cancer patients receiving ADC therapy across various tumour types and treatment settings

Abstract

INTRODUCTION: Antibody-drug conjugates (ADC) have emerged as an important part of systemic treatment across disease sites. To date, there is no robust pooled prevalence estimate of nausea and vomiting induced by ADCs. Establishing such estimates is essential to determine if ADC-induced nausea and vomiting (ADCINV) represents a clinically significant problem warranting further research into antiemetic prophylaxis. Our aim is to report the prevalence of reported ADCINV across literature. METHODS: A systematic search of Medline, Embase, Cochrane CENTRAL and Web of Science was conducted from database inception until September 24, 2025. Articles were included if they reported nausea and/or vomiting due to ADCs used in cancer treatment, in the abstract. Pooled prevalence was reported. Subgroup analysis was conducted by ADC. Meta-regression was conducted by age and sex. Quality assessment was conducted. Type I error was set at 0.05. RESULTS: A total of 209 studies with 15,493 patients were included. Thirty-nine percent (95%CI, 36-42%) of patients experience any nausea, and 26% (95%CI, 23-29%) experience any vomiting. Younger patients are more likely to experience nausea; each 10-year increase in age is associated with a 12% decrease in nausea rates. Higher emetogenic ADCs include trastuzumab deruxtecan, sacituzumab govitecan, brentuximabvedotin and patritumab deruxtecan. Lower emetogenic agents include disitimab vedotin, telisotuzumab vedotin and rovalpituzumab tesirine. DISCUSSION: This is the first study to report prevalence of ADCINV across ADCs. It is a prevalent adverse effect akin to chemotherapy-induced nausea and vomiting that should be viewed as clinically relevant and further investigated to help develop optimal strategies related to antiemetics.

References

1. 1.Chow, R., Zhang, D., Kannout, S., Ma, A., Zheng, C., Blayne, A., Dou, A., Talwar, S., Fazelzad, R., Rugo, H. S., Ruhlmann, C. H., Iihara, H., Affronti, M. L., Leigh, J., Scotté, F., & Eng, L. (2026). Prevalence of antibody drug conjugated-induced nausea and vomiting (ADCINV) in patients with cancer. Supportive Care in Cancer. https://doi.org/10.1016/j.annonc.2023.05.004