The oncology patient population is at an elevated risk for severe infections associated with increased mortality. The early recognition of fever is critical in patients with febrile neutropenia, because a fever may be the only sign of infection.¹ According to the 2010 Infectious Diseases Society of America (IDSA) guidelines, febrile neutropenia is defined as an absolute neutrophil count (ANC) of ≤500 cells/mm³, with a single oral temperature of ≥101°F or a temperature of ≥100.4°F sustained over a 1-hour period.²

The National Comprehensive Cancer Network (NCCN) is comprised of 27 leading cancer centers in the United States that focus on creating patient and prescriber guidelines for the diagnosis of, treatment of, and supportive care for patients affected by cancer. Since 1995, the NCCN has aimed to aid oncology prescribers by providing evidence-based clinical recommendations. Although those guidelines often focus on treatment, they also provide a large amount of supportive care recommendations, including guidelines for antiemesis. The NCCN antiemesis guidelines are based on the following criteria—emetic risk of the chemotherapy agents administered, previous use of antiemetic medications, and the patient’s risk factors.¹

Multidrug regimens have become a staple in oncology, thanks to their ability to overcome multiple areas of treatment resistance by the tumor. The use of multidrug regimens facilitates different mechanisms of attack against the tumor.¹ This multidrug regimen method frequently leads to the question of how to sequence chemotherapies or monoclonal antibodies. This is an important question that is asked of oncology pharmacists, because of findings that demonstrate greater toxicity and/or efficacy, depending on the sequencing of the agents.^1-5 A common misconception in oncology pharmacy is that these agents have been tested as part of a chemotherapy regimen and are therefore safe and effective, but this belief has been disproved by several studies.^2-4