Characterizing the prevalence of antibody-drug conjugated–induced nausea and vomiting (ADCINV) in patients with cancer.

Abstract

e24052 Background: 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, where there is no current standard approach to date. Our aim is to characterize the prevalence and variation of ADCINV in the literature. Methods: A systematic review of Medline, Embase, Cochrane CENTRAL and Web of Science was conducted from database inception until September 24, 2025. Both clinical trials and real-world studies reporting nausea and/or vomiting in patients receiving ADCs for cancer were included. Pooled prevalence of nausea/vomiting, and severe nausea/vomiting (CTCAE grade 3+) were calculated using a random effects model weighted by study size. 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: Among 4,669 screened records, 209 studies comprising 15,493 patients were included. Mean study size was 74 patients; 53% were female. Most studies were non-randomized interventional trials (84%); only 5% were randomized trials, and 11% were real-world cohort studies. 39% of patients experienced nausea (95%CI 36–42%) and 26% experienced vomiting (95%CI 23–29%). Severe nausea occurred in 1% (95%CI 0–1%) and severe vomiting in 1% (95%CI 0–2%). Antiemetic prophylaxis was not routinely used across studies and there was significant heterogeneity in antiemetic regimens when used. Higher nausea rates were observed with patritumab deruxtecan (59%), trastuzumab deruxtecan (55%), sacituzumab govitecan (51%), and brentuximab vedotin (47%), while lower rates were seen with disitamab vedotin (28%), telisotuzumab vedotin (22%), rovalpituzumab tesirine (19%), and belantamab mafodotin (6%). Meta-regression demonstrated that increasing age was independently associated with lower nausea risk, with a 12% relative decrease per 10-year age increase (10-year OR=0.89 (95%CI 0.83-0.95, p<0.001)), but no difference in vomiting risk. Female sex showed a non-significant trend toward higher nausea risk (OR=1.00 (0.99-1.01, p=0.072)) but no differences in vomiting risk. Conclusions: ADCINV is prevalent adverse effect, affecting every one in three patients with no standard prophylactic regimen to date. Severe nausea and vomiting rates remain relatively low. Younger patients, females and specific ADCs may be at higher risk. ADCINV should be recognized as a clinically relevant adverse effect, supporting the need for ADC-specific emetogenic classification and prospective evaluation of antiemetic prophylaxis strategies.