Aprepitant ,Olanzapine,Palonosetron and Dexamethasone for the Prevention of Chemotherapy-induced Nausea and Vomiting

Eligible patients will be randomized to receive different antiemetic regimens . In the experimental group,patients will receive aprepitant,olanzapine ,palonosetron and dexamethasone .In the other group,patients will accept the same dose of aprepitant ,palonosetron and dexamethasone .During the treatment, any grade of nausea and vomiting should be recorded in order to evaluate the complete response rate of CINV,nausea patients will be measured by a visual analogue scale (VAS) ,other adverse events should be recorded as well.

Inclusion criteria

• 18 years of age or older
• Histologically or cytologically confirmed malignant disease
• Accept chemotherapy for the first time
• Patients who will receive high emetogenic cancer chemotherapy (HEC) (cisplatin>=70mg/m2,adriamycin in combination with cyclophosphamide ,cyclophosphamide>=1500mg/m2,adriamycin>60mg/m2,epirubicin>90mg/m2,dacarbazine，ifosfamide>=2g/m2) or moderate emetogenic chemotherapy cancer (carboplatin>=300mg/m2,cyclophosphamide>=600-1000mg/m2,adriamycin>50mg/m2)
• Written informed consent

Exclusion criteria

• Pregnant or breast-feeding
• Uncontrolled psychosis history
• Inability or unwillingness to understand or cooperate with study procedures
• Central nervous system tumors primary or secondary
• Concurrent abdominal radiotherapy
• History of uncontrolled diabetes mellitus
• Patients of prostatic hyperplasia ，paralytic ileus，narrow feet glaucoma.
• Known cardiac arrhythmia, uncontrolled congestive heart failure ,or acute myocardial infarction with the previous six month
• Pre-existing nausea or vomiting
• Inadequate hematological function and abnormal liver and renal function.
• History of sensitivity to olanzapine
• Concurrent application of quinolone antibiotic therapy
• Treatment with another antipsychotic agent such as risperidone,quetiapine, clozapine,phenothiazine,or butyrophenone for 30 days prior to or during the chemotherapy.
• Cytochrome P450 3A4 substrates within 7 days (terfenadine, cisapride, astemizole, pimozide)
• Concurrent application of systemic corticosteroids
• Active infection or gastrointestinal dysfunction