Ramosetron, Aprepitant and Dexamethasone Versus Ondansetron, Aprepitant and Dexamethasone

Inclusion Criteria: 1. Patients diagnosed as malignancy who will be treated with highly emetogenic chemotherapeutic agents (NCCN guideline v1.0 2011 anti-emesis), over 20 years and both sex 2. ECOG performance status 0-2 3. Available oral administration of study drugs 4. Patients must sign an informed consent indicating that they are aware of the investigational nature of the study in keeping with the policy of the hospital Exclusion Criteria: 1. Severe Hypertension, severe Heart disease, kidney disease (serum creatinine \> 3 mg/dl), liver disease (AST, ALT \> 3 times of upper normal range, ALP \> 2 times of upper normal range) 2. Patients with GI obstruction, active gastric ulcer or other diseases that could provoke nausea and vomiting 3. Patients who have nausea and vomiting within 1 week before chemotherapy 4. Patients who should take steroid, antiemetics, pimozide, terfenadine, astemizole, cisapride, rifampin, carbamazepine, phenytoin, ketoconazole, itraconazole, nefazodone, troleandomycin, clarithromycin, ritonavir or nelfinavir for the treatment of other diseases 5. Patients with brain tumor, brain metastasis or seizure 6. Patients receiving chemotherapy within 12 months before enrollment 7. Patients who need radiation therapy during study period or receiving radiation therapy within 2 weeks before chemotherapy 8. Patients who have known allergy or severe side effect on study drugs 9. Pregnant or lactating women, or women who wish to become pregnant 10. Others whom the investigator judges inappropriate as subjects for this study