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The patients received 0.75?mg palonosetron or 40?��g/kg granisetron intravenously 30?min before the administration of chemotherapy. The acute complete response (CR) rate, which was the primary endpoint for effectiveness, was 75.3% in the palonosetron group and 73.3% in the granisetron group, demonstrating that palonosetron was not inferior to granisetron. However, the delayed CR rate was 56.8% in [http://www.selleckchem.com/products/i-bet151-gsk1210151a.html I-BET151 in vivo] the palonosetron group and 44.5% in the granisetron group. This difference was significant, showing the superiority of palonosetron to granisetron. While this trial compared palonosetron and granisetron using single intravenous doses, consecutive-day administration of [http://www.selleckchem.com/products/gsk2656157.html http://www.selleckchem.com/products/gsk2656157.html] granisetron and other first-generation 5-HT3RAs has been approved and is used in patients receiving regimens that include consecutive-day administration of HER anticancer agents and multi-drug combinations. Consecutive-day regimens involving multiple anticancer agents are widely used to treat bone and soft tissue sarcomas. Since many of these regimens use HER chemotherapy at high doses, treatment of bone and soft tissue sarcomas is frequently associated with CINV. Until recently, consecutive-day 5-HT3RA plus Dex was used for preventative antiemetic therapy; however, this regimen offers insufficient protection. Since the development of aprepitant, an NK-1RA, the combination of consecutive-day 5-HT3RA plus aprepitant and Dex, has become the recommended antiemetic therapy during chemotherapy for bone and soft tissue sarcomas. Although the PROTECT study found that single-shot palonosetron was superior to single-shot granisetron, there is no published comparative data on whether consecutive-day 5-HT3RA administration is [http://en.wikipedia.org/wiki/17-Dimethylaminoethylamino-17-demethoxygeldanamycin 17-DMAG (Alvespimycin) HCl] superior to single-shot palonosetron. The first aim of this study was to evaluate the efficacy of combination antiemetic therapy with a 5-HT3RA plus NK-1RA and Dex in patients receiving chemotherapy for high-grade bone and soft tissue sarcoma using multiple HER anticancer agents. The second aim was to compare the effectiveness and safety of single-shot palonosetron and consecutive-day granisetron in a randomized, single-blind, crossover trial. Materials and Methods Patients and treatment Eligible patients were 15?years of age or older, had confirmed high-grade malignant bone and soft tissue tumors, and were scheduled to receive chemotherapy with multiple emetogenic anticancer drugs. Patients were required to have an Eastern Cooperative Oncology Group (ECOG) performance status of 0�C2, as well as adequate bone marrow function (white blood cell count ��2?��?103?cells/L), hepatic function (aspartate aminotransferase and alanine aminotransferase