OBJECTIVES: Primary * To evaluate the efficacy of aprepitant as monotherapy for opioid-induced nausea and vomiting (OINV) in comparison to ondansetron hydrochloride in patients who have failed at least one prior anti-emetic agent/regimen. Secondary * To determine whether control of OINV improves quality of life. * To determine if control in OINV decreases pain. * To determine if control in OINV improves mood. OUTLINE: Patients are randomized to 1 of 2 treatment arms. * Arm A: Patients receive aprepitant orally once daily for 7 days in the absence of unacceptable toxicity or persistent grade 4 nausea and vomiting. * Arm B: Patients receive ondansetron hydrochloride orally 3 times daily for 7 days in the absence of unacceptable toxicity or persistent grade 4 nausea and vomiting. Patients complete the following questionnaires: Functional Assessment of Cancer Therapy-General (FACT-G); Center for Epidemiologic Studies Depression Scale (CES-D); and Brief Pain Index (BPI) at baseline and on day 7. Patients also complete symptom diaries documenting the following: number of episodes (an emetic episode is defined as a simple vomit or retch, or any number of continuous vomits or retches; distinct episodes that are separated by at least 1 minute) of vomiting or retching including the date and time; worst and average degree of nausea (recorded every 2 hours while awake during the first 24 hours after treatment and every 8 hours on days 1-7); and adverse events other than episodes of vomiting and nausea.
DISEASE CHARACTERISTICS: * History of malignancy (including hematological malignancies) * Has pain requiring opioid analgesics * Nausea and vomiting (associated with opioid analgesic use) that is unrelieved by at least one standard antiemetic regimen (including 5HT3 antagonist and dexamethasone combination therapy) * Patients who have failed ondansetron hydrochloride for treatment of opioid-induced nausea and vomiting will be excluded from the study PATIENT CHARACTERISTICS: * ECOG performance status 0-2 * Able to assess severity of nausea and vomiting and document it in the diary * Women must not be pregnant or lactating * Women of childbearing potential and sexually active males are strongly advised to use an accepted and effective method of contraception * Urine pregnancy test will be given to women of childbearing age * No concerns about compliance with medication regimen or medical follow-up (patient must be able to tolerate oral dosing) * No severe or chronic illness or other causes of nausea and vomiting, that in judgment of the treating physician, will place patient at risk * No severe gastrointestinal obstruction or active peptic ulcer disease * Serum ALT and AST \< 2 times upper limit of normal (ULN) * Serum bilirubin \< 2 times ULN * Serum alkaline phosphatase \< 2 times ULN PRIOR CONCURRENT THERAPY: * No surgery within the past 7 days * No chemotherapy within the past 7 days * No total or lower body radiation therapy within the past 7 days * Patient may not be scheduled to undergo total body irradiation or lower body irradiation, chemotherapy, or surgery during study participation * Patient must not be taking warfarin
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