Kang 2020.

Study characteristics
Methods	Randomised trial with 2 arms comparison of aprepitant + ramosetron + dexamethasone vs aprepitant + palonosetron + dexamethasone Enrolment period: August 2015 to September 2017 309 patients evaluated 292 patients randomised Masking: single‐blind Baseline patient characteristics: reported Follow‐up: n.r.
Participants	Inclusion criteria age 19 to 75 years pathologically confirmed malignant disease Eastern Cooperative Oncology Group performance status 0 to 2 scheduled to receive HEC on first day of treatment required to have adequate bone marrow, hepatic, and renal function Exclusion criteria medications, medical illness, or medical conditions and procedures that could affect nausea or vomiting Mean age (SD), years: 59.4 (12.0) in ramosetron group, 60.3 (11.8) in palonosetron group Gender: 37.2% (62.8% male) female in ramosetron group, 38.7% female (61.3% male) in palonosetron group Tumour/cancer type: solid tumours (lung and thymus, breast, head and neck, gynaecological and genitourinary, gastrointestinal, others) Chemotherapy regimen: individual highly emetogenic chemotherapies: 71.5% in ramosetron group, 72.5% in palonosetron group received cisplatin Country: Korea, multi‐centre
Interventions	Experimental: arm A: ramosetron aprepitant (Day 1, 125 mg p.o. 1 h before chemotherapy; Days 2 to 3, 80 mg p.o.), ramosetron (Day 1, 0.3 mg i.v. 30 min before chemotherapy), and dexamethasone (Day 1, 12 mg p.o. or i.v. 30 min before chemotherapy; Days 2 to 4, 8 mg p.o.) Experimental: arm B: palonosetron aprepitant (Day 1, 125 mg p.o. 1 h before chemotherapy; Days 2 to 3, 80 mg p.o.), palonosetron (Day 1, 0.25 mg i.v. 30 min before chemotherapy), and dexamethasone (Day 1, 12 mg p.o. or i.v. 30 min before chemotherapy; Days 2 to 4, 8 mg p.o.)
Outcomes	Primary endpoint overall complete response (CR), defined as no vomiting, including retching, and no requirement for rescue antiemetics within 5 days of HEC Secondary endpoints CR, complete protection (CP; CR + nausea score < 25 mm; 0 to 100 mm), and total control (TC; CR + nausea score < 5 mm; 0 to 100 mm) in acute (0 to 24 h), delayed (Day 2 to Day 5), and overall (Day 0 to Day 5) periods severity of nausea (determined using a 0 to 100 mm visual analogue scale); time to first occurrence of vomiting; QoL assessed by validated patient self‐assessment Functional Living Index‐Emesis (FLIE) questionnaire safety, clinical, and laboratory adverse events (AEs) between start day and day before the next chemotherapy, assessed according to National Cancer Institute Common Terminology Criteria for Adverse Events (NCI‐CTCAE)
Notes	"funding from Astellas Pharma Korea, Inc." "JH Kang has acted as an advisor for Amgen, Roche, Merck, MSD, Ono/BMS, AstraZeneca, YooHan, SL Bigen, has received research funding from AstraZeneca, Boehringer Ingelheim, Ono, Yoohan, and ChongKunDang, and has acted as a speaker for AstraZeneca,Roche, Merck, and Boehringer Ingelheim. JH Sohn has received research funding from MSD, Roche, Novartis, AstraZeneca, Lilly,Pfizer, Bayer, GSK, CONTESSA, and Daiichi Sankyo. JS Ahn reports personal fees from Amgen, personal fees from Pfizer, personal fees from AstraZeneca, personal fees from Menarini, personal fees from Roche, personal fees from Eisai, personal fees from BoehringerIngelheim, personal fees from BMS‐Ono, personal fees from MSD, personal fees from Janssen, personal fees from Samsung Bioepis,outside the submitted work. All remaining authors declare no conflicts of interest"
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Quote: "stratified block randomization was conducted with a 1:1 ratio between groups, randomly mixing block sizes of 2 and 4, considering (1) chemotherapeutic regimen (cisplatin vs.non‐cisplatin), (2) treatment schedule (single‐day vs. multiple‐ day), and (3) sex (male vs. female), as stratification factors"; "patients were assigned according to a pre‐defined randomization sequence created by an independent investigator with no clinical involvement in the trial"
Allocation concealment (selection bias)	Unclear risk	Not reported
Blinding of participants and personnel (performance bias) Blinding of participants	Low risk	Single‐blinded; participants were not aware of treatment
Blinding of participants and personnel (performance bias) Blinding of personnel	High risk	Physicians were aware of treatment
Blinding of outcome assessment (detection bias) Subjective outcomes (Patient reported outcomes)	Low risk	Outcome assessors (participants) were blinded to intervention
Blinding of outcome assessment (detection bias) Objective outcomes (including mortality and safety)	Low risk	Outcome was robust to blinding
Incomplete outcome data (attrition bias) Subjective outcomes (Patient reported outcomes)	High risk	Modified ITT was analysed (participants who received at least 1 treatment)
Incomplete outcome data (attrition bias) Objective outcomes (including mortality and safety data)	High risk	Safety population (ITT) analysed, but not all participants received intervention
Selective reporting (reporting bias)	Low risk	No reasons for any concerns detected
Other bias	Low risk	No other sources of bias detected