Kimura 2015.

Study characteristics
Methods	Randomised, cross‐over trial with 2 arms comparison of aprepitant 125/80 mg + palonosetron + dexamethasone vs aprepitant 125/80 mg + granisetron + dexamethasone Enrolment period: 1 April 2011 to 31 March 2013 24 patients enrolled and randomly assigned Masking: single‐blind Baseline patient characteristics: reported Follow‐up: patients were followed up for 10 days during each course for efficacy and safety endpoints
Participants	Inclusion criteria 15 years of age or older confirmed high‐grade malignant bone and soft tissue tumour scheduled to receive chemotherapy with multiple emetogenic anticancer drugs ECOG performance status 0 to 2 adequate bone marrow function (white blood cell count ≥ 2 × 10³ cells/L), hepatic function (aspartate aminotransferase and alanine aminotransferase < 100 U/L), and renal function (creatinine clearance ≥ 60 mL/min) Exclusion criteria vomiting, retching, or grade ≥ 2 nausea according to Common Terminology Criteria for Adverse Events (CTCAE), version 4, before administration of study drug known hypersensitivity to palonosetron, granisetron, other 5‐HT₃ RAs, or dexamethasone participation in another drug study or receipt of any investigational agent within a month of study entry treatment with an antiemetic drug within 24 h before administration of study drug Age (range), years: 36.1 (15 to 65) in palonosetron arm, 50.6 (18 to 70) in granisetron arm Gender: male + female Tumour/cancer type: osteosarcoma, malignant fibrous histiocytoma, synovial sarcoma, leiomyosarcoma, rhabdomyosarcoma, dedifferentiated liposarcoma, myxoid liposarcoma, clear cell sarcoma Chemotherapy regimen: cisplatin + doxorubicin, ifosfamide + doxorubicin/ifosfamide + etoposide Country: Japan
Interventions	Cross‐over study Experimental: arm A: palonosetron Day 1: p.o. 125 mg aprepitant  + i.v. 0.75 mg palonosetron  + i.v. 6.6 mg dexamethasone  Days 2 to 5: 80 mg aprepitant + 6.6 mg dexamethasone Experimental: arm B: granisetron Day 1: p.o. 125 mg aprepitant + i.v. 3 mg × 2 granisetron + i.v. 6.6 mg dexamethasone Days 2 to 5: 80 mg aprepitant + 3 mg × 2 granisetron + 6.6 mg dexamethasone
Outcomes	Primary endpoints proportions of patients with complete response and total control during overall phase (0 to 240 h post chemotherapy), acute phase (0 to 72 h post chemotherapy), and delayed phase (72 to 240 h post chemotherapy) Secondary endpoints complete response and total control rates for overall phase, acute phase, and delayed phase after first course of chemotherapy and during courses 1 to 4 of chemotherapy complete response and total control rates for each chemotherapeutic regimen antiemetic regimen preferred by patients time to administration of rescue therapy severity of nausea
Notes	no funding source reported conflicts of interest: "none declared"
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Quote: "a single randomization method was used to assign eligible patients to the palonosetron or granisetron arm"
Allocation concealment (selection bias)	Unclear risk	Commen: allocation concealment not reported
Blinding of participants and personnel (performance bias) Blinding of participants	Low risk	Quote: "all participants were blinded to the antiemetic treatment assignments for the duration of the study"
Blinding of participants and personnel (performance bias) Blinding of personnel	High risk	Comment: only patients were blinded to the study intervention
Blinding of outcome assessment (detection bias) Subjective outcomes (Patient reported outcomes)	High risk	Comment: although patients were blinded, unblinded personnel might have an influence on outcome assessment
Blinding of outcome assessment (detection bias) Objective outcomes (including mortality and safety)	Low risk	Comment: although this was a single‐blind study, we assume that both patients and personnel had no influence on objective outcomes (e.g. hiccups)
Incomplete outcome data (attrition bias) Subjective outcomes (Patient reported outcomes)	Low risk	Quote: "all patients were eligible for efficacy analysis ..."
Incomplete outcome data (attrition bias) Objective outcomes (including mortality and safety data)	Low risk	Quote: "safety was assessed for all patients who received treatment"
Selective reporting (reporting bias)	Low risk	Comment: all outcome measures were reported in the results section
Other bias	Low risk	Comment: no information to suggest other sources of bias