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BACKGROUND No clinical trials have examined the effect of netupitant/palonosetron (NEPA) on chronic nausea in cancer patients. In this pilot randomized trial, we assessed the efficacy of NEPA and placebo on chronic nausea. METHODS This double-blind, parallel, randomized trial enrolled cancer patients with chronic nausea for at least 1 month, intensity ≥4/10 and not on moderately or highly emetogenic systemic therapies. Patients started with a placebo run-in period from days 1 to 5; those without a placebo response proceeded to the double-blinded phase between days 6 to 15 (NEPA: placebo 2:1 ratio). The primary outcome was within-group change in average nausea over the 24 hours on a 0-10 numeric rating scale (NRS) between day 5 and 15. RESULTS Among the 53 enrolled patients, 46 proceeded to placebo run-in and 33 had blinded treatment (22 NEPA, 11 placebo). We observed a statistically significant within-group improvement in nausea NRS between day 5 and day 15 in the NEPA group (mean change -2.0, 95% CI -3.1,-0.8) and the placebo group (mean change -2.3, 95% CI -3.9, -0.7). A complete response was achieved in 8 (38%) patients in the NEPA group and 2 (20%) in the placebo group by day 15. No Grade 3-4 toxicities were attributed to NEPA. There were no statistically significant between-group differences for the primary/secondary outcomes. CONCLUSIONS Both NEPA and placebo were associated with similar magnitude of within-group improvement in chronic nausea without significant between-group differences. (Clinicaltrials.gov NCT03040726).