Fosaprepitant Versus Aprepitant in the Prevention of Chemotherapy Induced Nausea and Vomiting

Inclusion Criteria:

* Female Gender
* Age \> 18 years
* A histologic diagnosis of stage III/IV gynecologic cancer (e.g., epithelial ovarian, fallopian tube, peritoneal cancer and uterine cancer).
* Subjects who will be treated with Taxol and Carboplatin as standard of care for a newly diagnosed gynecological cancer.
* Adequate bone marrow function as demonstrated by:

Absolute neutrophil count (ANC) \> 1,500/μL; platelet count \> 100,000/μL; and hemoglobin \> 9 g/dL • Adequate renal function demonstrated by: Serum creatinine of \< 1.5 x ULN or 24-hr measured urine creatinine clearance \> 60 mL/min for patients with serum creatinine \> 1.5 x ULN

• Adequate hepatic function demonstrated by: Total bilirubin of \< 1.5 x ULN AST or ALT ≤ 2.5 x ULN

* EGOG status of \< 2: Postoperatively, patients demonstrate an ECOG score of 1 or 2. However, during the first cycle of chemotherapy, the patients' performance status improves to \< 1.
* Projected life expectancy of at least 3 months
* Ability to comply with the visit schedule and assessments required by the protocol
* Negative pregnancy test for women of childbearing potential
* Signed, IRB approved informed consent and HIPPA consent

Exclusion Criteria:

* Subjects with a diagnosis of epithelial ovarian, fallopian tube or peritoneal cancers of low malignant potential (borderline carcinomas) are not eligible.
* Allergy or intolerance to 5HT3 or NK-1 antagonists and dexamethasone
* An episode of vomiting or retching within 24 hours before the start of the initial treatment with chemotherapy
* Subjects with concomitant malignancy or a previous malignancy within the past three (3) years (except non-melanoma skin cancer)
* Current, recent (within 4 weeks of the first infusion of this study), or planned participation in an experimental drug study.
* Screening clinical laboratory values of:

ANC of \<1500/DL Platelet count of \<100,000/µL Total bilirubin of \*1.5 mg/dL x ULN SGOT (AST) or SGPT (ALT) \* 2.5 x ULN Serum creatinine of \* 1.5 mg/dL Hemoglobin of \* 9 gm/dL (may be transfused or receive a colony stimulating factor to maintain or exceed this level)

* EGOG status of \> 2
* Gastrointestinal obstruction or an active peptic ulcer
* Patients who are pregnant or breast feeding because aprepitant may be harmful to the developing fetus and newborn
* Known active HIV and viral hepatitis infections
* Inability to comply with study
* New York Heart Association (NYHA) Grade II or greater congestive heart failure (see Appendix D)