 Eligible subjects will be identified in weekly palliative care patient triage meetings. Patients who are 18 years of age or older, have histologically confirmed cancer, and confirmed refractory CINV will be eligible. After obtaining written informed consent and verifying that the study subject meets all eligibility criteria, the subject will be enrolled in the study through the University California San Diego UCSD Moores Cancer Center Clinical Trials Office. Subjects will be allowed to participate only once in the study. Study Day 1 will be the day of Akynzeo dosing. Subjects will receive a single capsule of Akynzeo 300 mg of netupitant and 0.5 mg of palonosetron on Study 1. Study drug may be taken with or without food. Subjects will complete a study drug diary to document date and time of Akynzeo administration. On Study Day 1, the study coordinator will educate the subject on how to complete the Multinational Association of Supportive Care in Cancer MASCC Antiemesis Tool, and Functional Living Index Emesis FLIE scale, and medication diary and each of these documents will be completed for that day. An adequate number of copies of each subject questionnaire and diary will be provided to the subject on Study Day 1 for completion at home during the post-treatment observation portion of the study Study Days 2-7 as needed. 