The various international clinical guidelines have consistently recommended the use of the combination of the antiemetic agents discussed in this text for the prevention of CINV. It is anticipated that the 5-HT3 receptor antagonists will continue to be used extensively in the preventative regimens due to their high efficacy in the prevention of emesis. The choice of whether to use ondansetron, granisetron, or palonosetron will be dependent on the issues of cost and efficacy. Palonosetron is the recommended agent of this class by the international guidelines based on efficacy, but its cost may be an issue for some institutions compared to the generic availability of ondansetron and granisetron. At this time, there do not appear to be other 5-HT3 receptor antagonists in development for commercial use.