Inclusion Criteria:  Adult chemotherapy naïve patients of at least 18 years old Diagnosed with a malignant disease and scheduled for highly emetogenic chemotherapy (as defined by NCCN guidelines v1.2019) No concurrent radiotherapy or use of other antiemetic drugs except (dexamethasone, ondansetron/granisetron, and olanzapine) Normal renal and hepatic function  Exclusion Criteria:  Pregnant or breast feeding Contraindication for capsaicin or other medications in the study Has ongoing nausea and/or vomiting of other etiology History of anticipatory nausea and/or vomiting or has vomited/nauseated within 24 hours prior to the start of scheduled chemotherapy Chronic alcoholism