Background Aprepitant, a substance P neurokinin-1 (NK1) receptor antagonist, is licensed for the prevention of acute and delayed nausea and vomiting associated with highly and moderately emetogenic cancer chemotherapy. Case: A 33 year-old male with metastatic gastro-oesophageal cancer had multiple admissions for refractory nausea and vomiting following insertion of an oesophageal stent. He was unable to sufficiently tolerate an oral diet and required IV hydration. Systemic cancer treatment was suspended pending resolution. The patient had multiple lengthy hospital admissions over a period of months with refractory symptoms. Action: Mechanical issues with the stent, stent removal and central causes were excluded. Multiple anti-emetic agents were trialled in combination and with varying routes of administration without significant symptomatic improvement. A trial of aprepitant was proposed as an off-licence therapy. Outcome: 165 milligrams of aprepitant was given orally every 3 days and then up titrated to once daily with significant symptomatic improvement enabling the patient to tolerate an oral diet. The patient remained stable at 12 weeks and has been accepted into 2 clinical trials for potential further cancer treatment. What now? Further research of NK1 inhibitors for indications other than chemotherapy-induced nausea and vomiting is indicated. Learning Points: 1) Although NK1 inhibitors are only licenced and funded for prevention of chemotherapy-induced nausea and vomiting we have demonstrated their utility in refractory nausea and vomiting not related to chemotherapy and their use over a much longer time-period. 2) Prolonged nausea and vomiting are not frequently reported complications of oesophageal stent insertion but patients should be counselled on these rare but serious complications prior to insertion. 3) The use of aprepitant in this case has allowed a patient deemed unsuitable for further life prolonging anti-cancer therapy despite multiple anti-emetics, including subcutaneous levomepromazine, to become eligible and have significantly improved quality of life.