Better Monitoring of Cisplatin-Induced Ototoxicity Needed

Patricia McKnight

April 28, 2023

Cisplatin is one of the most commonly used chemotherapeutic agents for treating a variety of cancers, such as lung, bladder, and ovarian cancers. But the therapy comes with a drawback ― ototoxicity.

"More than half of adult and pediatric patients with cancer treated with cisplatin developed hearing impairment with major impact on patients’ health-related quality of life," researchers note in a clinical review that was published in JCO Oncology Practice in March.

It is estimated that 36% of adult patients and 40% to 60% of pediatric patients experience cisplatin-induced ototoxicity. It can present as tinnitus (ringing in the ears), loss of hearing in the high-frequency range (4000 – 8000 Hz), or, at late stages, a decrease in the ability to hear lower frequencies.

The incidence of cisplatin-induced ototoxicity is estimated to be 36% of adult patients and 40% to 60% of pediatric patients. Ototoxicity can present as tinnitus (ringing in the ears), loss of hearing in the high-frequency range (4000 – 8000 Hz), or, at late stages, a decrease in the ability to hear lower frequencies.

The risk of developing cisplatin-induced ototoxicity depends on various factors, including the cumulative dose of cisplatin, the duration of treatment, and individual patient factors, such as age and preexisting hearing problems.

The lack of real-world practice patterns for monitoring ototoxicity makes identifying effective prevention and intervention strategies challenging, say the authors, led by Asmi Chattaraj, MD, from the University of Pittsburgh Medical Center (UPMC) McKeesport, in Pennsylvania.

The team conducted a survey of oncologists with the UPMC Hillman Cancer Center network regarding patterns for monitoring and reducing the risk of ototoxicity.

Of the 35 responding oncologists, the majority (97%) indicated that they regularly discuss the risk of ototoxicity with all patients before they receive cisplatin. However, only 18% of the respondents said they obtain audiograms for patients before administering cisplatin, 69% order audiograms only if patients complain of hearing loss or tinnitus, and 35% of respondents do not perform regular monitoring for ototoxicity.

"This heterogeneity of practice within a single network highlights the need for high-quality evidence to guide clinical practice and the urgent need to standardize the necessary diagnostic steps to monitor for ototoxicity and its effect on the quality of life in the adult oncology practice, similar to the current practice in the pediatric patient population," the researchers determined.

Proactive Rather Than Reactive

Managing cisplatin-induced ototoxicity "must be viewed as a proactive measure rather than a reactive measure," said Nisha Mohindra, MD, writing in an accompanying editorial.

Mohindra writes that although it is recommended that audiology assessments be conducted before, during, and after administration of ototoxicity drugs, the monitoring for ototoxicity remains underutilized in clinical practice. The path to better outcomes begins with implementing testing into clinical practice, she suggests.

"The most effective mechanism to manage ototoxicity currently is to identify patients at risk and implement programs to support ongoing monitoring," Mohindra writes.

"Even if ototoxicity cannot be prevented in some patients, providing treating oncologists with a timely opportunity to alter therapy or providing patients with support, guidance, and earlier access to rehabilitation services may mitigate long-term effects of hearing loss," she concludes.

The researchers have disclosed numerous relationships with industry, a full listing of which is available with the original article.

JCO Oncol Pract. Published online March 15, 2023. Full text, Editorial

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