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Permanent hearing loss is a common side effect of the medicine, but until now, studies have been too little and too varied to accurately characterize this risk.
Today in The Lancet Child & Adolescent Health, researchers at Children’s Hospital Los Angeles published results of the biggest analysis of cisplatin-induced hearing loss to date. The analysis establishes the initial benchmarks for the prevalence of hearing loss, and reveals that the probability of hearing loss is affected not only by how much medication is given, but by how that drug is delivered–dosing schedules, complementary treatments, and much more.
The lot of factors involve means that permanent hearing loss can occur in anywhere from 20-90percent of cisplatin-treated patients. But the new study shows that another important aspect of chemotherapy can affect a child’s risk for hearing loss.
Dr. Orgel and a team of researchers, including CHLA’s Diana Moke, MD, MS, collected information from over 1,400 patients treated in hospitals across the USA and Canada. A data pool of this size is no small accomplishment. “Pediatric cancers are rare, so they’re hard to study,” states Dr. Moke, who treats children with many of the included cancers. “We have gathered data from the greatest group ever of cisplatin-treated children and adolescents with a wide array of cancers,” she says.
We found that how we infuse the drug can significantly alter the risk of side effects. Cisplatin has been used to treat cancers in children and adults for more than fifty years, but for the first time, we have insights into how something as simple as adjusting our dosing approach may prevent hearing loss and still maintain effective treatments.”
Etan Orgel, MD, MS, Study Lead
Overall, the study showed that 44 percent of pediatric patients treated with cisplatin suffered from moderate to severe hearing loss. But the data showed that not all treatment schedules came with the same risk. Children who received higher doses of the chemotherapy were more likely to experience hearing loss, even when the complete amount of cisplatin over the course of the treatment was the same.
The team also uncovered a second, previously unknown, risk factor for hearing loss: concurrent use of vincristine, a second chemotherapy agent often added to treatment regimens.
The team addressed another barrier to understanding cisplatin-induced hearing loss: variation in distributing audiology scores. Many international medical centers categorize hearing loss differently, making direct comparisons impossible.
To overcome this issue, the group reviewed all of the study data using the identical global consensus system for cisplatin-induced hearing loss (developed by the International Society of Pediatric Oncology), allowing investigators to evaluate hearing loss using over 2,000 tests from patients treated at 19 unique institutions.
Uncovering how real-world variables affect risk of side effects enables oncologists to better serve every child. “Studies such as these are a crucial first step in developing a truly individualized approach to each individual,” says Bruce Carleton, PharmD, who led the Canadian arm of this study. “Data provided by this study will help oncologists identify patients that might be at greater risk of hearing loss in order that protective strategies can be considered.”
“We have developed these powerful tools to effectively fight cancer,” says Dr. Orgel. “Now we can focus in on how to use these tools in a way that maintains their power but reduces their footprint.”
Children’s Hospital Los Angeles