Prospective Observational Study of Evaluating Cisplatin-Induced Ototoxicity in Patients

Abstract

Abstract Introduction Platinum-based chemotherapeutic agents cisplatin and carboplatin are two of the most widely used drugs in cancer today. They display wide range of adverse reactions; among them, ototoxicity is an important cumulative toxicity that more commonly observed with cisplatin. At a later stage, it can affect speech of individual and lead to communication problem with decreased cognitive function and depression in cancer survivors. Periodic monitoring of hearing loss with pure-tone audiometry (PTA) provides early evidence of ototoxicity which may decrease debilitating effect of the same in a patient. Objective The primary objective of this study was to assess cisplatin-induced ototoxicity. We also investigated its severity, reversibility, and other modifying risk factors. Materials and Methods We conducted a prospective observational descriptive type of epidemiological study. The study was conducted over 80 randomly selected cancer patients (for estimation of sample size, the following formula was used n = [Zα 2 PQ] / d 2), who were starting with their first cycle of cisplatin from August 2018 to July 2020. This study was conducted at tertiary cancer care center in western Gujarat which caters patients from all over India. We performed PTA in all randomized patients at baseline and periodically. We classified hearing loss according to the World Health Organization (WHO) criteria. Results A total of 30% (n = 24) patients developed cisplatin-induced ototoxicity according to WHO criteria at end of 3 months after starting the first cycle of cisplatin. It was sensory neuronal, affecting both the ears equally, and was seen predominantly at high frequency. We observed hearing loss at 3 months to be significantly more common in the 301 to 400 mg/m2 cumulative dose group (47%), as compared with the other two groups (0–200 mg/m2 and 201–300 mg/m2; p < 0.05). It showed dose dependency with cisplatin. In the multivariate step-wise regression model, baseline hearing loss (odds ratio [OR] = 17.71, 95% confidence interval [CI]: 6.57–118.91, p < 0.05) and cumulative cisplatin dose of more than 300 mg/m2 were significantly associated with hearing loss at 3 months (OR = 6.62, 95% CI: 2.33–18.74, p < 0.05). Conclusion Cisplatin-induced ototoxicity manifests as a bilateral high frequency sensorineural hearing loss. Cumulative dose of cisplatin is an important predictor of development of ototoxicity. Baseline and periodic audiometric monitoring could detect ototoxicity early which leads to possible limitation on the severity of ototoxicity.