Cisplatin: Forty-five Years Later and What We Still Do Not Know about Ototoxicity

Cisplatin is a widely used chemotherapy agent that treats various types of malignancies. Over several decades, cisplatin has been integrated into both curative and palliative chemotherapy regimens. Ototoxicity from cisplatin is a dose-limiting side effect. True risk factors for ototoxicity with cisplatin have been difficult to elucidate, but these may include older age, previous hearing loss, concurrent radiation to the ear area, cumulative dose, and dose amount. Agents such as amifostine have been used as chemoprotectants to try to reduce the amount of ototoxicity, but have not had consistent results. As more patients are exposed to cisplatin at higher doses and at younger ages, the true impact of ototoxicity has not been determined. Currently there is no standard of care to screen patients for risk of ototoxicity prior to cisplatin use or to monitor patients for the development of ototoxicity while the patient is receiving cisplatin therapy. This review provides an overview of the current role of cisplatin and the proposed mechanism of ototoxicity and describes the literature for the use of chemoprotectants to try to reduce the incidence of ototoxicity. KEYWORDS Cisplatin - ototoxicity - cancer - chemoprotectants