Adding sodium thiosulfate after cisplatin chemotherapy can lower the incidence of cisplatin-induced hearing loss among children with liver cancer without jeopardizing survival, a new study found (N Engl J Med 2018;378[25]:2376). A total of 109 pediatric patients between 1 month and 18 years old were randomly assigned to receive cisplatin plus sodium thiosulfate, which was administered at a dose of 20 g per square meter intravenously over a 15-minute period and six hours after the discontinuation of cisplatin, or cisplatin alone, and their absolute hearing thresholds were measured through pure tone audiometry. Hearing loss of Brock grade 1 or higher occurred in 33 percent of the children in the cisplatin and sodium thiosulfate group, compared with 63 percent in the cisplatin-alone group, indicating a 48 percent lower incidence of hearing loss in the cisplatin and sodium thiosulfate group. At a median of 52 months of follow-up, the three-year rates of event-free survival were 82 percent in the cisplatin and sodium thiosulfate group and 79 percent in the cisplatin-alone group, and the three-year rates of overall survival were 98 percent and 92 percent, respectively.
The administration of sodium thiosulfate was associated with a trend toward reduced ototoxicity in all the Brock grades, said the study authors in an interview with MedPage Today. "Children with hearing of grade 0 may not have completely normal hearing but can manage life with little or no additional help," they said. "The otoprotective dose of sodium thiosulfate was associated with a high sodium load, which is a factor to consider in planning treatment. Sodium thiosulfate was emetogenic despite the use of prophylactic antiemetic agents, with nausea and vomiting being common adverse events."
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