Cisplatin and other platinum salt agents, including carboplatin and oxaliplatin, are
widely used chemotherapy agents in patients with solid malignancies. These agents remain
the backbone of treatment for ovarian, cervical, testicular, non-small-cell lung,
bladder, and head and neck cancers. It is estimated that more than 500,000 patients
diagnosed with these cancers annually in the United States could be candidates for
treatment with cisplatin. However, adverse effects such as ototoxicity, neurotoxicity,
and nephrotoxicity can sometimes limit their use. The incidence of ototoxicity induced by
cisplatin has been estimated to be 36% of adult patients with cancer and 40%-60% of
pediatric patients. Ototoxicity can be vestibular or cochlear toxicity or both, which can
manifest as tinnitus (ringing in the ear), ear pain, and frank hearing loss.
The receipt of cisplatin is associated with a 5-fold increase in the risk of hearing
impairment, and the incidence and severity are cumulative with exposure. Ototoxicity can
manifest as tinnitus, hearing loss in the high-frequency range (4,000 to 8,000 Hz), or at
late stages, a decreased ability to hear in the lower-frequency normal conversation
range. It can occur during or after treatment and can be unilateral or bilateral affect
both ears. Usually, hearing loss can start at higher frequencies in the beginning and can
be permanent. In fact, severe ototoxicity with deafness has been reported even after a
single cycle of cisplatin. Hence, monitoring and early identification of
cisplatin-induced hearing loss are crucial to prevent detrimental impact on hearing and
thereby the quality of life (QoL). Children affected by hearing loss have a poorer QoL as
evident from their ability to communicate and interact with family and peers, their
independence, and emotional well-being.The negative impact of hearing impairment on the
patients' health-related QoL including social isolation, anxiety, and depression is well
supported by a large body of evidence.
In the literature, two studies were found exploring the effect of statins on the
incidence of ototoxicity induced by cisplatin, one retrospective study found that
patients who used statins concurrently with their cisplatin chemotherapy had a lower
incidence of developing ototoxicity, similar results were proven by a study conducted on
mice that found that lovastatin protects against development of ototoxicity resulting
from cisplatin therapy , a randomized controlled trial exploring the effect of statins on
ototoxicity is needed.
