# Protect hearing from cisplatin in adults as we now do in children

Source: https://onco.cc/ideas/idea-moon-hearing-protection-cisplatin/  
OnCo record `idea-moon-hearing-protection-cisplatin` (Idea). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Cisplatin causes permanent hearing loss. A cheap drug, sodium thiosulfate, protects children; test and roll it out for adults too.

## Summary

Sodium thiosulfate is approved to reduce cisplatin ototoxicity in children with localised solid tumours after randomised trials. Adults with head and neck, testicular, lung and bladder cancers receive cisplatin in large numbers and commonly lose hearing, with no protective standard. The proposal is randomised trials of delayed sodium thiosulfate and other candidates (statins, transtympanic agents) in adult cisplatin regimens with audiometry and patient-reported hearing endpoints, with careful attention to tumour outcome non-inferiority.

## Fields

- Kind: Idea
- Last checked: 2026-09-08
- Hypothesis: Otoprotection reduces clinically significant hearing loss in adults on cisplatin by at least a third without reducing tumour control.
- Rationale: The mechanism (thiol scavenging of cisplatin) is not age-specific and the paediatric trials showed efficacy; adult trials have been small or absent because nobody owns the question.
- Proposed test: Phase 3 randomised trial in head and neck chemoradiation and testicular cancer with audiometric primary endpoint and progression-free survival non-inferiority.
- Maturity: early-clinical
- Actor: research

## Sources

- Bottleneck evidence (Toxicity and quality of life are undervalued): Di Maio et al., Symptomatic toxicities experienced during anticancer treatment: agreement between patient and physician reporting (JCO 2015): https://doi.org/10.1200/JCO.2014.57.9334

## Connected records

- cancers: [Bladder & urothelial cancer](https://onco.cc/cancers/urothelial/), [Head and neck squamous cell carcinoma](https://onco.cc/cancers/head-and-neck/), [Non-small-cell lung cancer](https://onco.cc/cancers/nsclc/)
- fronts: [Recovery & Rejuvenation](https://onco.cc/fronts/rejuvenation/)
- technologies: [Hearing after platinum and cranial radiotherapy in a developing child](https://onco.cc/technologies/rejuv-paed-hearing/), [Hearing and tinnitus after platinum chemotherapy](https://onco.cc/technologies/hearing-after-platinum-chemotherapy/), [Platinum agents](https://onco.cc/technologies/platinum/)
- bottlenecks: [Toxicity and quality of life are undervalued](https://onco.cc/bottlenecks/b-toxicity-qol/)
- key papers: [Symptomatic toxicities experienced during anticancer treatment: agreement between patient and physician reporting in three randomized trials](https://onco.cc/key-papers/paper-di-maio-j-clin-oncol/)
- roadmaps: [Chemotherapy roadmap: mustard gas → curative combinations → the warhead inside smarter drugs](https://onco.cc/roadmaps/chemotherapy-roadmap/), [Paediatric oncology roadmap: cooperative-group cures → engineered immunity → drugs developed for children first](https://onco.cc/roadmaps/paediatric-oncology-roadmap/)

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