OnCo
ideasIdea

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

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

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.

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.
What would test it
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
Who has to act
research
Cost to try
Medium ($1M to $50M)
Years to first evidence
4
Bottlenecks it attacks

Connected

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Pages like this

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cancers

3
Bladder & urothelial cancerHead and neck squamous cell carcinomaNon-small-cell lung cancer

technologies

1
Platinum agents

bottlenecks

1
Toxicity and quality of life are undervalued