Ototoxicity Review: A Growing Number of Non–Platinum-Based Chemo- and Immunotherapies

Abstract

Objective

To raise awareness of the growing list of non–platinum-based chemo- and immunotherapeutic agents that have been associated with ototoxicity and to introduce the possible mechanism of ototoxicity of these agents.

Data Sources

PubMed, Embase, and Web of Science.

Review Methods

A systematic review was performed following the PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-analyses). PubMed, Embase, and Web of Science databases were searched for published reports of ototoxicity from non–platinum-based chemo- and immunotherapeutic agents in adult and pediatric patients. Therapies that utilized any platinum-based agent were excluded.

Conclusions

Ototoxicity from non–platinum-based chemo- and immunotherapies is an evolving problem. There were 54 reports—39 case reports and 15 cohort studies—documenting ototoxicity from 7 agents/combination therapies. Of these reports, 37 (69%) were published within the last 15 years (after 2005). No recovery of hearing was documented in 21 of 56 cases (38%). Pretreatment audiograms were uncommon (19/54 studies, 35%), despite documented ototoxic associations.

Implications for Practice

There is a growing number of novel, ototoxic, non–platinum-based chemo- and immunotherapeutic agents with various potential mechanisms of action. Otolaryngologists will need to prioritize awareness of these agents. This growing list of agents, many of which have reversible effects, suggest a need for standardized ototoxicity monitor protocols so that appropriate and timely management options can be implemented.