My friend Xiaojun was recently complained by a patient!
Xiao Jun works in the oncology department of a general hospital in another city. A patient with endometrial cancer who had just finished chemotherapy in another hospital went to his hospital for a blood routine check, which showed a significant decrease in white blood cells and agranulocytosis. Considering that the patient’s immune system is extremely low, there is a possibility of secondary serious infection. So he was hospitalized for observation and treated with whitening. The patient’s white blood cells gradually returned to normal, but he did not expect tinnitus and hearing loss the day before he was discharged from the hospital. This patient blindly believed that my friend’s medication caused her deafness. The reason given was that my hearing was good when I came, and now I have tinnitus. Isn’t that your problem? In fact, this patient used 6 courses of cisplatin chemotherapy in a foreign hospital, and the ototoxicity of this drug can be said to be the greatest of all drugs. Although it has been clearly explained, the patient repeatedly insists on his reasons and how he is struggling financially. Although a serious illness is worthy of sympathy, it does not mean that “I am weak and I am reasonable”. Everything is based on evidence. Hospitals generally will not accept such invalid complaints.
Closer to the subject, the ototoxicity of cisplatin cannot be underestimated sometimes!
Cisplatin (DDP) is a divalent platinum compound. Although it has been on the market for 40 or 50 years, it has good efficacy, broad anti-tumor spectrum and low price. It is still widely used in clinical practice. , and is recognized as a first-line anticancer drug. Chemotherapy of lung cancer, breast cancer, urogenital malignancies, and various sarcomas is inseparable from cisplatin.
But the side effects of cisplatin are really great. The most common one is gastrointestinal reactions. Cisplatin is one of the most emetogenic chemotherapy drugs at present, and some of them have just been infused for an hour. Other common adverse reactions include nephrotoxicity, ototoxicity, and bone marrow suppression.
Cisplatin ototoxicity usually manifests as tinnitus and deafness, which gradually worsens and is irreversible. It can occur unilaterally or bilaterally. Occasionally, symptoms of vestibular involvement may occur. Tinnitus can be temporary or permanent and can occur alone or with hearing loss. Hearing loss is mostly in the high frequency region at first, and with the increase of single dose and total drug dose, it gradually transitions to low frequency region or even total hearing loss. In many studies with large sample sizes around the world, the incidence of hearing loss caused by cisplatin is above 50%, and the incidence rate is extremely high. Persistent tinnitus occurs in 19% to 42% of patients. The risk of this type of ototoxicity is higher in children, occurring in approximately 50% to 88%.
The risk of cisplatin ototoxicity is related to several factors:
1. Mode of administration If a single large dose is administered, various toxicities, including ototoxicity, will be significantly increased. However, as a cytotoxic chemotherapeutic drug, the efficacy of a single large-dose administration is better than that of multiple small-dose administrations.
2. Cumulative dose Cumulative dose is the clearest correlative factor for cisplatin ototoxicity. When the dose of cisplatin was >450mg/m2, 88% had high frequency hearing loss, and when the dose was >990mg/m2, there was speech and audio frequency hearing loss.
3. Age Children and the elderly are the most vulnerable to ototoxicity.
4. Other comorbid factors If the patient has renal insufficiency, the drug excretion is blocked, and ototoxicity will increase; if some ototoxic drugs such as furosemide, aminoglycoside antibiotics, ifosphos are used in combination Amides and vincristine, etc., will significantly increase ototoxicity.
5. Such as anemia, leukopenia or electrolyte imbalance (such as hypophosphatemia and hypomagnesemia, etc.), the probability of ototoxicity will also increase.
Ototoxicity caused by cisplatin is mostly irreversible once it occurs, and there is no effective treatment. Therefore, the clinical emphasis on cisplatin ototoxicity is prevention. It must be fully evaluated before taking the medicine. During use, a large amount of hydration and diuresis can promote excretion. Some auxiliary drugs, such as reduced glutathione and amifostine, can also be used at the same time to reduce toxicity. Once tinnitus or hearing loss occurs, the drug should be stopped in time. .