Prevention and treatment of cisplatin-induced ototoxicity in adults: A systematic review.

OBJECTIVES: Ototoxicity is a common disabling side effect of platinum-based chemotherapy. This study aimed to assess the evidence on the management of platinum-induced ototoxicity in adult cancer patients. METHODS: Four databases were searched up to 1 November 2022. Original studies were included if they reported on a pharmacologic or non-pharmacologic intervention to prevent or treat platinum ototoxicity in adults. The articles' quality was assessed via two grading scales. RESULTS: Nineteen randomised controlled trials and five quasi-experimental studies with 1673 patients were analysed. Eleven interventions were identified, nine pharmacological and two non-pharmacological. Six of the interventions (sodium thiosulphate, corticoids, sertraline, statins, multivitamins and D-methionine) showed mild benefits in preventing cisplatin-induced ototoxicity. Only one trial assessed corticoids as a potential treatment. Overall, only six trials were deemed with a low risk of bias. The majority of studies inadequately documented intervention-related adverse effects, thereby limiting safety conclusions. CONCLUSIONS: Current interventions have mild benefits in preventing cisplatin-induced ototoxicity in adult cancer patients. Sodium thiosulphate is the most promising intervention as a preventive strategy. Rigorous, high-quality research is warranted, encompassing an evaluation of all potential symptoms and innovative treatment modalities.

Factores pronósticos de la supervivencia en pacientes con melanoma de piel metastásico, que reciben primera línea de tratamiento con inmunoterapia anti PD-1 o régimen con anti PD-1 y anti CTLA-4, en el Instituto Nacional de Cancerología de Colombia / Prognostic factors for survival in patients with metastatic skin melanoma, receiving first-line treatment with anti-PD-1 or anti-PD-1 and anti-CTLA-4 immunotherapy regimen at the Instituto Nacional de Cancerología (Bogotá, Colombia)

Introducción. En melanoma metastásico, uno de los estándares de tratamiento es la inmunoterapia anti-PD-1 y anti-CTLA-4. El objetivo de esta investigación fue determinar factores pronósticos asociados con la supervivencia de pacientes con melanoma metastásico, con primera línea con inmunoterapia anti-PD-1 o anti-PD-1 y anti-CTLA-4, en el Instituto Nacional de Cancerología de Colombia.Métodos. Se revisaron 63 historias clínicas del Instituto Nacional de Cancerología de enero de 2016 a abril de 2020. Se realizó un análisis de supervivencia con método de Kaplan-Meier, prueba log-rank y regresión de Cox.Resultados. La mayoría de los pacientes fueron mujeres (58,7%); 47,6% tenían subtipo lentiginoso acral, 17,4% BRAF mutado, 20,6% compromiso en SNC, 50,8% recibieron nivolumab, 41,3% pembrolizumab y 7,9% nivolumab + ipilimumab. La mediana de supervivencia libre de progresión fue de 7,3 meses, con una tasa a 1, 2 y 3 años de 38,0%, 22,0% y 12,0% respectivamente; la mediana de supervivencia global fue 12,2 meses con una tasa a 1, 2 y 3 años de 50,0%, 25,0% y 19,0%. Como factor pronóstico protector para SLP se encontró el recibir nivolumab en comparación con pembrolizumab (HR=0,427; IC95% 0,21-0,86) y para SG el estado funcional al diagnóstico (ECOG 2 HR=12,38; IC95% 2,20-69,45).Conclusión. La SLP y SG fueron menores a la de ensayos clínicos aleatorizados en población caucásica, pero similar a la encontrada en estudios que incluyen mayor proporción del subtipo histológico lentiginoso acral, como la nuestra. Se encontraron como factores pronósticos el tipo de inmunoterapia utilizada y el estado funcional al diagnóstico.

Introduction: In metastatic melanoma, one of the standard treatments is anti-PD-1 and anti-CTLA-4 immunotherapy. This research aimed to determine prognostic factors associated with the survival of patients with metastatic melanoma who started first-line treatment with anti-PD-1 or anti-PD-1 and anti-CTLA-4 immunotherapy at the Instituto Nacional de Cancerología (INC) (Bogotá, Colombia).Methods: A total of 63 medical records from the INC were reviewed from January 2016 to April 2020. A survival analysis was performed using the Kaplan-Meier method, log-rank test, and Cox regression.Results: Most patients were women (58.7%); 47.6% had acral lentiginous subtype, 17.4% BRAF-mutated melanoma, 20.6% CNS involvement, 50.8% received nivolumab, 41.3% pembrolizumab, and 7.9% nivolumab + ipilimumab. Median progression-free survival (PFS) was 7.3 months with a rate at 1, 2, and 3 years of 38%, 22%, and 12%, respectively, while median overall survival (OS) was 12.2 months with a rate of 50%, 25%, and 19% at 1, 2, and 3 years, respectively. A protective prognostic factor for PFS was to receive nivolumab compared to pembrolizumab (HR=0.427; CI95% 0.21-0.86), and for OS, functional status at diagnosis (ECOG 2 HR=12.38; CI95% 2.20-69.45).Conclusion: PFS and OS were lower than those of randomized clinical trials in the Caucasian population, but similar to those found in studies that include a higher proportion of the acral lentiginous histological subtype, such as ours. The type of immunotherapy used and functional status at diagnosis were found as prognostic factors