Dexamethasone for the Prevention of Cisplatin-induced Ototoxicity

Background: Cisplatin is a commonly used anti-cancer drug. However, its use is associated with severe side effects including ototoxicity that affects a large fraction of cisplatin-treated patients. Approved therapies that reduce cisplatin-induced ototoxicity are lacking. Among the candidate therapeutics, dexamethasone stands out. There is extensive experience of its use in combination with cisplatin for the prevention of chemotherapy-induced nausea and vomiting indicating that dexamethasone does not affect the anti-cancer effects of cisplatin. Objective: The objective of this study is to assess the potential of dexamethasone for the prevention of cisplatin-induced ototoxicity by a systematic analysis of the available evidence. Method: The databases PubMed and Web of Science were used to identify relevant articles by using the search terms 'cisplatin', 'ototoxicity', and 'dexamethasone'. Results: We identified 16 relevant original research articles. The analyzed studies reported conflicting results on the effects of dexamethasone on cisplatin-induced ototoxicity. However, studies in which dexamethasone was used prior to cisplatin treatment and directly administered into the tympanic cavity of the middle ear consistently reported beneficial effects. The use of sustained release formulations that prolong the availability of dexamethasone within the ear further improved the efficacy of dexamethasone. Conclusion: Dexamethasone is a promising candidate drug for the prevention of cisplatin-induced ototoxicity when applied intratympanically. Optimized formulations and administration schedules with regard to dose and time of application need to be developed.