Sodium Thiosulfate Otoprotection During Salvage Cisplatin Therapy

This study will attempt to demonstrate the efficacy of Sodium Thiosulfate (STS) in preventing hearing loss in patients re-treated with cisplatin-based therapy according to regimens Cisplatin and STS (regimen CS) and Cisplatin, STS and Vorinostat/SAHA (regimen CSS).

Inclusion Criteria:Patients must be > 1 month and ≤ 39 years old at study enrollmentHistologically proven, at time of diagnosis or relapse:Stratum 1: Arm CS: Previously chemosensitive to cisplatin defined as an AFP drop of 1 log (90%) and/or an objective tumor response of 30% or greater on imaging while receiving cisplatin.Stratum 2A: CSS: Previously chemosensitive but with noted subsequent progression on cisplatin or initially chemoresistant to cisplatin (all other hepatoblastoma patients). Resistance to cisplatin is defined as rising AFP x 2 consecutive measurements or imaging progression including growth of known lesions or new lesions while patient is receiving a cycle of chemotherapy containing cisplatin or relapse noted within 3 months of last cisplatin administration.Stratum 2B: CSS: Relapsed/refractory Wilms tumor, Germ Cell Tumor, or NeuroblastomaPatients must have a life expectancy of ≥ 8 weeks.Patients must have fully recovered from the acute toxic effects of all prior chemotherapy, immunotherapy, or radiotherapy prior to entering this study:Myelosuppressive chemotherapy: Must not have received within 2 weeks of entry onto this study. Previous SAHA administration is permittedImmunotherapy: Must not have received within 2 weeks of entry onto this study.Radiation therapy (RT): greater than or equal to 2 weeks for local palliative RT (small port); greater than or equal to 6 months must have elapsed if prior craniospinal RT or if greater than or equal to 50% radiation of pelvisPatients may not be enrolled on another clinical trial or receiving any other investigational therapies (within 2 weeks prior to study enrollment).Organ Function RequirementsAdequate Bone Marrow Function Defined as:Peripheral absolute neutrophil count (ANC) greater than or equal to 750/uLPlatelet count greater than or equal to 75,000/uL (transfusion independent defined as no platelet transfusions within 7 days)Hemoglobin greater than or equal to 8.0 g/dL (may receive RBC transfusions)Adequate Liver Function Defined As:Total OR direct bilirubin less than or equal to 1.5 x upper limit of normal (ULN) for age, andSGOT (AST) or SGPT (ALT) < 10x upper limit of normal (ULN)Adequate Renal Function Defined As:Creatinine clearance or radioisotope GFR > 30 mL/min/1.73 m2Baseline Audiology Requirements:Subjects must have a successful audiology examination prior to enrollment. Patients may have Boston grade III or IV hearing loss and still be eligible to enroll as long as they did not receive 3 or more cycles of cisplatin during upfront therapy WITH sodium thiosulfate. There is no specific baseline hearing level/grade requirement beyond that to be eligible, but the baseline level of hearing must be clearly established and recordedExclusion Criteria:Patients with any uncontrolled, intercurrent illness including, but not limited to, uncontrolled infectionPatients with symptomatic congestive heart failure (defined as Grade 2 or higher heart failure per CTCAE version 5.0)Patients with Renal Tubular Acidosis (RTA) as evidenced by serum bicarbonate < 16 mmol/L and serum phosphate ≤ 2 mg/dL (or < 0.8 mmol/L) without supplementation. Patients requiring electrolyte supplementation for RTA will be permitted if bicarbonate ≥16 mmol/L and phosphate > 2mg/dL after at least 7 days of stable supplementation regimenPregnancy and Breastfeeding:Female patients who are pregnant or breast-feeding will not be entered in the study. A negative pregnancy test within 72 hours of starting therapy is required for female patients of childbearing potentialLactating females who plan to breastfeed their infants.Sexually active patients of reproductive potential must agree to use an effective contraceptive method for the duration of their study participationPatients on tacrolimus with levels targeted > 10 ng/mLKnown allergy to any component of CS or CSS therapy, as indicated