NAC to Prevent Cisplatin-induced Hearing Loss

Inclusion Criteria: * Are between 1 and 21 years of age (inclusive) at time of diagnosis of underlying malignancy * Have a new diagnosis of a localized malignancy with a planned treatment course to include at least two cycles of cisplatin * Diagnosis to be assigned by oncology attending of record (may be reported via designee), histological diagnosis does not need to be confirmed separately * Most common but not exclusive diagnoses consist of hepatoblastoma, medulloblastoma, osteosarcoma * Total cumulative dose of planned cisplatin must be \>200 mg/m2 (or 6.67 mg/kg equivalent for infants requiring weight-based dosing. Conversion factor used is 30:1). * Cisplatin must be delivered over \<3 days * Planned cisplatin dose to be infused over ≤6 hours for ≤2 days per cycle * Are anticipated to be able to comply with end-of-therapy audiology assessment (note that hearing assessments are performed per routine clinical care in children receiving cisplatin and consist of an audiogram or auditory brainstem response, and distortion-product otoacoustic emissions) * Patients with any hearing status are eligible for study (as long as they can comply with the study primary aims of assessing toxicity and dose-response) Exclusion Criteria: * no preexisting risk of serious arrhythmia as defined by (a) normal sinus rhythm on electrocardiogram and corrected QT interval \<500 and (b) no previous history of congenital arrhythmia (e.g. Wolf-Parkinson-White) * Hepatic, biliary, cardiac, or bone m…