Implementation of immunotherapy into the treatment of neuroblastoma - single center experience with the administration of dinutuximab and management of its adverse effects.

Abstract

BACKGROUND:

Neuroblastoma is the most common extracranial solid tumour of childhood with extremely heterogeneous bio-logical and clinical behaviour. Despite advances in its treatment, the long-term prognosis of patients with a high-risk and relapsed neuroblastoma remains poor. The implementation of immunotherapy into the treatment protocols has the potential to improve it. Dinutuximab, a chimeric monoclonal antibody, leads to the apoptosis of tumour cells through binding to the GD2 receptor. The article aim is to present the first experience of our centre with dinutuximab treatment.

PATIENTS AND METHODS:

In 2018-2019, we administered 31 cycles of dinutuximab to seven patients. Five patients with high-risk neuroblastoma received dinutuximab in the first line, in two patients with relapse, dinutuximab was administered in the second line of treatment. To evaluate the toxicity of the treatment, the nursing records of patients during immunotherapy were retrospectively analysed.

RESULTS:

Two patients treated with dinutuximab in the first line are in complete remission, three patients achieved a partial response. Both patients with relapsed neuroblastoma were dia-gnosed with a second relapse after immunotherapy and died of disease progression. The treatment tolerance was acceptable in most patients - in six patients adverse events were managed with adequate supportive care. These were mainly symptoms of capillary leak syndrome, pain and hypersensitivity reactions. In one patient, the treatment was discontinued due to severe neurotoxicity.

CONCLUSION:

Dinutuximab has a proven benefit in the eradication of the minimal residual disease in the treatment of neuroblastoma. Immunotherapy is currently the standard for first-line treatment of high-risk neuroblastoma. Its role in the treatment of relapsed neuroblastoma is a subject of several ongoing studies as well as the optimization of therapeutic regimens. Dinutuximab administration is associated with a considerable risk of severe adverse reactions, so the treatment belongs to the hands of an experienced paediatric oncology centre.

• Authors: Monika Achbergerová, Stanislava Hederová, Martina Mikesková, Kristína Husáková, Andrea Hrašková, Alexandra Kolenová
• Journal: Klinicka onkologie : casopis Ceske a Slovenske onkologicke spolecnosti (Klin Onkol) Vol. 33 Issue 5 Pg. 372-378 ( 2020) ISSN: 1802-5307 [Electronic] Czech Republic
• Vernacular Title: Implementácia imunoterapie do liečby neuroblastómu - skúsenosti jedného centra s podávaním a manažovaním nežiaducich účinkov dinutuximabu.
• PMID: 33108882 (Publication Type: Journal Article)

Chemical References

• Antibodies, Monoclonal
• Antineoplastic Agents
• dinutuximab

Topics

• Antibodies, Monoclonal (adverse effects, therapeutic use)
• Antineoplastic Agents (adverse effects, therapeutic use)
• Capillary Leak Syndrome (chemically induced)
• Drug Hypersensitivity (etiology)
• Humans
• Immunotherapy (adverse effects, methods)
• Neoplasm Recurrence, Local (drug therapy)
• Neuroblastoma (pathology, therapy)
• Treatment Outcome