Lidocaine for dinutuximab-associated pain? A multicenter retrospective observational cohort study.

Abstract

BACKGROUND:

Dinutuximab, an immune-mediated therapy indicated for high-risk neuroblastoma, targets the protein disialoganglioside (GD2) on neuroblastoma cells, neurons, and peripheral nerve fibers. Off-target effects lead to severe nerve pain. Pain regimens including continuous infusion opioids are required during treatment courses. Our institution utilizes a combination of intravenous (i.v.) lidocaine infusions and morphine for the treatment of dinutuximab-associated neuropathic pain.

OBJECTIVE:

The primary outcome of this study was to compare morphine equivalents for cycle 1 of dinutuximab at an institution that uses i.v. lidocaine (primary) versus those that do not (comparison). Secondary outcomes included both dinutuximab infusion time and safety of i.v. lidocaine.

METHODS:

A retrospective, multicentered, electronic chart review was performed at three tertiary academic medical centers. Patients between 0 and 18 years of age during their first course of dinutuximab were included to evaluate the primary outcome of adjuvant morphine equivalents needed.

RESULTS:

Twenty-one patients were identified for inclusion. Total morphine equivalents at the primary institution were 1.87 mg/kg versus 1.79 mg/kg at the comparison institutions (P = 0.413). Dinutuximab infusion time was statistically significantly less at the primary institution: 610.5 minutes versus 676.23 minutes (P = 0.046). Only one patient at the primary institution experienced nausea, vomiting, and paresthesias.

CONCLUSIONS:

This study did not find a statistically significant difference in morphine equivalents between patients receiving i.v. lidocaine and those who did not. Lidocaine use resulted in a statistically significant lower dinutuximab infusion time. Our data suggest it is a safe adjuvant medication, for use outside of the pediatric intensive care unit, in the treatment of dinutuximab-associated neuropathic pain.

• Authors: Julianna Featherly, Sarabeth Baxter Wojnowicz, Kelly Steidl, Jeni Burgess
• Journal: Pediatric blood & cancer (Pediatr Blood Cancer) Vol. 69 Issue 9 Pg. e29653 (09 2022) ISSN: 1545-5017 [Electronic] United States
• PMID: 35441791 (Publication Type: Journal Article, Multicenter Study, Observational Study)
• Copyright: © 2022 Wiley Periodicals LLC.

Chemical References

• Antibodies, Monoclonal
• Morphine Derivatives
• dinutuximab
• Lidocaine

Topics

• Antibodies, Monoclonal
• Child
• Humans
• Lidocaine
• Morphine Derivatives (therapeutic use)
• Neuralgia
• Neuroblastoma (drug therapy)
• Retrospective Studies