Pain mitigation and management strategies for anti-GD2 infusions: An expert consensus.

Abstract

Monoclonal antibodies (mAbs) targeting disialoganglioside 2 (GD2) are an important treatment advance for high-risk neuroblastoma, including in patients with refractory or relapsed disease. Dinutuximab and dinutuximab beta are administered for ≥8 hours (and up to 10 days for dinutuximab beta), whereas naxitamab is administered over 0.5 to 2 hours as tolerated. As acute pain is a class effect of anti-GD2 mAbs, effective pain management is crucial to successful treatment. Here, we provide an overview of current pain-management strategies for anti-GD2 mAb infusions, with a focus on strategies suitable for naxitamab infusions, which cause a more rapid onset of often severe pain. We discuss opioid analgesics, ketamine, gabapentin, and other similar agents and nonpharmacologic approaches. Potential future pain-management options are also discussed, in addition to the use of sedatives to reduce the anxiety that may be associated with infusion-related pain. In this expert consensus paper, specific guidance for pain management during naxitamab infusions is provided, as these infusions are administered over 0.5 to 2 hours and may not need overnight hospitalization based on the physician's assessment, and require rapid-onset analgesia options suitable for potential outpatient administration.

• Authors: Karsten Nysom, Andrea Gomez Morad, Margarida Simão Rafael, Judith Zier, Araz Marachelian, Tanya Watt, Daniel A Morgenstern
• Journal: Pediatric blood & cancer (Pediatr Blood Cancer) Vol. 70 Issue 5 Pg. e30217 (05 2023) ISSN: 1545-5017 [Electronic] United States
• PMID: 36772891 (Publication Type: Consensus Development Conference, Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: © 2023 The Authors. Pediatric Blood & Cancer published by Wiley Periodicals LLC.

Chemical References

• Antineoplastic Agents
• Gangliosides

Topics

• Humans
• Antineoplastic Agents (therapeutic use)
• Consensus
• Gangliosides
• Immunotherapy
• Neuroblastoma (drug therapy)
• Pain (drug therapy, etiology, prevention & control)
• Pain Management