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. 2023 May;70(5):e30217.
doi: 10.1002/pbc.30217. Epub 2023 Feb 11.

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

Karsten Nysom  1 , Andrea Gomez Morad  2 , Margarida Simão Rafael  3   4 , Judith Zier  5 , Araz Marachelian  6 , Tanya Watt  7 , Daniel A Morgenstern  3
Affiliations

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

Karsten Nysom et al. Pediatr Blood Cancer. 2023 May.

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.

Keywords: Antibodies; drug therapy; humanized; immunotherapy; monoclonal; neuroblastoma; pain.

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