Pain mitigation and management strategies for anti-GD2 infusions: An expert consensus.
Karsten NysomAndrea Gomez MoradMargarida Simão RafaelJudith ZierAraz MarachelianTanya WattDaniel A MorgensternPublished in: Pediatric blood & cancer (2023)
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.
Keyphrases
- pain management
- chronic pain
- emergency department
- primary care
- acute lymphoblastic leukemia
- climate change
- low dose
- liver failure
- neuropathic pain
- drug induced
- diffuse large b cell lymphoma
- intensive care unit
- acute myeloid leukemia
- spinal cord injury
- risk assessment
- spinal cord
- early onset
- respiratory failure
- human health
- sleep quality
- hodgkin lymphoma
- physical activity
- hepatitis b virus
- sensitive detection
- acute respiratory distress syndrome