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, including discussion of opioid analgesics, ketamine,
gabapentin, and other similar agents, and non-pharmacologic 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. 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.