Lidocaine for dinutuximab associated pain? A multicenter retrospective
observational cohort study
Abstract
Dinutuximab, an immune-mediated therapy used in the treatment of
high-risk neuroblastoma targets the protein disialoganglioside (GD2)
present on neuroblastoma cells, neurons, and peripheral nerve fibers.
Off target effects could lead to severe nerve pain. Pain regimens
including continuous infusion opioids are required during the first
treatment course. Our institution utilizes a combination of intravenous
(IV) lidocaine infusions and morphine for the treatment of
dinutuximab-associated neuropathic pain. The primary outcome of this
study was to compare morphine equivalents for cycle one of dinutuximab
at an institution that uses IV lidocaine (primary) versus those that do
not (comparison). Secondary outcomes included both dinutuximab infusion
time and safety of IV lidocaine. A retrospective, multi-centered,
electronic chart review was performed at three tertiary academic medical
centers. Patients between 0-18 years of age during their first course of
dinutuximab were included to evaluate the primary outcome of adjuvant
morphine equivalents needed. Total morphine equivalents at the primary
institution were 1.87 mg/kg vs 1.79 mg/kg at the comparison institutions
(p=0.413). Dinutuximab infusion time was significantly lower at the
primary institution: 610.5 minutes vs 676.23 minutes (p=0.046). Only one
patient at the primary institution experienced nausea, vomiting and
paresthesias. This study did not find a statistically significant
difference in morphine equivalents between patients who received IV
lidocaine and those who did not. However, we did find that use of IV
lidocaine resulted in a statistically significant lower dinutuximab
infusion time and that it is a safe adjuvant medication in the treatment
of dinutuximab-associated neuropathic pain.