Check for updatesReceived:19 October 2022 Revised:19 December 2022Accepted:3 January 2023D0h:101002/pbc30217PediatricBloodasphoSPECIAL REPORTCancerRmcamaCcabaWILEYPain mitigation and management strategies for anti-GD2infusions:An expert consensusKarsten Nysom1 Andrea Gomez Morad2 I Margarida Simao Rafael34 IJudith Zier5 I Araz Marachelian Tanya Watt?Daniel A.Morgenstern31Rigshospitalet,Copenhagen,Denmark2Boston Children's Hospital.Boston.AbstractMassachusetts,USAMonoclonal antibodies(mAbs)targeting disialoganglioside 2(GD2)are an important3The Hospitalfor Sick Children,Toronto,treatment advance for high-risk neuroblastoma,including in patients with refractoryOntario,Canadaor relapsed disease.Dinutuximab and dinutuximab betaare administered for 28 hours4SantJoan de Deu Barcelona Children'sHospital,Barcelona,Spain(and up to 10 days for dinutuximab beta),whereas naxitamab is administered over5Children's Respiratory and CriticalCare0.5 to 2 hours as tolerated.As acute pain is a class effect of anti-GD2 mAbs,effec-Specialists PA,Minneapolis,Minnesota,USAtive pain management is crucial to successful treatment.Here,we provide an overview6Children's Hospital,Los Angeles,California,of current pain-management strategies for anti-GD2 mAb infusions,with a focus onUSA7UT Southwestern Medical Center.strategies suitable for naxitamab infusions,which cause a more rapid onset of oftenDallas-Fort Worth,Texas,USAsevere pain.We discuss opioid analgesics,ketamine,gabapentin,and other similaragents and nonpharmacologic approaches.Potential future pain-management optionsCorrespondenceDanielA.Morgenstern,Division ofare also discussed,in addition to the use of sedatives to reduce the anxiety that mayHaematology/Oncology.The Hospital for Sickbe associated with infusion-related pain.In this expert consensus paper,specific guid-Children,555 University Avenue,Room 9402,Black Wing.Toronto,Ontario M5G 1X8.ance for pain management during naxitamab infusions is provided,as these infusionsCanada.are ad ministered over 0.5 to 2 hours and may not need overnight hospitalization basedEmail:daniel.morgenstern@sickkids.caon the physician's assessment,and require rapid-onset analgesia options suitable forpotential outpatient administrationKEYWORDSAntibodies,drug therapy,humanized,immunotherapy,monoclonal,neuroblastoma,pain1 I INTRODUCTION(ch14.18/CHO)are approved in the USA/Canada and the EuropeanUnion,respectively,for the treatment of pediatric patients with newlyPatients with high-risk (HR)neuroblastoma have a poor progno-diagnosed HR neuroblastoma who achieve at least a partial responsesis despite intensive multimodal therapy.4 The recent approvalsto prior first-line multiagent,multimodality therapy(dinutuximab),of three antidisialoganglioside 2 (anti-GD2)monoclonal antibodiesor induction chemotherapy,followed by myeloablative therapy and(mAbs)represent important advances for the treatment of thesestemcelltransplantation(dinutuximab beta).Dinutuximab betais alsopatients.Chimeric mAbs
