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

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.