Administration and Management of Anti-GD2 Immunotherapy for High Risk Neuroblastoma in the Outpatient Setting (200)

3:30 – 4:30 pm Thursday, October 28

Neuroblastoma, the most common extracranial solid tumor in children, develops from neural crest cells that, typically, differentiate to form the sympathetic nervous system. Most neuroblastoma cases present as high-risk neuroblastoma, which has long been associated with high relapse rates and poor survival.

The advent of immunotherapy using anti-GD2 monoclonal antibodies, which target the antigen found on the surface of neuroblastoma cells and effectively treat microscopic residual disease, has significantly improved progression-free survival. Dinutuximab is a chimeric anti-GD2 antibody approved for the upfront treatment of neuroblastoma that is administered over 10 to 20 hours per dose in the inpatient setting. A second anti-GD2 antibody, known as naxitamab, was recently approved by the U.S. Food and Drug Administration (FDA) for the treatment of relapsed or refractory neuroblastoma. Naxitamab is a humanized monoclonal antibody that is safely administered over 30 to 60 minutes in the outpatient setting and has a similar side effect profile to dinutuximab. As a result of its shorter infusion time, these side effects often are more intense but do not last as long as do the side effects of dinutuximab. Naxitamab is likely to be used by more institutions across the United States now that it has FDA approval. Nurses and advanced practice providers are instrumental in the care of and care coordination for children receiving anti-GD2 immunotherapy. Careful attention by nurses to assessment, preparation, premedication, and monitoring; a thorough understanding of the management of adverse events; and discharge education are critical to ensuring the safety of this vulnerable population. Naxitamab is administered following an established standard of practice, which includes guidance on the management of well-known side effects to anti-GD2 monoclonal antibodies: pain and allergic reactions. Thorough management of adverse events, including fever, hypotension, hypertension, altered level of consciousness, and bronchospasm, requires preparation and real-time oversight and is necessary for successful administration of naxitamab in the outpatient setting.



Jennifer Cabral, H.BSc BSN RN


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