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.
摘要：
靶向二唾液酸神经节苷脂2（GD2）的单克隆抗体（mAb）是高危神经母细胞瘤的重要治疗进展，包括难治性或复发性疾病患者。Dinutuximab和dinutuximabβ的给药时间≥8小时（对于dinutuximabβ，最长10天），而naxitamab的给药时间为0.5至2小时。由于急性疼痛是抗GD2单克隆抗体的一类效应，有效的疼痛管理是成功治疗的关键.这里,我们概述了目前抗GD2单克隆抗体输注的疼痛管理策略，专注于适合纳西他单抗输注的策略，这通常会引起剧烈的疼痛。我们讨论阿片类镇痛药，氯胺酮,加巴喷丁,以及其他类似的药物和非药理学方法。还讨论了未来潜在的疼痛管理选择，除了使用镇静剂以减少可能与输液相关疼痛相关的焦虑。在这份专家共识文件中，提供了纳西他单抗输注期间疼痛管理的具体指导，由于这些输液在0.5至2小时内进行，并且根据医生的评估，可能不需要过夜住院，并且需要适合潜在门诊给药的快速起效镇痛方案。
