This session will explore the following challenges related to GD-2 directed monoclonal antibody dinutuximab administration in the pediatric patient with neuroblastoma: neurotoxicity, anaphylaxis, and length of stay (with its potential impact on hospital census and patient/family satisfaction). Dinutuximab-associated neurotoxicity: A 5-year retrospective analysis of incidence presentation, risk factors and nursing interventions Despite its black box warning for neurotoxicity, the full spectrum of adverse effects related to dinutuximab remains poorly classified, limiting clinical guidance. Notably, systematic reviews reveal a lack of nurse-specific guidance for monitoring and managing dinutuximab-associated neurotoxicity. In a retrospective descriptive study at a large medical center, analyzing 437 cycles of dinutuximab administered to 65 patients between 2018 and 2023 we sought to 1) characterize neurotoxicity symptoms, 2) summarize initial nursing interventions, and 3) examine neurotoxicity risk factors and outcomes. We found that dinutuximab-related neurotoxicity is common and often presents early in treatment. Findings suggest targeted neurologic monitoring and nursing interventions are needed for safe administration. Understanding toxicity presentation can inform development of practice guidelines, though further research is needed to evaluate intervention effectiveness and outcomes. You’re doing what in the clinic? Initiating dinutuximab in the outpatient oncology setting Dinutuximab has a side effect profile that requires close monitoring and supportive care in an inpatient setting. At a time when many inpatient units are overflowing with patients, these long admissions may put additional strain on hospital systems already under stress. We proposed, developed, and implemented a new pathway for initiating dinutuximab in the outpatient setting prior to hospital admission. The project also served as a pilot, empowering nurses to activate chemo/immunotherapy orders via the electronic order entry system. The team addressed logistical challenges regarding supply availability, emergency preparedness, and patient transport as well as provided comprehensive education to nurses. Strict eligibility criteria have kept the number of patients following the pathway low, however, those who followed the new pathway experienced shorter hospital stays and expressed increased satisfaction with care. Dinutuximab desensitization in patients with relapsed/refractory neuroblastoma Dinutuximab therapy is associated with severe allergic symptoms in up to 26% of patients, manifested in bronchospasm, angioedema, and anaphylaxis. Historically, patients who experience severe allergic symptoms often require administration of epinephrine and discontinuation of this treatment. We developed a desensitization protocol that would enable patients with previous severe allergic symptoms to continue this therapy. Dinutuximab is infused over approximately 19.5 hours utilizing three bags of dinutuximab containing increasing concentrations of drug. Nursing increases the infusion rate at 12 different time points throughout the infusion and administers a standard supportive care regimen of antipyretics, antihistamines, intravenous fluids, and bronchodilators. To date, six patients were able to continue their dinutuximab therapy without experiencing severe allergic symptoms while utilizing the desensitization protocol.
This contains 2 sections:
- Video Presentation
- Reflection Questions
- Post-Session Evaluation