Lidocaine for dinutuximab associated pain? A multicenter retrospective observational cohort study

Abstract

Dinutuximab, an immune-mediated therapy used in the treatment of\nhigh-risk neuroblastoma targets the protein disialoganglioside (GD2)\npresent on neuroblastoma cells, neurons, and peripheral nerve fibers.\nOff target effects could lead to severe nerve pain. Pain regimens\nincluding continuous infusion opioids are required during the first\ntreatment course. Our institution utilizes a combination of intravenous\n(IV) lidocaine infusions and morphine for the treatment of\ndinutuximab-associated neuropathic pain. The primary outcome of this\nstudy was to compare morphine equivalents for cycle one of dinutuximab\nat an institution that uses IV lidocaine (primary) versus those that do\nnot (comparison). Secondary outcomes included both dinutuximab infusion\ntime and safety of IV lidocaine. A retrospective, multi-centered,\nelectronic chart review was performed at three tertiary academic medical\ncenters. Patients between 0-18 years of age during their first course of\ndinutuximab were included to evaluate the primary outcome of adjuvant\nmorphine equivalents needed. Total morphine equivalents at the primary\ninstitution were 1.87 mg/kg vs 1.79 mg/kg at the comparison institutions\n(p=0.413). Dinutuximab infusion time was significantly lower at the\nprimary institution: 610.5 minutes vs 676.23 minutes (p=0.046). Only one\npatient at the primary institution experienced nausea, vomiting and\nparesthesias. This study did not find a statistically significant\ndifference in morphine equivalents between patients who received IV\nlidocaine and those who did not. However, we did find that use of IV\nlidocaine resulted in a statistically significant lower dinutuximab\ninfusion time and that it is a safe adjuvant medication in the treatment\nof dinutuximab-associated neuropathic pain.