Dinutuximab-Associated Neurotoxicity: Incidence, Presentation, Risk Factors, and Nursing Interventions

BackgroundDinutuximab, a GD2-directed monoclonal antibody, is now incorporated into therapy for high-risk and relapsed or refractory neuroblastoma. Despite its boxed warning for drug-induced neurotoxicity, little is known about the incidence, risk factors, monitoring guidelines, or management of this spectrum of adverse neurologic effects. This study aimed to describe neurotoxicity symptoms, summarize nursing-related interventions, and evaluate potential risk factors for neurotoxicity.MethodThis retrospective descriptive study reviewed 437 dinutuximab cycles administered to 65 patients between 2018 and 2023. Data on patient demographics and clinical variables, occurrence of 11 potential distinct neurotoxicities, and nursing responses were analyzed to describe the sample and evaluate for differences and associations between variables.ResultsNeurotoxicity occurred in 159 (36.4%) cycles, affecting 83.1% of participants without relation to age or sex. Neurotoxicities encompassed nine separate symptoms and typically included urinary retention (66.2% of neurotoxic cycles) and visual changes (16.9% of neurotoxic cycles). Symptoms appeared on day 1 in 73.7% of cycles. Neurotoxicity was unrelated to dinutuximab use in upfront versus relapsed therapy (OR = 1.20, p = .484) or Curie score (OR = 1.0, p = .883). A total of 11 nursing interventions were identified and ranged from calling a code (0.46% of all cycles) to additional medication administration (29.5% of all cycles).DiscussionDinutuximab-associated neurotoxicity is common and appears early in treatment. Findings suggest patients may be universally at risk for toxicity with relation to demographics or clinical factors. Targeted neurologic monitoring and nursing interventions are needed for safe administration and should be developed and tested.