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Description
INNOVATION
Neuroblastoma is the most common extracranial solid tumor in children with approximately 700 cases diagnosed yearly. Children treated with traditional therapies experience a recurrence rate over 50%, increasing the chances of poor clinical outcomes. Integrating anti-disialoganglioside-2 (GD2) monoclonal antibodies like Naxitimab have significantly improved patient outcomes. However, there is no standardized process between pediatric institutions to administer the drug while managing adverse drug reactions. Naxitimab received accelerated approval from the US Food and Drug Administration for children over age one with relapsed/refractory high-risk Neuroblastoma. Approximately half of the patients receiving Naxitimab encountered acute adverse events (AEs). Different institutions manage these AEs in outpatient settings, which proved to be suboptimal for patients at our facility. While hospitalized, the AEs necessitated changes to infusion rates that were unsustainable for future administrations and created a negative experience for families. Understanding the impact this monoclonal antibody has on improving clinical outcomes, our goal was to implement a treatment protocol that would allow for repeated successful administrations. Therefore, a team of physicians, nurses, and pharmacists designed a sedated protocol for Naxitimab to safely administer the drug, providing timely management of the AEs.
Prior to OR the patient is premedicated to minimize the risk of reactions. A chemotherapy-certified nurse is preassigned to administer the infusion using a QRG and monitor for reactions. When sedated, the patient is started on an epinephrine infusion with pain and hypersensitivity medications available. Skin assessments and vitals are taken throughout the infusion and if interventions are necessary, the nurse notifies the attending physician, who gives orders to the anesthesiologist. Upon completion of Naxitimab, the patient is monitored in the post-anesthesia care unit (PACU) before returning to the inpatient unit.
Initially, Naxitimab treatments faced challenges due to adverse events (AEs). However, since implementing the QRG and sedated processes, four patients have completed all cycles with minimal complications.
Publication Date
9-27-2024
Keywords
Innovation, Oncology, Pediatric Oncology
Disciplines
Pediatric Nursing
Recommended Citation
Brown, Lauren; Marshall, Nikki; and Wright, Diamond, "Administration of Naxitamab in High-Risk Neuroblastoma Patients to Manage Adverse Reactions" (2024). 2024. 19.
https://scholarlycollection.childrens.com/nursing-anf2024/19
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This work is licensed under a Creative Commons Attribution-NonCommercial-No Derivative Works 4.0 International License.
