Care During Chemotherapy and Beyond



Trade Name: Unituxin uses generic names in all descriptions of drug. Unituxin is the trade name for dinutuximab. In some cases, health care professionals may use the trade name Unituxin when referring to the generic drug name dinutuximab.

Drug type: Dinutuximab is an anti-cancer ("antineoplastic" or "cytotoxic") chemotherapy drug. This medication is classified as an "antineoplastic agent and a chimeric monoclonal antibody" (for more detail, see "How Dinutuximab Works" below).

What Dinutuximab Is Used For

  • Indicated in combination with other agents for the treatment of children with high-risk neuroblastoma, a cancer of the sympathetic nervous system. It can also be considered in patients with refractory or relapsed neuroblastoma.

Note: If a drug has been approved for one use, physicians sometimes elect to use this same drug for other problems if they believe it might be helpful.

How Dinutuximab Is Given

  • As an infusion into a vein (intravenous, IV), over 10 to 20 hours for 4 consecutive days for each cycle.
  • Medications will be given before the infusion to reduce the occurrence of pain and infusion-related symptoms.
  • The infusion rate of dinutuximab starts at a slow rate and can be gradually increased as tolerated to infuse over 10 to 20 hours.
  • The amount of drug you will receive depends on many factors, including your height and weight, your general health or other health problems. Your doctor will determine your exact dose and schedule.

Side Effects

Important things to remember about the side effects of dinutuximab:

  • Most people do not experience all of the side effects listed.
  • There are options to help minimize or prevent side effects.
  • There is no relationship between the presence or severity of side effects and the effectiveness of the medication. The frequency and incidence of side effects can be greater when given with interleukin-2 therapy.

Infusion-related reactions (potential symptoms as a result of the actual treatment) include:

  • Infusion-related reactions generally occur during or within the first 24 hours after infusion. Symptoms include rash, fever, chills, flushing, and mild hypotension.
  • Pre-medications and fluid will be given to reduce the incidence of infusion-related reactions.
  • Occasionally, infusion-related reactions can be severe including shortness of breath, wheezing, difficult breathing, closing up of the throat, swelling of facial features, and/or hives. The patient will be watched closely while receiving this drug and for at least 4 hours following completion of each dinutuximab infusion for this type of allergic reaction (anaphylaxis).

The following side effects are common (occurring in greater than 30%) for patients taking dinutuximab:

These are less common side effects (occurring in 10-29%) for patients receiving dinutuximab:

A serious potential side effect of dinutuximab is infusion-related reaction. To reduce the incidence and severity of these reactions premedications are given before and throughout the infusion until it is complete. Infusion-related reactions with dinutuximab can also be influenced by the rate of the infusion. Therefore, the infusion rate can gradually be increased as tolerated or given at the slowest possible rate for the entire infusion. Monitoring for these reactions occurs when the infusion starts and until at least 4 hours after the last infusion is given for a given cycle.

Another serious potential side effect of dinutuximab is neuropathy (less than 1%), a very bad nerve problem or nerve pain. Dinutuximab targets glycolipid GD2 which is also located on normal human neurons and peripheral pain fibers. The binding to the GD2 antigen located on the surface of peripheral nerve fibers is likely the cause of dinutuximab-induced neuropathic pain. This can also lead to decreased sensation and paresthesia (numbness and tingling of the hands and feet). Sensory loss, numbness, and tingling, and difficulty in walking may last for at least as long as therapy is continued. These side effects may become progressively more severe with continued treatment, and your doctor may decide to decrease your dose if necessary. An opioid pain medication will be given prior to, during, and for at least 2 hours after infusion to control pain. Tell your doctor right away if you have severe pain or pain that gets worse. Tell your doctor right away if you have signs or nerve problems like burning, numbness, tingling, weakness, trouble passing urine, or inability to control bladder or bowels.

Not all side effects are listed above. Side effects that are very rare -- occurring in less than about 10 percent of patients -- are not listed here. But you should always inform your health care provider if you experience any unusual symptoms.

When to Contact Your Doctor or Health Care Provider

Contact your health care provider immediately, day or night, if you experience any of the following symptoms:

  • Fever of 100.4º F (38º C) or higher, chills (possible signs of infection)
  • Signs of a reaction (wheezing; chest tightness; fever; itching; bad cough; blue or grey skin color; seizures; swelling of the face, lips tongue or throat)
  • Persistent, worsening, and extreme pain unrelieved by prescribed medication
  • Signs and symptoms of nerve problems like burning, numbness, tingling, weakness, trouble passing urine, or inability to control bladder or bowels.
  • Vision changes (blurred vision, loss of vision, or other eye problems)
  • Trouble breathing
  • Chest pain or pressure or a fast heartbeat
  • Confusion

The following symptoms require medical attention but are not an emergency. Contact your health care provider within 24 hours of noticing any of the following:

  • Nausea (interferes with the ability to eat and unrelieved with prescribed medication)
  • Vomiting (vomiting more than 4-5 times in a 24-hour period)
  • Diarrhea (4-6 episodes in a 24-hour period)
  • Unusual bleeding or bruising
  • Black or tarry stools, or blood in your stools
  • Blood in your urine
  • Pain or burning with urination
  • Extreme fatigue (unable to carry out self-care activities)

Always inform your health care provider if you experience any unusual symptoms.


  • Before starting dinutuximab treatment, make sure you tell your doctor about any other medications you are taking (including prescription, over-the-counter, vitamins, herbal remedies, etc.). Do not take aspirin or products containing aspirin unless your doctor specifically permits this.
  • Because of the risk of low platelet counts associated with dinutuximab, avoid herbs such as: cat's claw, dong quoi, evening primrose, feverfew, garlic, ginger, ginkgo, red clover, horse chestnut, green tea, ginseng (all have antiplatelet activity). Discuss with your doctor when it might be safe to resume.
  • Do not receive any kind of immunization or vaccination without your doctor's approval while taking dinutuximab.
  • Inform your health care provider if you are pregnant or may be pregnant prior to starting this treatment. Pregnancy category X (dinutuximab may cause fetal harm when given to a pregnant women. This drug must not be given to a pregnant woman or a woman who intends to become pregnant. If a woman becomes pregnant while taking dinutuximab, the medication must be stopped immediately, and the woman given appropriate counseling).
  • For both men and women: use contraceptives, and do not conceive a child (get pregnant) while taking dinutuximab. Barrier methods of contraception, such as condoms, are recommended during treatment and for two months after the last dose of dinutuximab.
  • Do not breastfeed while taking dinutuximab.

Self-Care Tips

  • Dinutuximab may cause temporary low blood pressure. If you are taking medications to reduce your blood pressure, check with your doctor or nurse as to whether you should take it as usual or not before infusion.
  • You may experience shortness of breath, feel flushed or dizzy during the infusion. You will most likely receive medication before infusion, and you will be closely monitored during and after the infusion.
  • You may be at risk of infection so try to avoid crowds or people with colds, and report fever or any other signs of infection immediately to your health care provider.
  • Wash your hands often.
  • If applicable, use an electric razor and a soft toothbrush to minimize bleeding.
  • Avoid contact sports or activities that could cause injury.
  • To reduce nausea, take anti-nausea medications as prescribed by your doctor, and eat small, frequent meals as you can.
  • If needed, follow the regimen of anti-diarrhea medication as prescribed by your healthcare professional.
  • Eat foods that may help reduce diarrhea (see managing side effects - diarrhea).
  • Avoid sun exposure. Wear SPF 30 (or higher) sunblock and protective clothing.
  • In general, drinking alcoholic beverages should be kept to a minimum or avoided completely. You should discuss this with your doctor.
  • Get plenty of rest.
  • Maintain good nutrition.
  • Remain active as you are able. Gentle exercise, such as a daily walk, is encouraged.
  • If you experience symptoms or side effects, be sure to discuss them with your healthcare team. They can prescribe medications and/or offer other suggestions that are effective in managing such problems.

Monitoring and Testing While Taking Dinutuximab

You will be checked regularly by your doctor while you are taking dinutuximab to monitor side effects and check your response to therapy. Periodic blood work to monitor your complete blood count (CBC), as well as the function of other organs (such as your eyes, kidneys, and liver), will be ordered by your doctor.

How Dinutuximab Works

Targeted therapy is the result of about 100 years of research dedicated to understanding the differences between cancer cells and normal cells. To date, cancer treatment has focused primarily on killing rapidly dividing cells because one feature of cancer cells is that they divide rapidly. Unfortunately, some of our normal cells divide rapidly too, causing multiple side effects.

Targeted therapy works instead by using other identifying features of cancer cells. Scientists look for specific differences in cancer cells and the normal cells. This information is used to create a targeted therapy to attack the cancer cell without damaging the normal cells, thus leading to fewer side effects. Each type of targeted therapy works a little bit differently, but all interfere with the ability of the cancer cell to grow, divide, repair and/or communicate with other cells.

There are different types of targeted therapies, defined in two broad categories: monoclonal antibodies, or small-molecule drugs such as angiogenesis inhibitors. Some targeted therapies focus on the internal components and function of the cancer cell. These targeted therapies use small molecules that can get into the cell and disrupt the function of the cells, causing them to die. There are several types of targeted therapy that focus on the inner parts of the cells. Other targeted therapies target receptors that are on the outside of the cell. Therapies that target receptors are also known as monoclonal antibodies. Angiogenesis inhibitors target the blood vessels that supply oxygen to the cells, ultimately causing the cells to starve.

Researchers agree that targeted therapies are not a replacement for traditional therapies. They may best be used in combination with traditional therapies. More research is needed to identify which cancers may be best treated with targeted therapies and to identify additional targets for more types of cancer.

Dinutuximab is classified as a chimeric (human-mouse) monoclonal antibody. Antibodies are an integral part of the body's immune system. Normally, the body creates antibodies in response to an antigen (such as a protein in a germ) that has entered the body. The antibodies attach to the antigen in order to mark it for destruction by the immune system.

To make anti-cancer monoclonal antibodies in the laboratory, scientists analyze specific antigens on the surface of cancer cells (the targets). Then, using animal and human proteins, they create a specific antibody that will attach to the target antigen on the cancer cells. When given to the patient, these monoclonal antibodies will attach to matching antigens like a key fits a lock. Since monoclonal antibodies target only specific cells, they may cause less toxicity to healthy cells. Monoclonal antibody therapy is usually given only for cancers in which antigens (and the respective antibodies) have been identified already.

Dinutuximab binds to the glycolipid antigen disialoganglioside (GD2). This glycolipid is highly expressed on the surface of neuroblastoma cells and on minimally on normal cells of neuroectodermal (tissue leading to nervous system development) origin, including the central nervous system and peripheral nerves. Dinutuximab binds to cell surface GD2 and causes the death of the targeted cells.

Note: We strongly encourage you to talk with your health care professional about your specific medical condition and treatments. The information contained in this website is meant to be helpful and educational but is not a substitute for medical advice. is designed to provide the latest information about chemotherapy to patients and their families, caregivers and friends. For information about the 4th Angel Mentoring Program visit