Naxitamab with novel scheduling and stepped-up dosing of GM-CSF plus vaccine, but no myeloablative therapy for patients with high-risk neuroblastoma in first complete remission.

Naxitamab + GM-CSF was effective against chemo-resistant high-risk neuroblastoma (HR-NB), leading to approval by the Food and Drug Administration. We now describe toxicity and outcome of patients treated in first complete remission (CR) with naxitamab plus novel dosing of GM-CSF (nGM-CSF), initiated in February 2021, based on pharmacologic data. Treatment also included an anti-NB vaccine but no prior myeloablative therapy (MAT). This retrospective study covers all first CR HR-NB patients who started the novel naxitamab + nGM-CSF regimen from February 22, 2021 to December 11, 2023. As before, naxitamab (3 mg/kg) was infused on days 1-3-5 (i.e., 3 doses/cycle). Previously, priming doses of GM-CSF 250 μg/m2/day were subcutaneously administered ×5 (days -4 to 0), followed by step-up to 500 μg/m2/day ×5 (days 1 to 5), but now priming doses were ×3 (days -2 to 0) and stepped-up dosing was ×7 (days 1 to 7), that is, through 2 days after the last dose of naxitamab. After completing antibody treatment (5 monthly cycles), patients could receive vaccine. Event-free survival (EFS) and overall survival (OS) were calculated from start of naxitamab + nGM-CSF. Forty-three patients received 157 cycles. Acute toxicities were generally manageable, allowing outpatient treatment. Stepped-up dosing and extended administration of GM-CSF had no associated toxicity, hematological or otherwise. Human anti-human antibody developed in 5/43 (12%) patients. Thirty-four (79%) patients received the vaccine; 9 did not due to relapse (n = 4) and parental choice (n = 5). EFS/OS rates at 24 months were 88%/95% and at 36 months were 80%/95%. Naxitamab + nGM-CSF is a good option to consolidate first CR of HR-NB patients, including those who did not undergo MAT.