A retrospective analysis of trabectedin infusion by peripherally inserted central venous catheters

Abstract

The European Medicines Agency strongly recommends administration of trabectedin through a central venous catheter (CVC) to minimize the risk of extravasation. However, CVCs place patients at risk of catheter-related complications and have a significant budgetary impact for oncology departments. The most frequently used CVCs are subcutaneously implanted PORT-chamber catheters (PORTs); peripherally inserted central venous catheters (PICCs) are relatively new. We reviewed data of trabectedin-treated patients to evaluate the relative cost-effectiveness of the use of PORTs and PICCs in six Italian centres. Data on 102 trabectedin-treated patients (20 with sarcoma, 80 with ovarian cancer and two with cervical cancer) were evaluated. Forty-five patients received trabectedin by a PICC, inserted by trained nurses using an ultrasound-guided technique at the bedside, whereas 57 patients received trabectedin infusion by a PORT, requiring a day surgery procedure in the hospital by a surgeon. Device dislocation and infections were reported in four patients, equally distributed between PORT or PICC users. Thrombosis occurred in a single patient with a PORT. Complications requiring devices removal were not reported during any of the 509 cycles of therapy (median 5; range 1-20). PICC misplacement or early malfunctions were not reported during trabectedin infusion. The cost-efficiency ratio favours PORT over PICC only when the device is used for more than 1 year. Our data suggest that trabectedin infusion by PICC is safe and well accepted, with a preferable cost-efficiency ratio compared with PORT in patients requiring short-term use of the device (≤1 year).

Comparison of three types of central venous catheters in patients with malignant tumor receiving chemotherapy

“…Compared with port, the same experience was reported 25. In Martella et al’s25 report, the authors supported the utilization of PICCs when the patient was to be treated with trabectedin, and they found that PICCs showed an improved cost-efficiency ratio compared with ports when the device was used for less than a year as it was generally when patients received trabectedin. Compared with NTC, PICC had longer indwelling time and fewer complications that lead to catheter removal.…”

Extravasation emergencies: state-of-the-art management and progress in clinical research

“…Trabectedin should be administered through a central venous catheter to minimise the risk of extravasation [13]. Approved as monotherapy for advanced soft tissue sarcomas after anthracycline failure in 2007, local pain, blistering and necrosis has been sporadically described in case reports after extravasation [14].…”

Safety and efficacy of trabectedin when administered in the inpatient versus outpatient setting: Clinical considerations for outpatient administration of trabectedin

“…Damage may include blistering, severe pain, and/or tissue necrosis and can require surgical intervention in severe cases (eg, debridement, skin reconstruction). Device dislodgement and/or infections at the site of central venous access may be the cause of some of the complications that have been documented among patients treated with trabectedin . To the best of our knowledge, there are few published data to date regarding trabectedin‐associated extravasation, all of which have involved retrospective case studies or very small case series.…”

“…Device dislodgement and/or infections at the site of central venous access may be the cause of some of the complications that have been documented among patients treated with trabectedin. 9,10 To the best of our knowledge, there are few published data to date regarding trabectedin-associated extravasation, all of which have involved retrospective case studies or very small case series. Evidencebased guidance for managing extravasation in patients who receive cytotoxic treatments also is unclear.…”