Indwelling central venous access port insertion during bevacizumab-based therapy

Abstract

Indwelling central venous catheters and implantable port systems are widely used in the care of patients with cancer. Bevacizumab, a humanized monoclonal antibody against vascular endothelial growth factor, significantly prolongs survival when added to intravenous 5-fluorouracil-based chemotherapy as first-line treatment for metastatic colorectal cancer. It has also been shown to be of value in a range of other malignant diseases. Some elements of the toxicity profile of bevacizumab, however, such as bleeding and impaired wound healing, could interfere with surgical procedures involved in the treatment of the diseases. The aim of this study was to evaluate the possible effect of bevacizumab in increasing the morbidity associated with an indwelling central venous access port in patients currently receiving the drug, or those who had received it in the preoperative run-up to surgery. An analysis of the medical records of 57 patients with a variety of cancers, who had received an indwelling central venous access port, either during the course of treatment with bevacizumab or in the 4-week period before the commencement of therapy was carried out, with particular emphasis on periprocedural complications. Eight of the patients also had diabetes mellitus. There were no instances of delay in wound healing, abnormal bleeding, or wound infection in any of the patients and no episodes of skin ulceration during bevacizumab treatment. Although this is a relatively small study, and no definitive conclusions can be drawn at this stage, our data suggest that an indwelling central venous access port insertion may be carried out shortly before or during bevacizumab treatment without increasing periprocedural morbidity.

Safety of Early Bevacizumab Administration after Central Venous Port Placement for Patients with Colorectal Cancer

“…Erinjeri et al showed that the frequency of wound dehiscence was significantly higher in patients who used BEV within 14 days of implantation [ 12 ]. Meanwhile, Grenader, et al evaluated 20 patients in whom a CV port was implanted during BEV therapy and found no adverse events despite the early administration of BEV [ 13 ]. Consistent with this report, there were no BEV-related complications regardless of the timing of BEV treatment initiation; additionally, we found that the frequency of total complications was not affected by BEV treatment initiation early after CV port implantation.…”

“…Within 10–14 days after CV port implantation, the frequency of wound dehiscence may increase, as reported previously [ 11 , 12 ]. Meanwhile, a study that evaluated 20 patients in whom a CV port was implanted during BEV therapy has shown that there are no adverse events despite the early administration of BEV [ 13 ]. Japanese guidelines for CV port placement have not reached a consensus on when is the appropriate BEV administration time after CV port implantation [ 14 ].…”

The effect of chemotherapy type and timing among the other factors on patency of totally implantable vascular access devices in colorectal carcinoma

“…16 It was reported that the absolute risk of wound dehiscence was 2.1% versus 0.5% when the TIVAD was placed during the previous week. 5 It was found that the use of bevacizumab has affected the wound opening in Zawacki et al's 15 On the other hand, Grenader et al 17 found that a TIVAD may safely be inserted a short time before or during bevacizumab treatment. Grenader et al 17 reported that bevacizumab therapy had no effect on the wound healing process whereas Erinjeri et al 18 reported that the risk of wound dehiscence was inversely proportional to the interval between bevacizumab administration and TIVAD placement, with significantly higher risk seen when the interval is less than 14 days.…”

ESCMID Study Group for Infections in Compromised Hosts (ESGICH) Consensus Document on the safety of targeted and biological therapies: an infectious diseases perspective (Cell surface receptors and associated signaling pathways)

“…In addition, the use of granulocyte-colony stimulating factor (G-CSF) was not consistent across study arms in most of these studies. Despite its deleterious impact on wound healing, no increased periprocedural morbidity (including infections at the insertion site) has been observed after placing long-term central venous catheters in bevacizumab-treated patients [41], although a more recent study has provided conflicting results [42].…”