title: Increased rates of local complication of central venous catheters in the targeted anticancer therapy era: a 2-year retrospective analysis.
abstract: OBJECTIVE
  Totally implantable central venous accesses (port-a-cath) are often used for chemotherapy administration or prolonged intravenous infusions in cancer patients. Local and systemic complications may occur both during and after placement of port-a-cath despite the well-established techniques for its placement and care. Out of other catheter-related local complications, thrombosis and infections represent the most common. Complications related to central venous catheter may be associated with infusion of both conventional chemotherapy and molecularly targeted therapy. Incidence and nature of complications of central venous catheter have been well established for long-term chemotherapy. However, very sparse data exists on the incidence of complications of molecularly targeted therapies administered through a central venous catheter. Hence, we decided to retrospectively analyze the local complications of a central venous catheter in patients receiving molecularly targeted therapy and conventional chemotherapy, respectively.
  
  
  METHODS
  Over a 2-year period, 459 devices were placed in two academic Italian institutions. Patients' characteristics, catheter-related complications, and their relationship with targeted therapy administration were retrospectively assessed.
  
  
  RESULTS
  Catheter-related complications occurred in 30 out of the 459 analyzed cancer patients (7 %). Local complications occurred in 12 (40 %) and 18 (60 %) patients receiving standard chemotherapy and biological drugs, respectively. Eighteen (72 %) out of 25 patients developing biological complications (BC) were receiving biological drugs. Infusion of a biological drug through a central venous catheter has been shown to increase the risk of central venous catheter complications (p = 0.02). No difference between the incidence of complication between anti-angiogenic and anti-epidermal growth factor receptor (EGFR) agents was observed in our study despite the statistically significant early development of port-a-cath complication in the anti-EGFR group. Treatment with a biological drug and the stage of disease, in univariate analysis, had independent effect on the duration for development of catheter-related complications.
  
  
  CONCLUSIONS
  Molecularly targeted therapy may influence the occurrence of BCs, i.e., infection and dehiscence. Onset of BCs occurred earlier in patients receiving biological drugs (more frequently with bevacizumab than with anti-EGFR therapy) than those undergoing traditional chemotherapy. Further studies are needed to ascertain the findings of our study and to elucidate the reason for the higher incidence of catheter-related complications.
authors.affiliation: Medical Oncology Unit, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I - GM Lancisi - G Salesi, Via Conca 71, 60126, Ancona, Italy, r.berardi@univpm.it.
authors.forename: R
authors.initials: R
authors.lastname: Berardi
authors.forename: S
authors.initials: S
authors.lastname: Rinaldi
authors.forename: D
authors.initials: D
authors.lastname: Santini
authors.forename: B
authors.initials: B
authors.lastname: Vincenzi
authors.forename: R
authors.initials: R
authors.lastname: Giampieri
authors.forename: E
authors.initials: E
authors.lastname: Maccaroni
authors.forename: F
authors.initials: F
authors.lastname: Marcucci
authors.forename: M
authors.initials: M
authors.lastname: Francoletti
authors.forename: A
authors.initials: A
authors.lastname: Onofri
authors.forename: A
authors.initials: A
authors.lastname: Lucarelli
authors.forename: C
authors.initials: C
authors.lastname: Pierantoni
authors.forename: G
authors.initials: G
authors.lastname: Tonini
authors.forename: S
authors.initials: S
authors.lastname: Cascinu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use; D000068258:Bevacizumab; D055499:Catheter-Related Infections / Q000453:epidemiology*; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002408:Catheters, Indwelling / Q000009:adverse effects*; D062905:Central Venous Catheters / Q000009:adverse effects*; D066246:ErbB Receptors / Q000037:antagonists & inhibitors; D005260:Female; D006801:Humans; D015994:Incidence; D007262:Infusions, Intravenous / Q000009:adverse effects; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D058990:Molecular Targeted Therapy / Q000379:methods; D009369:Neoplasms / Q000188:drug therapy*; D012189:Retrospective Studies; D013927:Thrombosis / Q000209:etiology
chemical_list: D020533:Angiogenesis Inhibitors; D061067:Antibodies, Monoclonal, Humanized; D000068258:Bevacizumab; C512478:EGFR protein, human; D066246:ErbB Receptors