title: A retrospective analysis of trabectedin infusion by peripherally inserted central venous catheters: a multicentric Italian experience.
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).
authors.affiliation: aOncology Department, Azienda Sanitaria Firenze, Istituto Toscano Tumori, Florence bGynecologic Oncology Unit, Policlinico Gemelli, Cattolica University cDepartment of Gynecological and Obstetrical Sciences and Urological Sciences, Policlinico Umberto I, La Sapienza University, Rome dDivision of Oncology, Department of Urology and Gynecology, Istituto Nazionale Tumori "Fondazione G. Pascale" IRCCS, Naples eOncology Department, Azienda Ospedaliero Universitaria, Modena fDepartment of Obstetrics and Gynecology II, Azienda Ospedaliera Policlinico Universitario, Bari, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Martella
authors.forename: Vanda
authors.initials: V
authors.lastname: Salutari
authors.forename: Claudia
authors.initials: C
authors.lastname: Marchetti
authors.forename: Carmela
authors.initials: C
authors.lastname: Pisano
authors.forename: Marilena
authors.initials: M
authors.lastname: Di Napoli
authors.forename: Francesca
authors.initials: F
authors.lastname: Pietta
authors.forename: Dina
authors.initials: D
authors.lastname: Centineo
authors.forename: Anna M
authors.initials: AM
authors.lastname: Caringella
authors.forename: Angela
authors.initials: A
authors.lastname: Musella
authors.forename: Luisa
authors.initials: L
authors.lastname: Fioretto
mesh_terms: D000328:Adult; D000368:Aged; D018906:Antineoplastic Agents, Alkylating / Q000008:administration & dosage*; D002406:Catheterization, Peripheral / Q000191:economics; D062905:Central Venous Catheters / Q000191:economics; D003362:Cost-Benefit Analysis; D004149:Dioxoles / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D007558:Italy; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D044005:Tetrahydroisoquinolines / Q000008:administration & dosage*; D000077606:Trabectedin
chemical_list: D018906:Antineoplastic Agents, Alkylating; D004149:Dioxoles; D044005:Tetrahydroisoquinolines; D000077606:Trabectedin