Totally implanted ports preferable in patients receiving SACT for solid tumours: Lancet

Hickman-type tunnelled catheters (Hickman), peripherally inserted central catheters (PICCs), and totally implanted ports (PORTs) are generally used to deliver systemic anticancer treatment (SACT) via a central vein.

A group of researchers from the United Kingdom conducted a study to compare complication rates and costs of the three devices to establish acceptability, clinical effectiveness, and cost-effectiveness of the devices for patients receiving SACT.

The researchers performed an open-label, multicentre, randomised controlled trial (Cancer and Venous Access [CAVA]) of three central venous access devices: PICCs versus Hickman (non-inferiority; 10% margin); PORTs versus Hickman (superiority; 15% margin); and PORTs versus PICCs (superiority; 15% margin).

Adults receiving SACT for more than or equal to 12 weeks for solid or haematological malignancy from 18 oncology units in the UK were included. Between Nov 8, 2013, and Feb 28, 2018, of 2714 individuals screened for eligibility, 1061 were enrolled and randomly assigned, contributing to the relevant comparison or comparisons. Four randomisation options were available:

1. Hickman versus PICCs versus PORTs (2:2:1)
2. PICCs versus Hickman (1:1)
3. PORTs versus Hickman (1:1)
4. PORTs versus PICCs (1:1)

Randomisation was done using a minimisation algorithm stratifying by centre, body-mass index, type of cancer, device history, and treatment mode.

The primary outcome was complication rate assessed until device removal, withdrawal from the study, or 1-year follow-up.

The results of the study are as follows:

• Similar complication rates were observed for PICCs (110 [52%] of 212) and Hickman (103 [49%] of 212).
• Although the observed difference was less than 10%, non-inferiority of PICCs was not confirmed potentially due to inadequate power.
• PORTs were superior to Hickman with a complication rate of 29% versus 43%
• PORTs were superior to PICCs with a complication rate of 32% versus 47%

The researchers concluded that for most patients receiving SACT, PORTs are more effective and safer than both Hickman and PICCs. Our findings suggest that most patients receiving SACT for solid tumours should receive a PORT within the UK National Health Service.

Reference:

Central venous access devices for the delivery of systemic anticancer therapy (CAVA): a randomised controlled trial by Moss J et. al published in the Lancet.

DOI: https://doi.org/10.1016/S0140-6736(21)00766-2