The risk of pocket infection or bloodstream infection following central venous port placement for the patients with Cetuximab therapy

Abstract

Objective

Cetuximab is a molecular targeted drug that targets epithelial growth factor receptors. The skin toxicity of cetuximab arising from epithelial growth factor inhibition is well known. Some patients with cetuximab therapy decided to make central venous port during the long-term intravenous treatments. Therefore, the author hypothesized that cetuximab administration might increase the risk of central venous port-related infection due to damage to skin barrier function. The main aim of the present study was to investigate the relationship between cetuximab administration and central venous port-related infection.

Methods

A total of 83 patients had a central venous port placed from 2016 through 2021. We analyzed, retrospectively, the relationship between cetuximab therapy and the incidence of central venous port-related infection involving central line-associated bloodstream infection and pocket infection. Additionally, the risk factors of central venous port-related infection were examined in the population undergoing cetuximab therapy.

Results

In total populations (83 cases), central line-associated bloodstream infection happened in five patients (6%) and pocket infection happened in six patients (7%) after central venous port placement. In the cetuximab therapy group (45 cases), there were four patients with central line-associated bloodstream infection (9%) and six with pocket infection (13%). The pocket infection happened more frequently in the cetuximab group than the other group with significant differences. Additionally, in the cetuximab group, the patients who had an interval of less than seven days between central venous port placement and cetuximab dosing, or central venous port placement preceded by cetuximab dosing had more pocket infection with significant differences.

Conclusion

Skin complications after the central venous port placement were related to cetuximab administration and the timing of cetuximab therapy.

Keywords

Central venous port pocket infection after port placement cetuximab administration

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References

Lorch

Zwaan

Kagel

, et al. Central venous access ports placed by interventional radiologists: experience with 125 consecutive patients. Cardiovasc Intervent Radiol 2001; 24: 180–184.

Cil

Canyigit

Peynircioglu

, et al. Subcutaneous venous port implantation in adult patients: a single center experience. Diag Interv Radiol 2006; 12: 93–98.

Morris

Jaques

Mauro

. Radiology-assisted placement of implantable subcutaneous infusion port for long-term venous access. Radiol 1992; 184: 149–151.

Kock

Pietsch

Krause

, et al. Implantable venous access system: experience in 1500 patients with totally implanted central venous port systems. World J Surg 1998; 22: 12–16.

Damascelli

Patelli

Frigerio

, et al. Placement of long-term central venous catheters in outpatients: study of 134 patients over 24596 catheter days. AJR 1997; 168: 1235–1239.

Kluge

Stroh

Wagner

, et al. Fluoroscopically guided implantation of subcutaneous venous ports: complications and long-term results. RoFo 1998; 169: 63–67.

Alteaga

. Epidermal growth factor receptor dependence in human tumors: more than just expression? Oncologist 2002; 7: 31–39.

Pinto

Barone

Girolomoni

, et al. Management of skin toxicity associated with cetuximab treatment in combination with chemotherapy or radiotherapy. Oncologist 2011; 16: 228–238.

Angelica

Kornprat

Gonen

, et al. Lack of evidence for increased operative morbidity after hepatectomy with perioperative use of Bevacizumab: a matched case-control study. Ann Surg Oncol 2006; 14: 759–765.

10.

Zawachi

Walker

DeVasher

, et al. Wound dehiscence or failure to heal following venous access port placement in patients receiving Bevacizumab therapy. J Vasc Interv Radiol 2009; 20: 624–627.

11.

Kringel

Cottu

Fourchotte

, et al. Wound healing and catheter thrombosis after implantable venous access device placement in 266 breast cancers treated with bevacizumab therapy. Anticancer Drugs 2011; 22: 1020–1030.

12.

Eringeri

Fong

Kemeny

, et al. Timing of administration of bevacizumab chemotherapy affect wound healing after chest wall port placement. Cancer 2011; 117: 12961301.

13.

Buzby

Mullen

Matthews

, et al. Prognostic nutritional index in gastrointestinal surgery. Am J Surg 1980; 139: 160–167.

14.

Nurse

Bonczek

Barton

, et al. Low rate of bacteremia with a subcutaneous implanted central venous access device. J Vasc Access 2014; 15: 51–55.

15.

Klunger

Maki

. A meta-analysis of the risk of intravascular device-related blood stream infection based on 223 published prospective studies. Infect Control Hosp Epidemiol 2000; 21: 95–96.

16.

Biffi

Pozzi

Agazzi

, et al. Use of totally implantable central venous access ports for high-dose chemotherapy and peripheral blood stem cell transplantation: result of a monocentre series of 376 patients. Ann Oncol 2004; 15: 296–300.

17.

Gold

Lee

H-Y

Kim

. Targeted therapies in squamous cell carcinoma of the head and neck. Cancer 2009; 115: 922–935.

18.

Vermorken

Mesia

Rivera

, et al. Platinum-based chemotherapy plus cetuximab in head and neck cancer. N Engl J Med 2008; 359: 1116–1127.

19.

Frank

Hubner

Breier

, et al. Regulation of vascular endothelial growth factor expression in cultured keratinocytes. J Biol Chem 1995; 143: 720–727.

20.

Cheng

Neyemama

Jones

, et al. Wound healing complications with lenvatinib identified in a pharmacovigilance database. J Oncol Pharm Pract 2019; 25: 1817–1822.

21.

Brown

Curtsinger

White

, et al. Acceleration of tensile strength of incisions treated with EGF and TGF-β. Ann Surg 1988; 208: 788–794.

22.

Landen

Stahle

. Transition from inflammation to proliferation: a critical step during wound healing. Cell Mol Life Sci 2016; 73: 3861–3885.

23.

Lau

Paus

Tiede

, et al. Exploring the role of stem cells in cutaneous wound healing. Exp Dermatol 2009; 18: 921–933.

24.

Stoscheck

Nanney

King

Jr . Quantitative determination of EGF-R during epidermal wound healing. J Invest Dermatol 1992; 99: 645–649.

25.

Goltz

Scholl

Ritter

, et al. Peripherally placed totally implantable venous-access port system of the forearm: clinical experience in 763 consecutive patients. Cardiovasc Intervent Radiol 2010; 33: 1159–1167.

26.

Heinzerling

Huerta

. Bowell perforation from bevacizumab for the treatment of metastatic colon cancer: incidence, etiology, and management. Curr Surg 2006; 63: 334–337.

27.

Badgwell

Camp

Feig

, et al. Management of bevacizumab-associated bowel perforation. Ann Oncol 2008; 19: 577–582.

28.

Blick

SKA

Scott

. A review of its use in squamous cell carcinoma of the head and neck and metastatic colon cancer. Drug 2007; 67: 2585–2607.