INFUSION PUMPS MALFUNCTIONS

Br J Cancer. 2014 Feb 18. doi: 10.1038/bjc.2014.74. [Epub ahead of print]

Epidemiology and natural history of central venous access device use and infusion pump function in the NO16966 trial.

Chu E1, Haller D2, Cartwright T3, Twelves C4, Cassidy J5, Sun W1, Saif MW6, McKenna E7, Lee S7, Schmoll HJ8.

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Abstract

Background:Central venous access devices in fluoropyrimidine therapy are associated with complications; however, reliable data are lacking regarding their natural history, associated complications and infusion pump performance in patients with metastatic colorectal cancer.Methods:We assessed device placement, use during treatment, associated clinical outcomes and infusion pump perfomance in the NO16966 trial.Results:Device replacement was more common with FOLFOX-4 (5-fluorouracil (5-FU)+oxaliplatin) than XELOX (capecitabine+oxaliplatin) (14.1% vs 5.1%). Baseline device-associated events and post-baseline removal-/placement-related events occurred more frequently with FOLFOX-4 than XELOX (11.5% vs 2.4% and 8.5% vs 2.1%). Pump malfunctions, primarily infusion accelerations in 16% of patients, occurred within 1.6-4.3% of cycles. Fluoropyrimidine-associated grade 3/4 toxicity was increased in FOLFOX-4-treated patients experiencing a malfunction compared with those who did not (97 out of 155 vs 452 out of 825 patients), predominantly with increased grade 3/4 neutropenia (53.5% vs 39.8%). Febrile neutropenia rates were comparable between patient cohorts±malfunction. Efficacy outcomes were similar in patient cohorts±malfunction.Conclusions:Central venous access device removal or replacement was common and more frequent in patients receiving FOLFOX-4. Pump malfunctions were also common and were associated with increased rates of grade 3/4 haematological adverse events. Oral fluoropyrimidine-based regimens may be preferable to infusional 5-FU based on these findings.British Journal of Cancer advance online publication, 18 February 2014; doi:10.1038/bjc.2014.74 www.bjcancer.com.