CAVA Trial paper - published in The Lancet
Central venous access devices for the delivery of systemic anticancer therapy (CAVA): a randomised controlled trial
Jonathan G Moss, Olivia Wu, Andrew R Bodenham, Roshan Agarwal, Tobias F Menne, Brian L Jones, Robert Heggie, Steve Hill, Judith Dixon-Hughes, Eileen Soulis, Evi Germeni, Susan Dillon, Elaine McCartney, on behalf of the CAVA trial group.
Background Hickman-type tunnelled catheters (Hickman), peripherally inserted central catheters (PICCs), and totally
implanted ports (PORTs) are used to deliver systemic anticancer treatment (SACT) via a central vein. We aimed
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.
We did 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 (aged ≥18 years) receiving
SACT (≥12 weeks) for solid or haematological malignancy from 18 oncology units in the UK were included.
Four randomisation options were available: Hickman versus PICCs versus PORTs (2:2:1), PICCs versus Hickman (1:1),
PORTs versus Hickman (1:1), and 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 (composite of infection, venous thrombosis, pulmonary embolus, inability to aspirate blood,
mechanical failure, and other) assessed until device removal, withdrawal from study, or 1-year follow-up. This study is
registered with ISRCTN, ISRCTN44504648.
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.
The CAVA Trial
The Cancer and Venous Access (CAVA) trial is the largest randomised trial to compare these devices (PICCs, Hickman, and PORTs) and the only one to include all three, to our knowledge. It is also the only trial to include robust QOL data and a full economic analysis. There was little difference between PICCs and Hickman in terms of complications. CAVA showed that PORTs reduced the adverse event rate by approximately 50% compared with Hickman and PICCs. A device specific QOL instrument showed no difference between PICCs and Hickman, but a preference for PORTs. PORTs were associated with the highest total costs; however, after allowing for the dwell time of the devices, there was no difference between PICCs and Hickman, but the cost associated with PORTs was lower when compared with PICCs and Hickman.
First published: 27 July 2021