A Phase 2 interventional study of Modified early post-operative intraperitoneal chemotherapy (mEPIC) in Peritoneal Carcinomatosis, Appendiceal Neoplasms and Colorectal Cancer Metastatic, sponsored by Ciusss de L'Est de l'Île de Montréal. Recruiting at 1 site in Canada. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2026-05-14.
Sponsored by Ciusss de L'Est de l'Île de Montréal · Phase 2, Interventional, and Other
The goal of this prospective phase II unicentric Canadian clinical trial is to clarify the feasibility of modified early post-operative intraperitoneal chemotherapy (mEPIC) following cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in the clinical context of peritoneal carcinomatosis from colorectal and appendicular neoplasms.
The primary objective of this study is to confirm the feasibility of mEPIC by evaluating its completion rate compared to the one of historical standard early post-operative intraperitoneal chemotherapy (EPIC) cohorts. The secondary objectives of the study are to evaluate the safety of the mEPIC protocol by monitoring adverse events arising during the protocol and to assess logistical implementation barriers for the nursing and Oncology pharmacy teams, respectively.
Participants will undergo a modified schedule of EPIC (mEPIC) designed to maximize therapeutic benefit by exploiting the known pharmacokinetics and pharmacodynamics properties of fluorouracil (5-FU) while limiting the logistical issues of the standard protocol. mEPIC consists in shortening the original protocol from five to two days of postoperative intraperitoneal chemotherapy. Additionally, instead of solely administering a singular 5-FU bolus per 24 hours-period, mEPIC is based on the De Gramont intravenous regimen and consists of administering one intraperitoneal bolus of 5-FU (400 mg/m2) followed by a 24 hours-intraperitoneal infusion of 5-FU (1200 mg/m2) on postoperative days 1 and 2.
Early postoperative intraperitoneal chemotherapy (EPIC) was first introduced by Sugarbaker in the 1990s in an effort to reduce disease recurrence and to prolong long-term survival of patients with peritoneal carcinomatosis from colorectal and appendicular malignancies including pseudomyxoma peritonei (PMP). Given the high risk of peritoneal recurrence, even after optimal cytoreduction, EPIC was a simple way of delivering high doses of cytotoxic agents targeted at the peritoneal surfaces without systemic compromise and eliminating any residual microscopic tumor deposits before the formation of fibrinous adhesions. The original protocol consists of administering 650 mg / m2 of intraperitoneal Fluorouracil (5-FU) in hypertonic, high molecular weight solution on postoperative days one to five. This solution is administered as an intraperitoneal bolus, remains for 23 hours with the surgical drains clamped before one hour of free drainage. Currently, there is no definitive randomised data comparing the benefit of EPIC versus no EPIC in any indication. One study that evaluated repeated cycles of intraperitoneal 5-FU in colon cancer demonstrated improved survival, but the study was discontinued early due to poor recruitment. Non-randomised data from the St George Hospital Peritoneal Surface Malignancy Program suggests a benefit for the addition of EPIC to hyperthermic intraperitoneal chemotherapy (HIPEC) with respect to survival outcomes in low-grade appendiceal cancers with no differences in morbidity but requires increased time in high dependency care unit. A recent study also demonstrates that in low-grade appendiceal neoplasms with pseudomyxoma peritonei, the addition of EPIC to HIPEC with cytoreductive surgery (CRS) improves overall survival in propensity score matched cases but results in prolonged hospitalisation. There is also conflicting data showing no advantage for the addition of EPIC to HIPEC in colorectal and high grade appendiceal cancer and an increased rate of grade III/IV complications.
From a therapeutic perspective, the use of intraperitoneal 5-FU benefits from the high peritoneal to plasma area under the curve, hence allowing the administration of higher intraperitoneal doses than intravenous doses with a resultant 250-fold increased tissue exposure. Even with significantly higher doses of 5-FU, systemic toxicities are much lower than systemic infusion due in part from the first pass metabolism through the liver. However, the standard EPIC protocol does not take into account the short perfusate half-life of 5-FU (0.75-1.5 hour). Consequently, by administering it as a large bolus, the majority of 5-FU is metabolized from the intraperitoneal compartment within 4-7.5 hours even though the solution remains intraperitoneally for 23 hours. In comparison to systemic therapy, infusions regimens of 5-FU based on protracted venous infusion or the so-called De Gramont regimen have essentially replaced bolus regimens such as the Mayo and Roswell Park regimens due to superior efficacy and better toxicity profiles. It consists in administering a bolus of 5-FU to achieve therapeutic concentrations followed by protracted venous infusion of 5-FU. This mode of administration also maximizes the inhibition of thymidylate synthase and other targets of 5-FU.
Additionally, there are clinical and administrative down-sides to the existing standard EPIC. These include: protracted occupancy of high dependency unit beds with a high nurse to patient ratio, which aggravates existing access issues. Furthermore, there are risks of abdominal tamponade, generalised discomfort during the procedure, prolonged ileus and increased risk of fistula and collection, hence prolonging length of stay. For these mentioned reasons, many patients do not complete every day of the planned treatment. For instance, out of the 435 patients who received EPIC in a high-volume center (St George Hospital) between 1996 and 2017, 269 (61.8%) completed the 5-day protocol, 33 (7.6%), 30 (6.9%), 45 (10.3%) and 58 (13.3%) completed 1, 2, 3 and 4 days of EPIC, respectively.
Rationale for Performing this Study:
Although, there is no randomised evidence to support EPIC, it has become one of the standard therapies for management of colorectal and appendicular neoplasms with peritoneal carcinomatosis in many high-volume surgical oncology centers. There is a need to devise a logistically more feasible regimen and also exploit the known pharmacokinetics and pharmacodynamics properties of 5-FU. Our phase II trial proposes a modified schedule of EPIC (mEPIC) designed to maximize therapeutic advantages and reduce logistical barriers. This modified EPIC (mEPIC) consists in shortening the original protocol from five to two days of postoperative intraperitoneal chemotherapy. Additionally, instead of solely administering a singular 5-FU bolus per 24 hours-period, mEPIC is based on the De Gramont intravenous regimen and consists of administering one intraperitoneal bolus of 5-FU (400 mg/m2) followed by a 24 hours-intraperitoneal infusion of 5-FU (1200 mg/m2) on postoperative days 1 and 2. The total proposed intraperitoneal dose of 1600 mg / m2 per day is comparable to and/or lower than described dosing ranges of 5-FU described in the literature. These doses are equivalent to systemic (intravenous) doses but the systemic exposure would be significantly less due to the known intraperitoneal to plasma area under the curve (AUC) ratios of up to 1000-fold. In this regard, the proposed dose is considered to be toxicologically safe.
The purpose of the study is to confirm the feasibility of mEPIC by evaluating its completion rate compared to the one of historical EPIC cohorts in patients with colorectal and appendicular neoplasms with peritoneal carcinomatosis treated with CRS and HIPEC. The hypothesis of this study is that mEPIC will be superior to the standard EPIC protocol in terms of completion rate. The safety of mEPIC (adverse events) and logistical nursing or pharmaceutical problems will also be recorded and assessed. Demonstrating feasibility of mEPIC will facilitate development of subsequent clinical trials evaluating its efficacy (recurrence free survival) and safety (30-day morbidity/mortality) compared to the standard EPIC protocol.
249 studies on the registry are indexed under Peritoneal Neoplasms; 55 are open to participants now.
This study's planned enrollment of 25 is below the median of 46 across 202 interventional studies indexed under Peritoneal Neoplasms.
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Go through the criteria one by one — yes, no or not sure — and take the list to your doctor or the study team. Kept in this browser only.
Exclusion Criteria:
Pre-cytoreductive surgery:
Post-cytoreductive surgery:
Underlined terms in the criteria open these too. Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
A scale of how much an illness limits everyday activity. For people being assessed to join a study, scores run from 0 (fully active) to 4; lower is more active.
Studies most often ask for 0–1 or 0–2. Your doctor gives the score; the WHO scale uses the same steps. The full scale also has 5, which records death.
A biopsy takes a small piece of tissue to examine. “Archival tissue” is a sample already taken, for example at diagnosis, and kept by the hospital.
Whether a stored sample will do depends on when it was taken, how much there is and what the study needs. Ask whether the study accepts your stored sample or needs a new biopsy.
Neoadjuvant treatment is given before the main treatment (usually surgery), often to shrink a tumour. Adjuvant treatment is given after it, to lower the chance of the cancer coming back.
Before you join, the study team explains what taking part involves — its purpose, what happens, the risks and possible benefits — and answers your questions, so you can decide freely. Consent is usually recorded on a form (the informed consent form, ICF) signed by you or, where the law allows, by someone legally authorised to decide for you.
You can keep asking questions during the study, you are told of new information that matters, and you can choose to leave at any time.
The number of neutrophils, white blood cells that help fight infection, in a given amount of blood. Too few raises the risk of infection.
It is a count, not a percentage of the white cells. Limits are written in units that mean the same: ≥ 1.5 × 10⁹/L is ≥ 1,500 per mm³ (µL). Each lab has its own reference range.
Blood cells that help blood clot. Too few raises the risk of bleeding and bruising. A usual adult range is about 150–400 × 10⁹/L (150,000–400,000 per µL); each lab has its own reference range.
The top of the normal range for a blood test, as set by the laboratory that runs it. Each lab prints its own range next to your result.
“≤ 2.5 × ULN” means the result can be up to two and a half times that top value.
How quickly the kidneys clear creatinine, a waste product, from the blood. A study may estimate it from a blood test with age, weight and sex (often by the Cockcroft–Gault formula), or measure it using blood and urine collected over a set time. Given in mL/min; higher is better.
A yellow substance made when red blood cells are broken down, which the liver clears. A high level can mean a problem with the liver or the bile ducts.
Criteria often allow more for people with Gilbert’s syndrome, a harmless inherited condition that raises bilirubin.
Malignancy means cancer. Criteria about another or earlier malignancy ask whether you have had a different cancer, usually within a set number of years.
Some are commonly allowed, such as treated skin cancers other than melanoma and early cancers removed completely — check the exceptions this study lists.
A reason a treatment, test or procedure should not be given to a particular person, such as an allergy, another illness or a medicine they take.
ECOG performance status
A scale of how much an illness limits everyday activity. For people being assessed to join a study, scores run from 0 (fully active) to 4; lower is more active.
Studies most often ask for 0–1 or 0–2. Your doctor gives the score; the WHO scale uses the same steps. The full scale also has 5, which records death.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Biopsy and archival tissue
A biopsy takes a small piece of tissue to examine. “Archival tissue” is a sample already taken, for example at diagnosis, and kept by the hospital.
Whether a stored sample will do depends on when it was taken, how much there is and what the study needs. Ask whether the study accepts your stored sample or needs a new biopsy.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Adjuvant and neoadjuvant
Neoadjuvant treatment is given before the main treatment (usually surgery), often to shrink a tumour. Adjuvant treatment is given after it, to lower the chance of the cancer coming back.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Informed consent
Before you join, the study team explains what taking part involves — its purpose, what happens, the risks and possible benefits — and answers your questions, so you can decide freely. Consent is usually recorded on a form (the informed consent form, ICF) signed by you or, where the law allows, by someone legally authorised to decide for you.
You can keep asking questions during the study, you are told of new information that matters, and you can choose to leave at any time.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Absolute neutrophil count (ANC)
The number of neutrophils, white blood cells that help fight infection, in a given amount of blood. Too few raises the risk of infection.
It is a count, not a percentage of the white cells. Limits are written in units that mean the same: ≥ 1.5 × 10⁹/L is ≥ 1,500 per mm³ (µL). Each lab has its own reference range.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Platelets
Blood cells that help blood clot. Too few raises the risk of bleeding and bruising. A usual adult range is about 150–400 × 10⁹/L (150,000–400,000 per µL); each lab has its own reference range.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
ULN (upper limit of normal)
The top of the normal range for a blood test, as set by the laboratory that runs it. Each lab prints its own range next to your result.
“≤ 2.5 × ULN” means the result can be up to two and a half times that top value.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Creatinine clearance (CrCl)
How quickly the kidneys clear creatinine, a waste product, from the blood. A study may estimate it from a blood test with age, weight and sex (often by the Cockcroft–Gault formula), or measure it using blood and urine collected over a set time. Given in mL/min; higher is better.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Bilirubin
A yellow substance made when red blood cells are broken down, which the liver clears. A high level can mean a problem with the liver or the bile ducts.
Criteria often allow more for people with Gilbert’s syndrome, a harmless inherited condition that raises bilirubin.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Cancer (malignancy)
Malignancy means cancer. Criteria about another or earlier malignancy ask whether you have had a different cancer, usually within a set number of years.
Some are commonly allowed, such as treated skin cancers other than melanoma and early cancers removed completely — check the exceptions this study lists.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Contraindication
A reason a treatment, test or procedure should not be given to a particular person, such as an allergy, another illness or a medicine they take.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Adults (male and female) with a diagnosis of appendicular or colorectal cancer with peritoneal carcinomatosis will undergo mEPIC on post-operative days 1 and 2 following cytoreductive surgery and hyperthermic intraperitoneal chemotherapy.
Drug: Modified early post-operative intraperitoneal chemotherapy (mEPIC)
On post-operative days 1 and 2, an abdominal reservoir is obtained by administering 1000 mL of plasmalyte with 50 mEq NaHCO3 via a Tenckhoff catheter. Participants will then receive an intraperitoneal fluorouracil bolus of 400 mg/m2 administered over 1 to 2 minutes followed by a continuous intraperitoneal fluorouracil infusion of 1200 mg/m2 over the next 24 hours. During the continuous intraperitoneal infusion of fluorouracil, 50 mg of folinic acid is administered intravenously. After completion of mEPIC day 1, the perfusate is drained out before starting mEPIC day 2.
Also known as: mEPIC
Feasibility of mEPIC
Evaluate mEPIC completion rate in patients with colorectal and appendicular cancer with peritoneal carcinomatosis treated with CRS and HIPEC and followed by mEPIC in a tertiary Canadian centre.
Time frame: 2 days (assessed at the end of mEPIC protocol).
Safety of mEPIC
Evaluate the safety of the mEPIC protocol by monitoring adverse events arising during the protocol.
Time frame: Up to 3 weeks (assessed during the hospitalization following the participant's surgery).
Satisfaction of care team
Assess satisfaction of care team including surgery and nursing teams regarding the implementation process of the mEPIC protocol. It is evaluated using a questionnaire form collecting comments from the care team about logistical barriers encountered during mEPIC protocol.
Time frame: 2 days (assessed during mEPIC protocol)
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Ciusss de L'Est de l'Île de Montréal