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ICARuS Post-operative Intraperitoneal Chemotherapy (EPIC) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) After Optimal Cytoreductive Surgery (CRS) for Neoplasms of the Appendix, Colon or Rectum With Isolated Peritoneal Metastasis (ICARuS)

Primary Purpose

Appendix Cancer, Colorectal Cancer

Status
Recruiting
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
Cytoreductive Surgery
HIPEC with Mitomycin-C
EPIC with FUDR and Leucovorin
Sponsored by
Memorial Sloan Kettering Cancer Center
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Appendix Cancer focused on measuring ICARuS, Intraperitoneal Chemotherapy, hyperthermic intraperitoneal chemotherapy, Optimal Surgical Debulking, Leucovorin, Floxuridine (FUDR), Mitomycin, 12-289

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Patient's age 18 years or older, both genders.
  • Clinical diagnosis of appendiceal or colorectal neoplasm with peritoneal mucinosis or metastasis.
  • Patient must be planning to undergo complete cytoreduction of all peritoneal disease.
  • ECOG performance status ≤ 1.
  • Hematology: ANC ≥ 1,500/ μL; Platelets > 75,000/ μL.
  • Adequate Renal function Creatinine <1.5 x the upper limit of normal (ULN) or calculated creatinine clearance of ≥ 50ml/min.
  • Adequate Hepatic function: Bilirubin less than 1.5mg/dL; (except in patients with Gilbert's Syndrome, who must have a total bilirubin less than 3.0mg/dL).
  • Women with childbearing potential who are negative for pregnancy test (urine or blood) and who agree to use effective contraceptive method. Reliable contraception should be used from trial screening and must be continued throughout the study. A woman of childbearing potential is defined as one who is biologically capable of becoming pregnant.
  • A man participating in this study must agree to utilize reliable barrier form of contraception for the duration of the study.
  • Signed and dated written informed consent to participate in this clinical trial must be obtained prior to any study procedure.
  • Subjects with a history of endometrial cancer are eligible only if they presented with a stage lower than 1A and if the histology was a subtype other than poorly differentiated.

Exclusion Criteria:

  • Subjects who have previously undergone intraperitoneal chemotherapy.
  • Subjects with classical carcinoid
  • Tumors of low malignant potential
  • Other prior malignancies, except for cured non-melanoma skin cancer, curatively treated in situ carcinoma of the cervix, adequately treated malignancies for which there has been no evidence of activity for more than 3 years or indolent tumors for which observation over three years is a reasonable option.
  • Presence of clinically apparent or suspected metastasis to sites other than lymph nodes or peritoneal surfaces.
  • Women who are pregnant or lactating.
  • Subjects with a condition which may interfere with the subjects' ability to understand the requirements of the study.
  • Active coronary artery disease (defined as unstable angina or a positive cardiac stress test).
  • Subjects with a history of coronary artery disease may be included if they have had a normal stress test within 60 days of enrollment and/or were cleared by MSK cardiology.
  • Uncontrolled hypertension defined as >140/90 and not cleared for surgery at the time of consent.
  • New York Heart Association (NYHA) Class II or higher Congestive heart failure.
  • Restrictive or obstructive pulmonary disease that would limit study compliance or place the patient at unacceptable risk for participation in the study.
  • History of cerebrovascular disease. that would limit study compliance or place the patient at unacceptable risk for participation in the study.
  • Subjects with other concurrent severe medical problems unrelated to the malignancy that would significantly limit full compliance with the study or places them at an unacceptable risk for participation in the study.
  • Patients with known floxuridine, leucovorin ,or mitomycin allergy.
  • Evidence of extensive intraperitoneal adhesions at the time of surgery which prohibits intraperitoneal therapy, as determined by the operating surgeon.
  • Any condition that would preclude the ability to deliver appropriate IP therapy.
  • Use of an oral medication, lacking a suitable non-oral substitute, that if held for up to ten days, would be felt an unacceptable risk by the investigator.
  • Life expectancy < 12 weeks.

Sites / Locations

  • University of Miami
  • Washington University School of MedicineRecruiting
  • Memorial Sloan Kettering Basking Ridge (Consent and Follow up)Recruiting
  • Memorial Sloan Kettering Monmouth (Consent and Follow up)Recruiting
  • Memorial Sloan Kettering Bergen (Consent and Follow up)Recruiting
  • Memorial Sloan Kettering Commack (Consent and Follow up)Recruiting
  • Memorial Sloan Kettering Westchester (Consent and Follow up)Recruiting
  • Memorial Sloan Kettering Cancer CenterRecruiting
  • Memorial Sloan Kettering Nassau (Consent and Follow up)Recruiting

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm 4

Arm Type

Experimental

Experimental

Experimental

Experimental

Arm Label

Appendiceal, no chemotherapy within 6 months prior to surgery

Appendiceal, chemotherapy within 6 months prior to surgery

Colorectal, no chemotherapy within 6 months prior to surgery

Colorectal, chemotherapy within 6 months prior to surgery

Arm Description

First, patients will be stratified by previous systemic chemotherapy and by the organ of origin as determined by the PI or Co-PI. Exposure to chemotherapy in the prior 6 months vs. no such exposure Appendix vs. Colon or Rectum Then, patients will be randomly assigned in the operating room, by envelope, to either HIPEC (Group A) or EPIC (Group B) after the operating surgeon determines that the patient is optimally cytoreduced to nodules no greater than 2.5mm.

First, patients will be stratified by previous systemic chemotherapy and by the organ of origin as determined by the PI or Co-PI. Exposure to chemotherapy in the prior 6 months vs. no such exposure Appendix vs. Colon or Rectum • Then, patients will be randomly assigned in the operating room, by envelope, to either HIPEC (Group A) or EPIC (Group B) after the operating surgeon determines that the patient is optimally cytoreduced to nodules no greater than 2.5mm.

First, patients will be stratified by previous systemic chemotherapy and by the organ of origin as determined by the PI or Co-PI. Exposure to chemotherapy in the prior 6 months vs. no such exposure Appendix vs. Colon or Rectum • Then, patients will be randomly assigned in the operating room, by envelope, to either HIPEC (Group A) or EPIC (Group B) after the operating surgeon determines that the patient is optimally cytoreduced to nodules no greater than 2.5mm.

First, patients will be stratified by previous systemic chemotherapy and by the organ of origin as determined by the PI or Co-PI. Exposure to chemotherapy in the prior 6 months vs. no such exposure Appendix vs. Colon or Rectum • Then, patients will be randomly assigned in the operating room, by envelope, to either HIPEC (Group A) or EPIC (Group B) after the operating surgeon determines that the patient is optimally cytoreduced to nodules no greater than 2.5mm.

Outcomes

Primary Outcome Measures

disease-free survival
Documentation of tumor recurrence will be made based on surveillance CT/PET CT scans at time points as determined by attending radiologist, with clinical correlation from the treating physician.

Secondary Outcome Measures

surgical toxicity grade 3 to 5
We will evaluate toxicity up to 30 days postoperatively for any surgical Grade 3-5 complications/toxicites or chemotherapy related Grade 4 or 5 toxicities. Surgical morbidity will be graded using the Common Terminology Criteria for Adverse Events (CTCAE) Version 4.0
chemotherapy toxicity grade 3 to 5
We will evaluate toxicity up to 30 days postoperatively for any surgical Grade 3-5 complications/toxicities or chemotherapy related Grade 4 or 5 toxicities.

Full Information

First Posted
March 13, 2013
Last Updated
January 12, 2023
Sponsor
Memorial Sloan Kettering Cancer Center
Collaborators
The Cleveland Clinic, Brigham and Women's Hospital, University of Miami, University of Pittsburgh Medical Center, Washington University School of Medicine
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1. Study Identification

Unique Protocol Identification Number
NCT01815359
Brief Title
ICARuS Post-operative Intraperitoneal Chemotherapy (EPIC) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) After Optimal Cytoreductive Surgery (CRS) for Neoplasms of the Appendix, Colon or Rectum With Isolated Peritoneal Metastasis
Acronym
ICARuS
Official Title
ICARuS (Intraperitoneal Chemotherapy After cytoReductive Surgery): A Multi-center, Randomized Phase II Trial of Early Post-operative Intraperitoneal Chemotherapy (EPIC) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) After Optimal Cytoreductive Surgery (CRS) for Neoplasms of the Appendix, Colon or Rectum With Isolated Peritoneal Metastasis
Study Type
Interventional

2. Study Status

Record Verification Date
January 2023
Overall Recruitment Status
Recruiting
Study Start Date
March 2013 (undefined)
Primary Completion Date
September 2023 (Anticipated)
Study Completion Date
September 2023 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Memorial Sloan Kettering Cancer Center
Collaborators
The Cleveland Clinic, Brigham and Women's Hospital, University of Miami, University of Pittsburgh Medical Center, Washington University School of Medicine

4. Oversight

5. Study Description

Brief Summary
This is the first randomized trial comparing Early post-operative intraperitoneal chemotherapy (EPIC) and hyperthermic intraperitoneal chemotherapy (HIPEC) for appendiceal and colorectal cancer. The purpose of this study is to find out what effects, good and/or bad, EPIC and HIPEC after cytoreductive surgery have on the patient and the appendiceal, rectal or colon cancer.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Appendix Cancer, Colorectal Cancer
Keywords
ICARuS, Intraperitoneal Chemotherapy, hyperthermic intraperitoneal chemotherapy, Optimal Surgical Debulking, Leucovorin, Floxuridine (FUDR), Mitomycin, 12-289

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Single Group Assignment
Model Description
After the initial 212 patients are accrued, the final 70 patients will be accrued to only the appendiceal cohorts
Masking
None (Open Label)
Allocation
Randomized
Enrollment
292 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Appendiceal, no chemotherapy within 6 months prior to surgery
Arm Type
Experimental
Arm Description
First, patients will be stratified by previous systemic chemotherapy and by the organ of origin as determined by the PI or Co-PI. Exposure to chemotherapy in the prior 6 months vs. no such exposure Appendix vs. Colon or Rectum Then, patients will be randomly assigned in the operating room, by envelope, to either HIPEC (Group A) or EPIC (Group B) after the operating surgeon determines that the patient is optimally cytoreduced to nodules no greater than 2.5mm.
Arm Title
Appendiceal, chemotherapy within 6 months prior to surgery
Arm Type
Experimental
Arm Description
First, patients will be stratified by previous systemic chemotherapy and by the organ of origin as determined by the PI or Co-PI. Exposure to chemotherapy in the prior 6 months vs. no such exposure Appendix vs. Colon or Rectum • Then, patients will be randomly assigned in the operating room, by envelope, to either HIPEC (Group A) or EPIC (Group B) after the operating surgeon determines that the patient is optimally cytoreduced to nodules no greater than 2.5mm.
Arm Title
Colorectal, no chemotherapy within 6 months prior to surgery
Arm Type
Experimental
Arm Description
First, patients will be stratified by previous systemic chemotherapy and by the organ of origin as determined by the PI or Co-PI. Exposure to chemotherapy in the prior 6 months vs. no such exposure Appendix vs. Colon or Rectum • Then, patients will be randomly assigned in the operating room, by envelope, to either HIPEC (Group A) or EPIC (Group B) after the operating surgeon determines that the patient is optimally cytoreduced to nodules no greater than 2.5mm.
Arm Title
Colorectal, chemotherapy within 6 months prior to surgery
Arm Type
Experimental
Arm Description
First, patients will be stratified by previous systemic chemotherapy and by the organ of origin as determined by the PI or Co-PI. Exposure to chemotherapy in the prior 6 months vs. no such exposure Appendix vs. Colon or Rectum • Then, patients will be randomly assigned in the operating room, by envelope, to either HIPEC (Group A) or EPIC (Group B) after the operating surgeon determines that the patient is optimally cytoreduced to nodules no greater than 2.5mm.
Intervention Type
Procedure
Intervention Name(s)
Cytoreductive Surgery
Intervention Description
Optimal Surgical Debulking
Intervention Type
Drug
Intervention Name(s)
HIPEC with Mitomycin-C
Intervention Type
Drug
Intervention Name(s)
EPIC with FUDR and Leucovorin
Primary Outcome Measure Information:
Title
disease-free survival
Description
Documentation of tumor recurrence will be made based on surveillance CT/PET CT scans at time points as determined by attending radiologist, with clinical correlation from the treating physician.
Time Frame
3 years
Secondary Outcome Measure Information:
Title
surgical toxicity grade 3 to 5
Description
We will evaluate toxicity up to 30 days postoperatively for any surgical Grade 3-5 complications/toxicites or chemotherapy related Grade 4 or 5 toxicities. Surgical morbidity will be graded using the Common Terminology Criteria for Adverse Events (CTCAE) Version 4.0
Time Frame
up to 60 days
Title
chemotherapy toxicity grade 3 to 5
Description
We will evaluate toxicity up to 30 days postoperatively for any surgical Grade 3-5 complications/toxicities or chemotherapy related Grade 4 or 5 toxicities.
Time Frame
up to 60 days

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Patient's age 18 years or older, both genders. Clinical diagnosis of appendiceal or colorectal neoplasm with peritoneal mucinosis or metastasis. Patient must be planning to undergo complete cytoreduction of all peritoneal disease. ECOG performance status ≤ 1. Hematology: ANC ≥ 1,500/ μL; Platelets > 75,000/ μL. Adequate Renal function Creatinine <1.5 x the upper limit of normal (ULN) or calculated creatinine clearance of ≥ 50ml/min. Adequate Hepatic function: Bilirubin less than 1.5mg/dL; (except in patients with Gilbert's Syndrome, who must have a total bilirubin less than 3.0mg/dL). Women with childbearing potential who are negative for pregnancy test (urine or blood) and who agree to use effective contraceptive method. Reliable contraception should be used from trial screening and must be continued throughout the study. A woman of childbearing potential is defined as one who is biologically capable of becoming pregnant. A man participating in this study must agree to utilize reliable barrier form of contraception for the duration of the study. Signed and dated written informed consent to participate in this clinical trial must be obtained prior to any study procedure. Subjects with a history of endometrial cancer are eligible only if they presented with a stage lower than 1A and if the histology was a subtype other than poorly differentiated. Exclusion Criteria: Subjects who have previously undergone intraperitoneal chemotherapy. Subjects with classical carcinoid Tumors of low malignant potential Other prior malignancies, except for cured non-melanoma skin cancer, curatively treated in situ carcinoma of the cervix, adequately treated malignancies for which there has been no evidence of activity for more than 3 years or indolent tumors for which observation over three years is a reasonable option. Presence of clinically apparent or suspected metastasis to sites other than lymph nodes or peritoneal surfaces. Women who are pregnant or lactating. Subjects with a condition which may interfere with the subjects' ability to understand the requirements of the study. Active coronary artery disease (defined as unstable angina or a positive cardiac stress test). Subjects with a history of coronary artery disease may be included if they have had a normal stress test within 60 days of enrollment and/or were cleared by MSK cardiology. Uncontrolled hypertension defined as >140/90 and not cleared for surgery at the time of consent. New York Heart Association (NYHA) Class II or higher Congestive heart failure. Restrictive or obstructive pulmonary disease that would limit study compliance or place the patient at unacceptable risk for participation in the study. History of cerebrovascular disease. that would limit study compliance or place the patient at unacceptable risk for participation in the study. Subjects with other concurrent severe medical problems unrelated to the malignancy that would significantly limit full compliance with the study or places them at an unacceptable risk for participation in the study. Patients with known floxuridine, leucovorin ,or mitomycin allergy. Evidence of extensive intraperitoneal adhesions at the time of surgery which prohibits intraperitoneal therapy, as determined by the operating surgeon. Any condition that would preclude the ability to deliver appropriate IP therapy. Use of an oral medication, lacking a suitable non-oral substitute, that if held for up to ten days, would be felt an unacceptable risk by the investigator. Life expectancy < 12 weeks.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Garrett Nash, MD, MPH
Phone
212-639-8668
First Name & Middle Initial & Last Name or Official Title & Degree
Andrea Cercek, MD
Phone
646-888-4189
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Garrett Nash, MD, MPH
Organizational Affiliation
Memorial Sloan Kettering Cancer Center
Official's Role
Principal Investigator
Facility Information:
Facility Name
University of Miami
City
Miami
State/Province
Florida
Country
United States
Individual Site Status
Active, not recruiting
Facility Name
Washington University School of Medicine
City
Saint Louis
State/Province
Missouri
ZIP/Postal Code
63110
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Sean Glasglow, MD
Phone
314-747-7222
First Name & Middle Initial & Last Name & Degree
Benjamin Tan, MD
Facility Name
Memorial Sloan Kettering Basking Ridge (Consent and Follow up)
City
Basking Ridge
State/Province
New Jersey
ZIP/Postal Code
07920
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Garrett Nash, MD, MPH
Phone
212-639-8668
Facility Name
Memorial Sloan Kettering Monmouth (Consent and Follow up)
City
Middletown
State/Province
New Jersey
ZIP/Postal Code
07748
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Garrett Nash, MD, MPH
Phone
212-639-8668
Facility Name
Memorial Sloan Kettering Bergen (Consent and Follow up)
City
Montvale
State/Province
New Jersey
ZIP/Postal Code
07645
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Garrett Nash, MD,MPH
Phone
212-639-8668
Facility Name
Memorial Sloan Kettering Commack (Consent and Follow up)
City
Commack
State/Province
New York
ZIP/Postal Code
11725
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Garrett Nash, MD, MPH
Phone
212-639-8668
Facility Name
Memorial Sloan Kettering Westchester (Consent and Follow up)
City
Harrison
State/Province
New York
ZIP/Postal Code
10604
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Garrett Nash, MD, MPH
Phone
212-639-8668
Facility Name
Memorial Sloan Kettering Cancer Center
City
New York
State/Province
New York
ZIP/Postal Code
10065
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Garrett Nash, MD, MPH
Phone
212-639-8668
First Name & Middle Initial & Last Name & Degree
Andrea Cercek, MD
Phone
646-888-4189
First Name & Middle Initial & Last Name & Degree
Garrett Nash, MD, MPH
Facility Name
Memorial Sloan Kettering Nassau (Consent and Follow up)
City
Uniondale
State/Province
New York
ZIP/Postal Code
11553
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Garrett Nash, MD, MPH
Phone
212-639-8668

12. IPD Sharing Statement

Links:
URL
http://www.mskcc.org/
Description
Memorial Sloan Kettering Cancer Center

Learn more about this trial

ICARuS Post-operative Intraperitoneal Chemotherapy (EPIC) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) After Optimal Cytoreductive Surgery (CRS) for Neoplasms of the Appendix, Colon or Rectum With Isolated Peritoneal Metastasis

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