Heated Versus Aerosol-based Laparoscopic Chemotherapy for Cancer That Has Spread to the Peritoneum (Abdominal Lining) (Charlie-2)

Randomized Phase II Trial of Heated Vs. Pressurized/Aerosolized Chemotherapy (HIPEC vs. PIPAC) for Peritoneal Carcinomatosis

This research study aims to improve the treatment of Peritoneal Carcinomatosis (PC), a condition where cancer spreads within the abdomen. Patients with PC often experience significant pain and nutritional problems. Currently, there isn't a standard treatment approach, and doctors use different combinations of chemotherapy, surgery, and methods to deliver chemotherapy directly into the abdomen (intra-peritoneal or "IP" chemotherapy).

The study will compare two IP chemotherapy methods: HIPEC and PIPAC. HIPEC involves circulating heated chemotherapy through the abdomen during surgery, while PIPAC delivers chemotherapy as a pressurized aerosol during a laparoscopic procedure. Both methods aim to achieve the same goal, but they haven't been directly compared to see which is safer, more tolerable, more effective, and provides better value.

Study Overview

• Status: Recruiting
• Conditions: Abdominal Cancer; Peritoneal Carcinomatosis; Abdominal Cancer Patients; Peritoneal (Metastatic) Cancer
• Intervention / Treatment: Procedure: Heated intra-peritoneal chemotherapy; Procedure: Aerosolized intra-peritoneal chemotherapy

Detailed Description

Mitomycin C is the chemotherapy that is being administered but it is not being evaluated in the study. Mitomycin C is an FDA-approved antineoplastic antibiotic, meaning it's a type of chemotherapy drug used to treat cancer. It works by interfering with DNA synthesis, which is essential for cell growth and division. By disrupting DNA, mitomycin C can prevent cancer cells from multiplying and spreading.

The study will enroll up to 200 patients who will be randomly assigned (like the flip of a coin) to receive either HIPEC or PIPAC. Participants will be active on the study for 120-180 days.

During the study, patients will undergo standard diagnostic laparoscopies (a minimally invasive surgical procedure) to assess their eligibility for surgery to remove as much cancer as possible. Before treatment begins, small tissue samples (biopsies) will be taken for analysis in the pathology department. A small portion of this tissue will be saved by the researchers to study the effects of treatment on tumors. Patients will then receive three rounds of chemotherapy administered by either HIPEC or PIPAC, each about six weeks apart, and each during a laparoscopic procedure. Tumor tissue biopsies will be collected at the time of each treatment for analysis in the pathology department, and a small portion of each biopsy will again be saved by the researchers for laboratory work to study the effects of the treatment on tumors.

Finally, patients will have another laparoscopy to assess the treatment's effect and check for any side effects. Although patients will be followed for up to 5 years, no study-specific follow-up visits are required. Participants undergoing this type of treatment also complete quality-of-life surveys at the start of the study, and after each IP chemotherapy treatment, that asks about general health, well-being and ability to do daily activities. Patient responses to these surveys are collected for research purposes.

HIPEC and PIPAC chemotherapy, are already standard ways to treat PC. This means there's no extra risk to study participants. However, as with any treatment, there are some potential risks, such as infection inside the abdomen or injury to organs during the procedure to deliver the chemotherapy. These risks are small and would be the same whether the participant were in the study or receiving these treatments as part of their normal care.

• Study Type: Interventional
• Enrollment (Estimated): 200
• Phase: Phase 2

Contacts and Locations

• Study Contact: Name: Patrick Wagner, MD; Phone Number: 412-359-3731; Email: patrick.wagner@ahn.org
• Study Contact Backup: Name: AHN Clinical Trial Contact Clinical Trial Contact; Phone Number: 412-359-3731; Email: clinicaltrials@ahn.org

Study Locations

• United States
  • Pennsylvania
    • Pittsburgh, Pennsylvania, United States, 15224
      • Recruiting
      • Allegheny Health Network West Penn Hospital
      • Contact: Patrick Wagner, MD; Phone Number: 412-359-3731; Email: patrick.wagner@ahn.org
      • Principal Investigator: Patrick Wagner, MD
      • Sub-Investigator: David Bartlett, MD
      • Sub-Investigator: Alexander Shannon, MD
      • Sub-Investigator: Casey Allen, MD
      • Contact: AHN Clinical Trial Contact Clinical Trial Contact; Phone Number: 412-359-3731; Email: clinicaltrials@ahn.org

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

1. Males or females age 18 to 80 years.
2. Biopsy-proven or clinically suspected peritoneal carcinomatosis
3. Receipt of at least three months of standard systemic chemotherapy prior with persistence of disease at the time of randomization
4. Not a candidate for surgical cytoreduction at the time of laparoscopy
5. Women at least 18 years of age of childbearing potential must have a negative urine/serum pregnancy test and must use an acceptable method of contraception, including abstinence, a barrier method (diaphragm or condom), Depo-Provera, or an oral contraceptive, for the duration of the study.
6. Must be able to read and understand English and consent for themselves

Exclusion Criteria:

1. Patients who are eligible for definitive cytoreductive surgery at the time of enrollment

2. Laboratory abnormalities that indicate clinically significant hematologic, hepatobiliary, or renal disease:

   AST/SGOT > 2.5 times the upper limit of normal ALT/SGPT > 2.5 times the upper limit of normal Total bilirubin > 2.5 times the upper limit of normal Hemoglobin < 7 gm/dL White blood cell count < 3,000/ mm3 Platelet count < 50,000/mm3

3. Any investigational drug use within 30 days prior to enrollment.
4. Systemic therapy within 14 days prior to randomization
5. Allergy or medical contra-indication to chemotherapy utilized in this study
6. Medical contraindication to laparoscopic surgery or complex cytoreductive surgery
7. Pregnant or lactating females.
8. Subjects who, in the opinion of the Investigator, may be non-compliant with study schedules or procedures.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Triple

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Heated Intra-Peritoneal Chemotherapy (HIPEC) Administration of Mitomycin C Chemotherapy; Laparoscopic intraperitoneal administration of mitomycin C chemotherapy through peritoneal catheters, heated intra-peritoneal chemotherapy (HIPEC) delivered during surgical procedures.	Procedure: Heated intra-peritoneal chemotherapy; Mitomyocin C 40 mg will be administered in divided doses (30mg at time zero and 10mg at 60 minutes) for a total of 90 minutes at 41-43 degrees Celsius. Laparoscopic HIPEC will then be repeated laparoscopically up to two more times at 45 +/- 15 day intervals until three doses have been completed.; Other Names: HIPEC
Active Comparator: Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC) Administration of Mitomycin C Chemotherapy; Conventional administration of pressurized/aerosolized laparoscopic delivery of mitomycin C chemotherapy (PIPAC)	Procedure: Aerosolized intra-peritoneal chemotherapy; PIPAC will be performed with mitomycin C, 12.5mg/m2, delivered laparoscopically for 30 minutes at ambient temperature. Laparoscopic PIPAC or be repeated laparoscopically up to two more times at 45 +/- 15 day intervals until three doses have been completed.; Other Names: PIPAC

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Heated intra-peritoneal chemotherapy (HIPEC) Adverse Events	Frequency of drug-related adverse events following HIPEC as assessed by CTCAE v5	150 days from Day #1 visit
Heated intra-peritoneal chemotherapy (HIPEC) Surgical Complications	Frequency of surgical complications following HIPEC	150 days from Day #1 visit
Heated intra-peritoneal chemotherapy (HIPEC) Adverse Events	Severity of drug-related adverse events following HIPEC as assessed by CTCAE v5	150 days from Day #1 visit
Heated intra-peritoneal chemotherapy (HIPEC) Surgical Complications	Severity of surgical complications following HIPEC as assessed by using Clavien-Dindo scale	150 days from Day #1 visit
Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC) Adverse Events	Frequency of drug-related adverse events following PIPAC as assessed by CTCAE v5	150 days from Day #1 visit
Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC) Adverse Events	Severity of drug-related adverse events following PIPAC as assessed by CTCAE v5	150 days from Day #1 visit
Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC) Surgical Complications	Frequency of surgical complications following PIPAC	150 days from Day #1 visit
Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC) Surgical Complications	Severity of surgical complications as assessed following PIPAC by using Clavien-Dindo scale	150 days from Day #1 visit
Heated intra-peritoneal chemotherapy (HIPEC) Tolerability	The relative tolerability of HIPEC as determined by length of hospital stay	150 days from Day #1 visit
Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC) Tolerability	The relative tolerability of PIPAC as determined by length of hospital stay	150 days from Day #1 visit
Heated intra-peritoneal chemotherapy (HIPEC) Tolerability	The relative tolerability of HIPEC as determined by usage of pain medication in opioid equivalents prior to discharge	150 days from Day #1 visit
Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC) Tolerability	The relative tolerability of PIPAC as determined by usage of pain medication in opioid equivalents prior to discharge	150 days from Day #1 visit
Heated intra-peritoneal chemotherapy (HIPEC) Tolerability	The relative tolerability of HIPEC as determined by patient-reported outcomes using the Short Form-20 instrument	150 days from Day #1 visit
Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC) Tolerability	The relative tolerability of PIPAC as determined by patient-reported outcomes using the Short Form-20 instrument	150 days from Day #1 visit

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Heated Intra-Peritoneal Chemotherapy (HIPEC) Efficacy	Serological indicators of tumor response following HIPEC using serum levels of CEA, CA19-9 or CA-125 as applicable in individual patients	150 days from Day #1 visit
Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC) Efficacy	Serological indicators of tumor response following PIPAC using serum levels of CEA, CA19-9 or CA-125 as applicable in individual patients	150 days from Day #1 visit
Heated Intra-Peritoneal Chemotherapy (HIPEC) Efficacy	Radiographic indicators of tumor response following HIPECusing RECIST criteria, when available.	150 days from Day #1 visit
Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC) Efficacy	Radiographic indicators of tumor response following PIPAC using RECIST criteria, when available	150 days from Day #1 visit
Heated Intra-Peritoneal Chemotherapy (HIPEC) Efficacy	Proportion of patients achieving complete cytoreduction following HIPEC using the Completeness of Cytoreduction score	5.5 years from Day #1 visit
Pressurized Intraperitoneal Aerosol (PIPAC) Efficacy	Proportion of patients achieving complete cytoreduction following PIPAC using the Completeness of Cytoreduction score	5.5 years from Day #1 visit
Heated Intra-Peritoneal Chemotherapy (HIPEC) Efficacy	Total cost of care following PIPAC using hospital financial records to determine the total direct cost in US dollars	5.5 years from Day #1 visit
Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC) Efficacy	Total cost of care following PIPAC using hospital financial records to determine the total direct cost in US dollars	5.5 years from Day #1 visit
Heated Intra-Peritoneal Chemotherapy (HIPEC) Efficacy	Biomarkers analysis of treatment response using tissue biopsy	150 days from Day #1 visit
Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC) Efficacy	Biomarkers analysis of treatment response using tissue biopsy	150 days from Day #1 visit

Collaborators and Investigators

• Sponsor: Patrick Wagner, MD, FACS
• Investigators: Principal Investigator: Patrick Wagner, MD, Allegheny Health Network

Study record dates

Study Major Dates

• Study Start (Actual): January 5, 2026
• Primary Completion (Estimated): December 1, 2035
• Study Completion (Estimated): November 1, 2040

Study Registration Dates

• First Submitted: October 30, 2025
• First Submitted That Met QC Criteria: December 5, 2025
• First Posted (Actual): December 15, 2025

Study Record Updates

• Last Update Posted (Actual): February 27, 2026
• Last Update Submitted That Met QC Criteria: February 25, 2026
• Last Verified: February 1, 2026

More Information

Terms related to this study

• Keywords: HIPEC; intra-abdominal; mitomycin-C; intraperitoneal; cytoreduction; Pressurized Intraperitoneal Aerosol Chemotherapy; PIPAC; peritoneal cavity; Heated Intra-Peritoneal Chemotherapy
• Additional Relevant MeSH Terms: Pathologic Processes; Neoplasms by Site; Digestive System Neoplasms; Digestive System Diseases; Neoplastic Processes; Peritoneal Diseases; Abdominal Neoplasms; Pathological Conditions, Signs and Symptoms; Neoplasms; Neoplasm Metastasis; Peritoneal Neoplasms; Therapeutics; Drug Therapy; Hyperthermia, Induced; Combined Modality Therapy; Chemotherapy, Adjuvant; Hyperthermic Intraperitoneal Chemotherapy
• Other Study ID Numbers: 2025-177

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: Yes
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No