A trial looking at a different way to give chemotherapy called PIPAC for cancer that has spread to the peritoneum (PICCOS)

Pressurised intraperitoneal aerosolised chemotherapy (PIPAC) is a way of giving chemotherapy directly to the peritoneum. The peritoneum is a sheet of tissue that covers the inside of the abdomen, pelvis and the organs inside them.

You have keyhole surgery to have PIPAC. You have a general anaesthetic . You will be in a deep sleep and have no feeling during the surgery. The surgeon puts 2 or 3 small cuts into the skin on your abdomen. 

Through one of the cuts, they put a thin, flexible tube with a camera on the end. They use this to see inside of the abdomen and the peritoneum. Through the tube the surgeon fills the abdomen with carbon dioxide gas. This is to make sure that the chemotherapy reaches all the surfaces of the peritoneum.

To give the chemotherapy, the surgeon puts another tube into another cut. The tube is a nebuliser. The chemotherapy is a liquid. The nebuliser turns the liquid into a fine spray (aerosol). The aerosol comes into contact with the cancer spread in the peritoneum. 

The surgeon then removes the chemotherapy and carbon dioxide gas from the abdomen, takes the tubes out and stitches the cuts to close them. The procedure takes about 30 minutes.

You may need to stay in hospital overnight after having PIPAC.

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On the day of having PIPAC
You must not drink or eat anything for a few hours before your surgery. Your doctor will tell you how many hours this is. Before surgery you see the surgeon and the anaesthetist . They will tell you about the surgery and what to expect. They will answer any questions you have before you agree to have the surgery. 

We have more information about having cancer surgery.

This is a phase 2 trial. This is a randomised trial. A computer puts you into a treatment group. Neither you nor your doctor chooses which treatment group you are in. 

People with bowel cancer
The team need 78 people to join this group. The treatment groups are:

• standard chemotherapy
• standard chemotherapy and pressurised intraperitoneal aerosolised chemotherapy (PIPAC)

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You have one or a combination of the following standard chemotherapy treatments:

• FOLFIRI and cetuximab
• FOLFOX and cetuximab
• capecitabine and oxaliplatin (CAPOX)
• panitumumab 

Your doctor will tell you which treatment you have. You have all the chemotherapy as a drip into a vein, apart from capecitabine. Capecitabine is a tablet you take at home. 

Depending on the chemotherapy, you have treatment every 2 or 3 weeks. Each 2 or 3 weeks is a cycle of treatment . If your cycle of treatment is 2 weeks, you have up to 9 cycles. If your cycle of treatment is 3 weeks, you have up to 6 cycles.  

Those having PIPAC will have 3 treatments. There is 6 weeks between each PIPAC procedure. The chemotherapy they use for PIPAC will be either oxaliplatin or mitomycin C. Your doctor will tell you more about this. You will have standard chemotherapy treatment between each PIPAC. 

People with ovarian cancer
The team need 66 people to join this group. The treatment groups are:

• standard chemotherapy
• pressurised intraperitoneal aerosolised chemotherapy (PIPAC)

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You have one of the following standard chemotherapy treatments:

• paclitaxel 
• liposomal doxorubicin 

You have these as a drip into a vein. 

You have chemotherapy treatment every 4 weeks. Each 4 weeks is a cycle of treatment . You have up to 6 cycles. 

Those who have PIPAC will have 3 treatments. You have it once every 6 weeks. The chemotherapy they use for PIPAC is a combination of cisplatin and doxorubicin. Your doctor will tell you more about this.

People with stomach cancer
The team need 72 people to join this group. The treatment groups are:

• standard chemotherapy
• standard chemotherapy and pressurised intraperitoneal aerosolised chemotherapy (PIPAC)

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You have one of the following standard chemotherapy treatments:

• FOLFOX
• CAPOX
• cisplatin and capecitabine (CX)
• CX and trastuzumab
• CAPOX and trastuzumab
• FOLFOX and trastuzumab
• CAPOX and nivolumab
• FOLFOX and nivolumab

Your doctor will tell you which treatment you are to have. You have all the chemotherapy as a drip into a vein, apart from capecitabine. Capecitabine is a tablet you take at home. 

Depending on the chemotherapy, you have treatment every 2 or 3 weeks. Each 2 or 3 weeks is a cycle of treatment. If your cycle of treatment is 2 weeks, you have up to 9 cycles. If your cycle of treatment is 3 weeks, you have up to 6 cycles.  

Those who have PIPAC have 3 treatments. There is 6 weeks between each PIPAC. The chemotherapy they use for PIPAC is a combination of doxorubicin and cisplatin. Your doctor will tell you more about this. You will still have standard chemotherapy between your PIPAC treatment.

Samples for research
The team ask everyone for a piece of the sample tissue (biopsy ) taken when you were first diagnosed. If you have surgery to remove the cancer, the team will ask for a piece of the tissue that is taken out. 

These may be used to learn more about these cancers. The samples may also be stored in a safe and secure place for future researchers to use.

You don’t have to agree to have these samples taken. You can still take part in the trial.

Quality of life
Everyone fills in questionnaires:

• before starting treatment
• at regular times during treatment
• at regular times after treatment

The questions ask about:

• your general health and wellbeing
• your daily activities
• any side effects or symptoms

These are quality of life questionnaires.