EPA for Metastasis Trial 2

NCT ID: NCT03428477

Last Updated: 2025-04-18

Basic Information

• Recruitment Status: ACTIVE_NOT_RECRUITING
• Clinical Phase: PHASE3
• Total Enrollment: 418 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2018-05-02
• Study Completion Date: 2026-04-30

Brief Summary

A significant proportion of patients who undergo liver surgery to remove bowel cancer that has spread to the liver (metastases) develop disease recurrence and die from the disease. A previous small study (the EMT study) suggested a possible survival benefit in patients who took the naturally-occurring omega-3 fatty acid EPA (a fish oil supplement) before liver surgery. The EMT2 study is a larger study which will recruit 448 men and women with liver metastases from bowel cancer. Trial participants will receive either Icosapent Ethyl (pure EPA derived from fish oil) or placebo (dummy capsules). EMT2 will investigate whether patients who take this supplement before liver surgery and for up to four years after surgery, remain free of recurrence for longer than those who take placebo (dummy capsules)

Detailed Description

Despite significant advances in diagnosis and treatment of colorectal cancer (CRC), it remains the second most common cause of cancer-related death in the UK. The majority of deaths from CRC are related to distant metastasis, predominantly to the liver. Overall 5-year survival following liver resection and adjuvant chemotherapy for colorectal cancer liver metastases (CRCLM) is, at best, 40-60%. Despite surgery with curative intent, up to 60% of patients develop recurrence within 2 years of surgery. The preliminary EMT study was a Phase II RCT of EPA 2 g daily in patients (n=88) undergoing liver resection surgery for CRCLM. Although there was no difference in the primary endpoint (tumour proliferation index), metastases from the EPA arm had a lower vascularity score (suggesting possible anti-angiogenic activity) than placebo-treated tumours. Although EPA (or placebo) treatment was limited to the pre-operative period, overall survival (OS) and disease-free survival (DFS) were specified as exploratory end-points on the basis that oral dosing with EPA before liver surgery would provide tissue EPA exposure in the immediate peri-operative period with prolonged bioavailability in the post-operative period due to the slow tissue 'washout' kinetics of EPA. Survival analysis demonstrated that the median DFS in the EPA group was 22.6 months compared with 14.7 months in the placebo group. Any DFS benefit was explained by a reduction in CRC recurrence from 12 months after surgery onwards.

The EMT2 study is a randomised, double-blind, placebo-controlled, multi-centre, phase III trial of the omega-3 fatty acid (O3FA) eicosapentaenoic acid (EPA) as the ethyl ester (icosapent ethyl [IPE; Vascepa®]) in patients undergoing liver resection surgery for colorectal cancer liver metastasis (CRCLM) with curative intent designed to determine whether EPA treatment improves Progression-Free Survival (PFS). A key secondary objective is overall survival (OS).

Investigators will recruit adult individuals listed for CRCLM resection with curative intent.

Randomisation will be 1:1 to receive either IPE capsules or placebo capsules. 4 capsules per day containing IPE (equivalent to 4 g EPA-ethyl ester [EE] daily) or 4 placebo capsules per day. Participants will start treatment a prior to CRCLM surgery and will continue to receive treatment for a minimum of 2 years and a maximum of 4 years post-liver resection. Participants are followed up for 60 days beyond the end of treatment.

Participants are clinically assessed 6 months post-operatively (from liver resection) and at 6-monthly intervals thereafter for disease progression/recurrence.

Conditions

Liver Metastasis; Colon Cancer

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: PREVENTION
• Blinding Strategy: QUADRUPLE

Study Groups

Icosapent Ethyl (EPA-EE)

Soft gelatin capsules containing 1g pure EPA-EE equivalent to 914mg EPA-FFA. Administered as 4g per day to be taken as 2 capsules in the morning and 2 capsules in the evening.

Group Type: EXPERIMENTAL

Icosapent Ethyl

Intervention Type: DRUG

Composition: soft amber to light yellow, oblong gelatin capsules. One capsule contains 1g pure EPA-EE Dose: 4 capsules per day

Placebo

Soft gelatin capsules containing light mineral oil. 4 capsules to be taken per day (2 in the morning and 2 in the evening).

Group Type: PLACEBO_COMPARATOR

Placebo

Intervention Type: OTHER

Composition: soft, amber to light yellow, oblong gelatin capsules containing light mineral oil:

Dose: 4 capsules per day

Interventions

Icosapent Ethyl

Composition: soft amber to light yellow, oblong gelatin capsules. One capsule contains 1g pure EPA-EE Dose: 4 capsules per day

Intervention Type: DRUG

Placebo

Composition: soft, amber to light yellow, oblong gelatin capsules containing light mineral oil:

Dose: 4 capsules per day

Intervention Type: OTHER

Other Intervention Names

Vascepa

Eligibility Criteria

Inclusion Criteria

• Aged ≥ 18 years
• Able to provide written informed consent
• Histological diagnosis of colorectal cancer with evidence of liver metastases
• Planned liver resection surgery for colorectal cancer liver metastases with curative intent, including repeat 're-do' colorectal cancer liver metastases surgery (a second independent resection for a separate colorectal cancer liver recurrence)
• Intention to receive IMP prior to colorectal cancer liver metastases surgery

Exclusion Criteria

• Previous CRCLM surgery for the management of the current metastatic disease
• Incurable extra-hepatic metastases
• Current (in the last 2 months) or planned regular (>3 doses per week) use of O3FA-containing drugs or supplements, including Vazkepa®, Omacor®, fish oil and cod-liver oil supplements
• Fish/seafood allergy
• Diagnosis of hereditary fructose intolerance
• Soya or peanut allergy
• Inability to comply with trial treatment and follow-up schedule
• Known bleeding tendency/condition (e.g. von Willebrand disease)
• A previous malignancy within the last 5 years other than:

• colorectal cancer
• non-melanoma skin cancer where treatment consisted of resection only or radiotherapy
• ductal carcinoma in situ (DCIS) where treatment consisted of resection only
• cervical carcinoma in situ where treatment consisted of resection only
• superficial bladder carcinoma where treatment consisted of resection only
• A previous malignancy where the patient has been disease free for ≤ 5 years
• Pregnant or breastfeeding women or women of childbearing potential not willing to use effective contraceptive measures. Women of childbearing potential are defined as fertile, following menarche and until becoming post-menopausal, unless permanently sterile
• Men defined as fertile (post-pubescent and not permanently sterile by vasectomy or bilateral orchidectomy) and not willing to use effective contraceptive measures if appropriate.

• Minimum Eligible Age: 18 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Yorkshire Cancer Research

OTHER

Sponsor Role: collaborator

Amarin Pharma Inc.

INDUSTRY

Sponsor Role: collaborator

Mark A Hull, PhD FRCP

OTHER

Sponsor Role: lead

Responsible Party

Mark A Hull, PhD FRCP

Prof Mark Hull

Responsibility Role: SPONSOR_INVESTIGATOR

Principal Investigators

Mark Hull

Role: PRINCIPAL_INVESTIGATOR

University of Leeds

Locations

Oxford University Hospital NHS Foundation Trust

Oxford, Oxfordshire, United Kingdom

Hampshire Hospitals NHS Foundation Trust

Basingstoke, Royal Hampshire, United Kingdom

Aintree University Hospitals NHS Foundation Trust

Aintree, , United Kingdom

University Hospitals Birmingham NHS Foundation Trust

Birmingham, , United Kingdom

Cambridge UniversityHospitals NHS Foundation Trust

Cambridge, , United Kingdom

University Hospital of Wales

Cardiff, , United Kingdom

Leeds Teaching Hospitals NHS Foundation Trust

Leeds, , United Kingdom

King's College London

London, , United Kingdom

Royal Free London NHS Foundation Trust

London, , United Kingdom

Newcastle Upon Tyne Hospitals NHS Foundation Trust

Newcastle, , United Kingdom

Nottingham University Hospitals NHS Trust

Nottingham, , United Kingdom

Sheffield Teaching Hospitals NHS Foundation Trust

Sheffield, , United Kingdom

University Hospital Southampton NHS Foundation Trust

Southampton, , United Kingdom

Countries

United Kingdom

References

Hull MA, Ow PL, Ruddock S, Brend T, Smith AF, Marshall H, Song M, Chan AT, Garrett WS, Yilmaz O, Drew DA, Collinson F, Cockbain AJ, Jones R, Loadman PM, Hall PS, Moriarty C, Cairns DA, Toogood GJ. Randomised, placebo-controlled, phase 3 trial of the effect of the omega-3 polyunsaturated fatty acid eicosapentaenoic acid (EPA) on colorectal cancer recurrence and survival after surgery for resectable liver metastases: EPA for Metastasis Trial 2 (EMT2) study protocol. BMJ Open. 2023 Nov 29;13(11):e077427. doi: 10.1136/bmjopen-2023-077427.

Reference Type: DERIVED

PMID: 38030258 (View on PubMed)

Provided Documents

Document Type: Study Protocol

View Document

Other Identifiers

MO16/053

Identifier Type: -

Identifier Source: org_study_id