Neoadjuvant Moderately Hypofractionated Radiotherapy Combined With Chemotherapy and Immunotherapy for High-risk pMMR/MSS Locally Advanced Rectal Cancer: A Prospective, Multi-center Randomized Control Phase II Trial

Обзор

This study aims to observe and evaluate the efficacy and safety of moderately hypofractionated radiotherapy combined with chemotherapy and immunotherapy, compared with conventional neoadjuvant chemoradiotherapy, in patients with high-risk locally advanced colorectal cancer.

Вмешательства

• Лучевая терапия Moderately Hypofractionated Radiotherapy
  CapOx Regimen Recommended Dose：Capecitabine: 1000 mg/m² orally twice daily on days 1-14 of each 21-day cycle.Oxaliplatin: 130 mg/m² intravenously on day 1 of each 21-day cycle. Serplulimab: 300 mg intravenously on day 1 of each 21-day cycle. Moderately Hypofractionated Radiotherapy：Delivered using a simultaneous integrated boost (SIB) technique.Gross tumor volume (GTV): 3.5 Gy per fraction; clinical target volume (CTV): 3.0 Gy per fraction.Once daily, 5 fractions per week, for a total of 10 fra
• Препарат Serplulimab
  CapOx Regimen Recommended Dose：Capecitabine: 1000 mg/m² orally twice daily on days 1-14 of each 21-day cycle.Oxaliplatin: 130 mg/m² intravenously on day 1 of each 21-day cycle. Serplulimab: 300 mg intravenously on day 1 of each 21-day cycle. Long-course Concurrent Chemoradiotherapy：Delivered using a conventional fractionation schedule.Gross tumor volume (GTV): 1.8-2.0 Gy per fraction, total dose 50-50.4 Gy.Clinical target volume (CTV): 1.8 Gy per fraction, total dose 45 Gy.Once daily, 5 fractio
• Другое CapOx+Long-course radiotherapy
  CapOx Regimen Recommended Dose：Capecitabine: 1000 mg/m² orally twice daily on days 1-14 of each 21-day cycle.Oxaliplatin: 130 mg/m² intravenously on day 1 of each 21-day cycle. Long-course Concurrent Chemoradiotherapy：Delivered using a conventional fractionation schedule.Gross tumor volume (GTV): 1.8-2.0 Gy per fraction, total dose 50-50.4 Gy.Clinical target volume (CTV): 1.8 Gy per fraction, total dose 45 Gy.Once daily, 5 fractions per week.GTV receives 25-28 fractions; CTV receives 25 fractio

Первичные конечные точки

• Complete Remission (CR) Rate [Срок оценки: At the time of surgery for pCR, and at 1 year after achieving cCR for sustained cCR]

Вторичные конечные точки (5)

• 3-Year Disease-Free Survival (DFS) Rate [Срок оценки: Up to 3 years after randomization]
• 3-Year Overall Survival (OS) Rate [Срок оценки: up to 5 years]
• 3-Year Event-Free Survival (EFS) Rate [Срок оценки: up to 3 years from treatment]
• Objective Response Rate [Срок оценки: Up to 1 years]
• AE rate [Срок оценки: 24months]

Критерии участия

Критерии включения

• Age ≥ 18 years and ≤ 75 years.
• Histologically confirmed colorectal adenocarcinoma with the lower margin of the lesion ≤ 10 cm from the anal verge as assessed by MRI, and immunohistochemistry confirming pMMR, or genetic testing demonstrating MSI-L or MSS.
• Presence of at least one of the following high-risk factors as assessed by pelvic MRI: cT4a/b; N2; extramural vascular invasion (EMVI+); mesorectal fascia involvement (MRF+); enlarged lateral lymph node (longest diameter > 7 mm).
• Eastern Cooperative Oncology Group (ECOG) performance status score of 0-1
• No prior surgery, radiotherapy, chemotherapy, or targeted therapy.
• Able to tolerate radiotherapy, chemotherapy, and immunotherapy: ECOG performance status score 0-2. Laboratory results: white blood cell count ≥ 4.0 × 10⁹/L, platelet count ≥ 100 × 10⁹/L, hemoglobin ≥ 80 g/L, ALT < 2 × ULN, total bilirubin < 35 μmol/L, serum creatinine < 1.5 × ULN or creatinine clearance ≥ 50 mL/min, thyroid-stimulating hormone within normal range (patients with stable thyroid function after hormone replacement therapy may be enrolled).
• Willing to participate and able to provide written informed consent.

Критерии исключения

• Presence of distant metastasis.
• Patients with stage I or II rectal cancer who do not require preoperative neoadjuvant therapy.
• Severe diseases involving the heart, lung, brain, kidney, gastrointestinal tract, or other systemic conditions.
• Untreated chronic hepatitis B or HBV carriers with HBV DNA > 500 IU/mL, or patients positive for HCV RNA. Patients with inactive hepatitis B surface antigen (HBsAg) carriers, those with hepatitis B who have been treated and are stable (HBV DNA < 500 IU/mL), and those who have been cured of hepatitis C may be enrolled.
• Active autoimmune disease or history of autoimmune disease with potential for relapse.
• Receipt of corticosteroids (at a dose equivalent to prednisone > 10 mg/day) or other immunosuppressive therapy within 2 weeks prior to study drug administration.
• History of thyroid dysfunction.
• Severe chronic or active infection requiring systemic antifungal or antiviral therapy, including tuberculosis infection.
• History of allergic constitution or allergy to multiple drugs.
• History of prior pelvic radiotherapy.
• History of inflammatory bowel disease.
• Unwillingness to participate or inability to provide written informed consent.

Критерии приведены из реестра в оригинале (на английском). Окончательную оценку соответствия проводит исследовательский центр.

Здоровые добровольцы: Нет

Дизайн исследования

Распределение

Рандомизированное

Модель

Параллельные группы

Маскирование

Открытое

Основная цель

Лечение

Центры проведения

Китай · 1 центр

• Zhongshan hosptial, Fudan University — Шанхай

Идентификаторы

NCT: NCT07527520 · KY2026078

Первоисточники (государственные реестры)

• ClinicalTrials.gov (NIH, США)

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