Locally Advanced Rectal Cancer (LARC), MSS (Microsatellite Stable)
Conditions
Keywords
Total Neoadjuvant Therapy, Immunotherapy, Survival Rate, Organ preservation, Locally advanced rectal cancer
Brief summary
In this prospective, multicentre, randomized phase III trial, 612 locally advanced rectal cancer (LARC, T3-4/N+M0) patients with at least one high-risk features (lower location (≤5cm), cT4, cN2, MRF+, EMVI+, TD+) will be included, and randomly assigned to TNT group and iTNT group (1:1). TNT group receives long-course chemoradiotherapy (50Gy/25Fx concurrent with oral capecitabine) followed by 6 cycles of CAPOX. iTNT group receives short-course radiotherapy (25Gy/5Fx) followed by 6 cycles of Serplulimab combined with CAPOX. After the efficacy evaluation, the patients who achieves clinical complete response (cCR) will be managed by a watch and wait (W&W) protocol and non-cCR patients will be recommended surgery. The primary endpoint is 3-year event-free survival rate (3yEFS%). The secondary endpoints include the complete response (CR, pathological complete response \[pCR\] plus cCR) rate, 3-year organ preservation rate, 3-year disease-free survival rate (3yDFS%), 3-year local recurrence free survival rate (3yLRFS%), 3-year distant metastasis free survival rate (3yDMFS%), 3-year overall survival rate (3yOS%), grade 3-4 acute adverse effects (AE) rate, rate of surgical complications, anal functions and quality of life, etc.
Interventions
RADIATIONshort-course radiaotherapy
short-course radiaotherapy (25Gy/5Fx)
RADIATIONlong-course chemoradiaothearpy
long-course chemoradiotherapy (50Gy/25Fx concurrent with oral capecitabine 825mg/m2 bid d1-5 qw)
DRUGCapecitabine
Capecitabine: 1000mg/m2 bid d1-14 q3w
DRUGOxaliplatin
Oxaliplatin 130mg/m2 d1 q3w
DRUGPD-1 inhibitor
Serplulimab 300mg d1 q3w
Sponsors
Fudan University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 75 Years
Healthy volunteers
No
Inclusion criteria
1. Age 18-75 years old, female and male; 2. Pathological confirmed adenocarcinoma; 3. The distance from anal verge ≤ 10 cm; 4. MSI/MMR status: MSS/pMMR; 5. Clinical stage T3-4 and/or N+, without distance metastases; 6. At least one of the following factors is present: distance from the anus ≤5 cm, cT4, cN2, positive cMRF, positive cEMVI, positive tumor deposit or positive lateral lymph node; 7. KPS ≥ 70; 8. No radiotherapy, chemotherapy, immunotherapy, or any other anti-tumor therapy had been administered prior to enrollment; 9. Baseline blood and biochemical indicators meet the following criteria: neutrophils ≥ 1.5 × 10\^9/L, Hb ≥ 90 g/L, PLT ≥ 100 × 10\^9/L, ALT/ AST ≤ 2.5 ULN, Cr ≤ 1 ULN; 10. With good compliance and signed the consent form.
Exclusion criteria
1. Pregnancy or breast-feeding women; 2. Known history of other malignancies within 5 years; 3. Known history of severe neurological or mental illness (such as schizophrenia, dementia or epilepsy); 4. Current severe cardiac disease (cardiac dysfunction and arrhythmia), renal dysfunction and liver dysfunction; 5. Acute cardiac infarction or cerebral ischemic stroke occurred within 6 months before recruitment; 6. Uncontrolled infection which needs systemic therapy; 7. Active autoimmune disease or immunodeficiencies, known history of organ transplantation or systematic use of immunosuppressive agents; 8. Known history of human immunodeficiency virus (HIV) infection (i.e., HIV 1 to 2 antibody positive), active syphilis infection, active pulmonary tuberculosis infection; 9. Allergic to any component of the therapy.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| 3 year event-free survival rate | From date of randomization until the date of first documented early local failure, disease progression during neoadjuvant therapy, pelvic recurrence, distant metastasis, or death, whichever came first, assessed up to 36 months. | Rate of 3 year event free survival |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Complete response (CR) rate | 1 month after the surgery or the decision of W&W | Rate of complete response (CR), including the rate of pathologic complete response (pCR) after surgery and the rate of cCR with W\&W strategy. |
| 3 year organ preservation rate | From date of randomization until the resection of rectum or anus, assessed up to 36 months. | 3 year organ preservation rate |
| 3 year disease free survival rate | From date of randomization until the date of first documented recurrence and metastasis after the completion of treatment or death from any cause, whichever came first, assessed up to 36 months. | Rate of 3 year disease free survival |
| 3 year local recurrence free survival rate | From date of randomization until the date of first documented pelvic failure, assessed up to 36 months. | Rate of 3 year local recurrence free survival |
| 3 year distant metastasis free survival rate | From date of randomization until the date of first documented distant metastasis, assessed up to 36 months. | Rate of 3 year distant metastasis free survival |
| 3 year overall survival rate | From date of randomization until the date of death from any cause, assessed up to 36 months. | Rate of 3 year overall survival |
| Grade 3-4 adverse effects rate | From date of randomization until 3 months after the completion neoadjuvant therapy | Rate of chemotherapy, radiotherapy and immunotherapy related adverse events |
| Rate of surgical complications | The surgical complications were assessed within 1 year after the surgery. | Rate of surgical complications |
| Low Anterior Resection Syndrome Score | From date of randomization until five years after the completion of treament. | Evaluating the anal function using Low Anterior Resection Syndrome (LARS) score（range 0-42, with higher scores representing worse anal function） |
| Wexner Continence Grading Scale | From date of randomization until five years after the completion of treament. | Evaluating the anal function using Wexner Continence Grading Scale (range 1-20, with higher scores representing worse anal function) |
Countries
China
Contacts
CONTACTZhen Zhang, MD, PhD
Outcome results
None listed