Gastrointestinal Cancers, Gastrointestinal Cancers - Anus, Gastrointestinal Cancers - Colorectal, Gastrointestinal Cancers - Stomach
Conditions
Keywords
Gastrointestinal cancers, Colorectal cancer, Gastric cancer
Brief summary
Purpose: The purpose of this study is to evaluate the safety and efficacy of Non-Operative Management (NOM) and Organ Preservation First Strategy (OPFS) compared with Radical Operation (RO) in patients with deficient mismatch repair/microsatellite instability-high (dMMR/MSI-H) or POLE-mutated gastrointestinal cancers. Background & Design: With the remarkable efficacy of neoadjuvant immunotherapy in dMMR/MSI-H or POLE-mutated gastrointestinal tumors, organ preservation has become a promising alternative to highly invasive surgeries. The NOR-MP trial is a single-center, bidirectional registry study consisting of two parts: a retrospective cohort study and a prospective observational registry. Intervention Group (NOM/OPFS): Patients who achieve a clinical complete response (cCR) or near-cCR after neoadjuvant immunotherapy will undergo a "Watch & Wait" (W&W) strategy. Patients with near-cCR or non-cCR who are eligible for organ preservation will undergo local excision (LE) or endoscopic resection (including ESD or EMR). Comparison Group (Radical Operation): Patients who undergo standard radical surgical resection after neoadjuvant immunotherapy. The study aims to determine whether an organ-preserving approach can achieve comparable oncological outcomes and safety profiles while significantly improving patients' quality of life compared to radical surgery.
Detailed description
The NOR-MP trial is a single-center, bidirectional registry study designed to compare the clinical outcomes of Organ Preservation First Strategy (OPFS) / Non-Operative Management (NOM) against standard Radical Operation (RO) for patients diagnosed with dMMR/MSI-H or POLE-mutated gastrointestinal cancers. The study is divided into two sequential parts based on the nature of data collection: Part 1: Retrospective Cohort Study This part retrospectively reviews the medical records of eligible patients with dMMR/MSI-H or POLE-mutated gastrointestinal cancers who previously completed neoadjuvant immunotherapy. Patients are allocated into two historical cohorts: Experimental Cohort (NOM/OPFS): Patients who achieved cCR/near-cCR after neoadjuvant immunotherapy and entered the "Watch & Wait" (W&W) program, as well as those with near-cCR or non-cCR who underwent local excision (LE) or endoscopic resection (including Endoscopic Submucosal Dissection \[ESD\] or Endoscopic Mucosal Resection \[EMR\]). Control Cohort (RO): Patients who underwent radical surgical operation after neoadjuvant immunotherapy. Pathological outcomes (including the proportions of ypCR, ypTisN0, and ypT1-2N0) and surgical safety data will be collected and analyzed. Part 2: Prospective Registry Study This part prospectively enrolls newly diagnosed patients with dMMR/MSI-H or POLE-mutated gastrointestinal cancers receiving neoadjuvant immunotherapy. Following treatment evaluation by the multi-disciplinary NOR-MP research team, patients are enrolled into two parallel observational tracks: Experimental Cohort (NOM/OPFS): Patients eligible for and consenting to NOM or OPFS. This includes the W&W strategy for those achieving cCR/near-cCR, and LE or endoscopic resection (ESD/EMR) for those with near-cCR or non-cCR. Control Cohort (RO): Patients who proceed to standard radical operation. Pathological response distribution (proportions of ypCR, ypTisN0, ypT1-2N0, and ypT3+ diseases) and short-to-long-term surgical safety endpoints will be prospectively documented. By comparing the retrospective and prospective cohorts, this study evaluates whether the omission of radical surgery is oncologically safe and preserves organ function without compromising long-term survival.
Interventions
OTHERNOM/OPFS
Patients eligible for and consenting to NOM or OPFS. This includes the W\&W strategy for those achieving cCR/near-cCR, and LE or endoscopic resection (ESD/EMR) for those with near-cCR or non-cCR.
Sponsors
Peking University Cancer Hospital & Institute
Study design
Observational model
COHORT
Time perspective
OTHER
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Histologically confirmed primary gastrointestinal adenocarcinoma or squamous cell carcinoma (e.g., colorectal cancer, gastric cancer, gastroesophageal junction cancer). * Confirmed as deficient mismatch repair (dMMR) by immunohistochemistry (IHC), high microsatellite instability (MSI-H) by polymerase chain reaction (PCR) or next-generation sequencing (NGS), or harboring POLE exonuclease domain mutations. * Received neoadjuvant/conversion immunotherapy (immune checkpoint inhibitors, either monotherapy or combination therapy) prior to treatment response evaluation. * For the Retrospective Cohort (Part 1): Patients treated between \[Start Month/Year\] and \[End Month/Year\] who completed evaluation and subsequent strategy (NOM/OPFS or RO). * For the Prospective Cohort (Part 2): Newly diagnosed patients who consent to long-term follow-up and multi-disciplinary team (MDT) assessment for organ preservation or radical surgery. * Age ≥ 18 years at the time of diagnosis. * Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1.
Exclusion criteria
* Concurrently diagnosed with other active malignant tumors within the past 5 years. * Patients with proficient mismatch repair (pMMR) / microsatellite stable (MSS) tumors, or wild-type POLE status. * Evidence of untreatable distant metastasis or systemic disease that precludes local tumor management (NOM/OPFS or radical operation). * Inability to undergo regular endoscopic, radiological (MRI/CT), or clinical follow-up due to compliance or geographic reasons. * Refusal to sign the informed consent form (applicable to the prospective cohort).
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Organ Preservation Rate (for OPFS/NOM group) | Up to 3 years after the completion of neoadjuvant immunotherapy. | The percentage of patients in the NOM/OPFS group who successfully maintain their native organ without requiring radical surgical resection or permanent stoma. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Surgical Safety and Postoperative Complications | Within 30 days and 90 days post-surgery. | Incidence and severity of perioperative complications classified by the Clavien-Dindo classification. This compares the safety data among patients undergoing Radical Operation (RO), Local Excision (LE), or endoscopic resection (ESD/EMR). |
| Pathological Response Distribution (for RO group) | At the time of radical surgery (typically within 4-12 weeks post-immunotherapy). | Proportions of patients in the radical operation cohort achieving pathological complete response (ypCR), ypTisN0, ypT1-2N0, and ypT3+ diseases to characterize the pathological efficacy of neoadjuvant immunotherapy. |
| Local Regrowth / Recurrence Rate | Followed up at regular intervals (every 3-6 months) up to 3 years. | Rate of tumor regrowth in patients undergoing the "Watch \& Wait" strategy, or local recurrence in patients undergoing local/endoscopic excision. |
| Overall Survival (OS) | Up to 5 years. | Defined as the time from treatment initiation to death from any cause. |
| Disease-Free Survival (DFS) / Disease-Specific Survival (DSS) | From enrollment/treatment initiation up to 5 years. | To compare the long-term oncological efficacy between the NOM/OPFS group and the RO group. DFS is defined as the time from the start of neoadjuvant immunotherapy to the date of first documentation of disease recurrence (local, regional, or distant), progression, or death from any cause. |
Contacts
CONTACTXiaokang Lei, M.D.
Outcome results
None listed