SCRT Followed by CAPOX + Bev ± PD-1 Inhibitor for TNT in LARC

Not Applicable

Recruiting

• Conditions: Rectal Cancer; Targeted Therapy; Rectal Adenocarcinoma; Immunotherapy; Rectal Cancer, Radiotherapy; Rectal Cancer Patients; Total Neoadjuvant Therapy; Total Neoadjuvant Treatment; Chemoradiotherapy
• Interventions: Drug: PD-1 inhibitor based immunotherapy

• Registration Number: NCT07198165
• Lead Sponsor: Ruijin Hospital

Brief Summary

This study aims to evaluate the efficacy and safety of short-course radiotherapy combined with CAPOX plus bevacizumab with or without a PD-1 inhibitor in patients with locally advanced rectal cancer (LARC). The hypothesis is that the addition of immunotherapy (PD-1 inhibitor) can significantly improve the complete response (CR) rate and enhance local control while reducing the incidence of distant metastasis. This study will compare the effects of sequential chemoradiotherapy and targeted therapy with or without immunotherapy following short-course radiotherapy, aiming to explore the optimal regimen for total neoadjuvant therapy.

Detailed Description

Not available

Study Timeline

• Status Verified: 2025-09
• Study Start: 2025-09-05
• Study First Submitted: 2025-09-21
• Study First Submitted QC: 2025-09-27
• Last Update Submitted: 2025-09-27
• Study First Posted: 2025-09-30
• Last Update Posted: 2025-09-30
• Primary Completion: 2030-12-31
• Study Completion: 2030-12-31

Recruitment & Eligibility

• Status: RECRUITING
• Sex: All
• Target Recruitment: 104

Inclusion Criteria

• Histopathologically confirmed rectal adenocarcinoma with no prior antitumor therapy.
• Exclusion of patients with BRAF mutations or MSI-H status, as determined by pre-enrollment genetic testing including RAS, BRAF, and MSI analysis. RAS mutation status is permitted regardless.
• Absence of severe intestinal obstruction symptoms and no evidence of distant metastasis confirmed by imaging examinations such as CT, MRI, or PET/CT.
• Confirmation as locally advanced rectal cancer by rectal MRI, meeting one or more of the following criteria: T3c-d or T4, N2, EMVI(+), MRF(+), lateral lymph node metastasis; or patients with low-lying rectal cancer (≤5 cm from the anal verge) unsuitable for sphincter-preserving surgery prior to neoadjuvant therapy.
• Age 18 to 75 years.
• ECOG Performance Status of 0 to 1, without severe comorbid medical conditions.
• Adequate organ function:

Hematopoietic: Hemoglobin ≥90 g/L, Platelets ≥80 × 10^9/L, Absolute Neutrophil Count ≥1.5 × 10^9/L.

Hepatic: ALT and AST < 2.5 × ULN. Renal: Serum Creatinine < 1.5 × ULN.

• Provision of signed and dated written informed consent.

Exclusion Criteria

• Patients found to have BRAF mutations or MSI-H status.
• Patients who have previously received chemotherapy, radiotherapy, immunotherapy, targeted therapy, or surgical resection for colorectal cancer prior to enrollment.
• History or presence of another malignancy (except for early-stage basal cell carcinoma or carcinoma in situ of the cervix) within the past 3 years, with the disease not under control.
• Patients who are pregnant (confirmed by serum or urine β-HCG test) or breastfeeding.
• Patients with severe cardiac, hepatic, renal, neurological, or psychiatric diseases.
• Patients with active infections.
• Poor overall health status, with an ECOG performance status ≥2.
• Patients who have undergone organ transplantation requiring immunosuppressive therapy, or those requiring long-term corticosteroid treatment for autoimmune diseases.
• Patients with comorbid conditions that, in the investigator's judgment, seriously endanger the patient's safety or affect the completion of the study.
• Known hypersensitivity to any of the study drugs.

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Intervention group	PD-1 inhibitor based immunotherapy	Short-course radiotherapy (25Gy/5Fx) followed by 4 cycles of CAPOX regimen (Oxaliplatin 130mg/m² IV infusion, Capecitabine 1000mg/m² orally for 14 days, Q3w) combined with Bevacizumab (7.5mg/kg IV infusion, D1, Q3w) + PD-1 inhibitor (Toripalimab 240mg IV infusion, D1, Q3w). Following completion of total neoadjuvant therapy, the treatment strategy (watch-and-wait or surgical resection) will be selected based on tumor response. The decision regarding adjuvant chemotherapy will be determined according to postoperative pathological findings.

Primary Outcome Measures

Name	Time	Method
Complete Response rate	2 weeks after the surgery	Measurement Methods: Chi-square test, Fisher's exact test, multivariate regression analysis (Cox regression model).; Description: For pCR and cCR, chi-square test or Fisher's exact test was used to compare differences between the two groups. Multivariate regression analysis (Cox regression model) was employed to assess the relationship between the intervention and the CR rate.

Secondary Outcome Measures

Name	Time	Method
Disease-Free Survival (DFS)	from enrollment to the end of follow-up at 48 months	Measurement Method: Kaplan-Meier survival analysis, Log-rank test to compare survival curves between the two groups.; Methods for Handling Missing Values: * For missing data, the Last Observation Carried Forward (LOCF) method or multiple imputation method will be applied.; * For subjects with significant non-compliance or loss to follow-up, sensitivity analysis will be considered to assess the impact on results.
Distant Metastasis Rate	from enrollment to the end of follow-up at 48 months	Measurement Method: Kaplan-Meier survival analysis, Log-rank test to compare survival curves between the two groups.; Methods for Handling Missing Values: * For missing data, the Last Observation Carried Forward (LOCF) method or multiple imputation method will be applied.; * For subjects with significant non-compliance or loss to follow-up, sensitivity analysis will be considered to assess the impact on results.
Local Recurrence Rate	from enrollment to the end of follow-up at 48 months	Measurement Method: Kaplan-Meier survival analysis, Log-rank test to compare survival curves between the two groups.; Methods for Handling Missing Values: * For missing data, the Last Observation Carried Forward (LOCF) method or multiple imputation method will be applied.; * For subjects with significant non-compliance or loss to follow-up, sensitivity analysis will be considered to assess the impact on results.
Overall Survival (OS)	from enrollment to the end of follow-up at 48 months	Measurement Method: Kaplan-Meier survival analysis, Log-rank test to compare survival curves between the two groups.; Methods for Handling Missing Values: * For missing data, the Last Observation Carried Forward (LOCF) method or multiple imputation method will be applied.; * For subjects with significant non-compliance or loss to follow-up, sensitivity analysis will be considered to assess the impact on results.
Pathological Stage	2 weeks after the surgery	ypT and ypN staging; Measurement Method: Chi-square test or Fisher's exact test
Tumor Regression Grade(TRG)	2 weeks after the surgery	Measurement Method: Chi-square test or Fisher's exact test
Sphincter Preservation Rate	2 weeks after the surgery	Measurement Method: Logistic regression analysis; Methods for Handling Missing Values: * For missing data, the Last Observation Carried Forward (LOCF) method or multiple imputation method will be applied.; * For subjects with significant non-compliance or loss to follow-up, sensitivity analysis will be considered to assess the impact on results.

Trial Locations

Locations (1)

Ruijin Hospital, Shanghai Jiaotong University School of Medicine; 🇨🇳 Shanghai, China