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pMMR/MSS and 32 dMMR/MSI-H patientspatients were planned to be enrolled. Patients with dMMR/MSI-H will be randomly assigned to the immunotherapy arm or short-course radiotherapy sequential immunotherapy arm; pMMR/MSS patients will receive capecitabine-irinotecan based concurrent radiotherapy before being randomly assigned to the XELIRI or FOLFRINOX arm.
The rate of complete response (sustained cCR for ≥ 1 year), long-term prognosis and adverse effects will be analyzed.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| ARM A: dMMR/MSI-H patients | Experimental | patients will receive 12 cycles of PD-1 antibody |
|
| ARM B: dMMR/MSI-H patients | Experimental | patients will receive 5*5Gy short-course radiotherapy, followed by 12 cycles of PD-1 antibody |
|
| ARM C: pMMR/MSS patients | Experimental | patients will receive CRT followed by 6 cycles of XELIRI |
|
| ARM D: pMMR/MSS patients | Experimental | patients will receive CRT followed by 12 cycles of FOLFRINOX |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Toripalimab | Drug | 3mg/Kg iv d1q2w |
|
| Measure | Description | Time Frame |
|---|---|---|
| complete response (CR) rate. | cCR ≥ 1 year. | The status of cCR will be evaluated after the completion of neoadjuvant therapy. |
| Measure | Description | Time Frame |
|---|---|---|
| adverse effects rate. | CTC 4.0 standard. | From date of randomization until the date of death from any cause, assessed up to 5 years ] Rate of chemotherapy, radiotherapy and immunotherapy related adverse events. |
| QoL |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| JI ZHU | Contact | 13501978674 | zhuji@zjcc.org.cn |
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Zhengjiang Cancer Hospital | Recruiting | Hangzhou | Zhejiang | China |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 38200410 | Derived | Huang CY, Bai MH, Shen JW, Sun QQ, Feng YR, Chen QP, Mao W, Ju HX, Zhu J. Anus preservation in low rectal adenocarcinoma based on MMR/MSI status (APRAM): a study protocol for a randomised, controlled, open-label, multicentre phase III trial. BMC Cancer. 2024 Jan 10;24(1):57. doi: 10.1186/s12885-024-11829-2. |
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| ID | Term |
|---|---|
| C000656314 | toripalimab |
| D000069287 | Capecitabine |
| D000077146 | Irinotecan |
| D000077150 | Oxaliplatin |
| D005472 | Fluorouracil |
| ID | Term |
|---|---|
| D003841 | Deoxycytidine |
| D003562 | Cytidine |
| D011741 | Pyrimidine Nucleosides |
| D011743 | Pyrimidines |
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| CRT | Radiation | IMRT 50Gy/25fx 625mg/m2 bid d1-5 qw Irinotecan:1、Full wild (GG+6/6): 80mg/m2/week for 5 times 2、Single site mutation (GG+6/7 or GA+6/6): 65mg/m2/week for 5 times 3、Double locus mutation (GG+7/7 or AA+6/6 or GA+6/7): 50mg/m2/week for the 1st, 2nd, 4th and 5th week for 4 times |
|
|
| SCRT | Radiation | 25Gy/5fx |
|
|
| XELIRI | Drug | Capecitabine: 1000mg/m2 bid d1-14 Irinotecan: 200mg/m2 ivgtt d1 q3w |
|
|
| FOLFRINOX | Drug | Irinotecan: 150mg/m2 ivgtt d1 (double locus mutation downregulated to 120mg/m2) Oxaliplatin: 85mg/m2 ivgtt d1 5-FU: 2400mg/m2 ivgtt 46h q2w |
|
|
Quality of life will be evaluated using EORTC QLQ-C30 score
| From date of randomization until the date of death from any cause, assessed up to 10 years |
| 3 year local recurrence free survival rate | Rate of 3 year local recurrence free survival | From date of randomization until the date of first documented pelvic failure, assessed up to 36 months. ] |
| 3 year disease free survival rate | Rate of 3 year disease free survival | From date of randomization until the date of first documented progression or date of death from any cause, whichever came first, assessed up to 36 months. ] |
| 3 year overall survival rate | Rate of 3 year overall survival | From date of randomization until the date of death from any cause, assessed up to 36 months. |
| Organ preservation | TME-free survival | From date of randomization until the date of surgery |
| D006573 |
| Heterocyclic Compounds, 1-Ring |
| D006571 | Heterocyclic Compounds |
| D014498 | Uracil |
| D011744 | Pyrimidinones |
| D003853 | Deoxyribonucleosides |
| D009705 | Nucleosides |
| D009706 | Nucleic Acids, Nucleotides, and Nucleosides |
| D002166 | Camptothecin |
| D000470 | Alkaloids |
| D056831 | Coordination Complexes |
| D009930 | Organic Chemicals |