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The study compares the efficacy and safety of regorafenib alone or in combination with hypofractionated radiotherapy and low-dose radiotherapy (LDRT) plus toripalimab in patients with microsatellite stable metastatic colorectal cancer (MSS mCRC). Patients are randomly assigned (1:1) into the control arm and the experimental arm. Control arm: a total of 54 patients will receive regorafenib monotherapy. Experimental arm: a total of 54 patients will first receive 1 cycle of regorafenib and toripalimab followed by hypofractionated/low-dose radiotherapy. Regorafenib and toripalimab will be continued after the completion of radiotherapy. The survival benefits, response rates, and adverse effects will be analyzed.
Control arm: regorafenib 120 mg orally once daily on days 1-21 of each 28 days cycle.
Experimental arm: regorafenib is administered 80 mg once daily on days 1-21 of each 28 days cycle with intravenous toripalimab 240 mg every 3 weeks. Radiotherapy regimes include hypofractionated radiotherapy (5 fractions of 4-12Gy) and low-dose radiotherapy (5 fractions of 0.5-2Gy).
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| monotherapy | Active Comparator | a total of 54 patients will receive regorafenib monotherapy. |
|
| combination therapies | Experimental | a total of 54 patients will first receive 1 cycle of regorafenib and toripalimab followed by hypofractionated/low-dose radiotherapy. Regorafenib and toripalimab will be continued after the completion of radiotherapy. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Regorafenib | Drug | Regorafenib 120 mg orally once daily on days 1-21 of each 28 days cycle. |
|
| Measure | Description | Time Frame |
|---|---|---|
| OS | Defined as the time from initiation of treatment to death from any cause. | Up to 2 years |
| Measure | Description | Time Frame |
|---|---|---|
| PFS | Defined as the time from initiation of treatment to PD or death from any cause. | Up to 2 years |
| DCR | The percentage of patients with disease control in all metastatic lesions. Disease control is defined as CR, PR, or stable disease (SD) per RECIST v1.1 and iRECIST after treatment. |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Zhen Zhang, MD, PHD | Contact | 18801735029 | zhen_zhang@fudan.edu.cn |
| Name | Affiliation | Role |
|---|---|---|
| Zhen Zhang, MD, PHD | Fudan University | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Fudan University Shanghai Cancer Center | Recruiting | Shanghai | China |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 37869085 | Derived | Zhou S, Wang C, Shen L, Wang Y, Zhang H, Wu R, Wang Y, Chen Y, Xuan Y, Xia F, Zhang Z, Wan J. Regorafenib alone or in combination with high/low-dose radiotherapy plus toripalimab as third-line treatment in patients with metastatic colorectal cancer: protocol for a prospective, randomized, controlled phase II clinical trial (SLOT). Front Oncol. 2023 Oct 5;13:1274487. doi: 10.3389/fonc.2023.1274487. eCollection 2023. |
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| Toripalimab | Drug | 240 mg intravenously every 3 weeks |
|
| Radiotherapy | Radiation | hypofractionated radiotherapy (5 fractions of 4-12Gy) and low-dose radiotherapy (5 fractions of 0.5-2Gy). |
|
| Regorafenib | Drug | Regorafenib 80mg orally once daily on days 1-21 of each 28 days cycle. |
|
| Up to 1 year |
| ORR | The percentage of patients with objective response in all metastatic lesions. | Up to 1 year |
| DoR | Defined as the time between PR/CR and subsequent progression disease (PD) per RECIST v1.1 and iRECIST or death from any cause. | Up to 1 year |
| Adverse events | The percentage of patients with treatment-related acute toxicities as assessed by NCI CTCAE v5.0, from treatment initiation until 90 days upon completion of immunotherapy. | Up to 1 year |
| ID | Term |
|---|---|
| C559147 | regorafenib |
| C000656314 | toripalimab |
| D011878 | Radiotherapy |
| ID | Term |
|---|---|
| D013812 | Therapeutics |
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