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This study is a randomized controlled phase II trial to evaluate the efficacy of the combination of stereotactic body radiation therapy (SBRT) and immunotherapy with postoperative chemotherapy in colorectal cancer liver metastasis (CRLM) patients with high risk of locally recurrence. Researchers will compare the combination therapy with the postoperative chemotherapy alone to see if postoperative chemotherapy plus SBRT and immunotherapy can further reduce the risk of recurrence and metastasis after surgery.
40-50% of colorectal cancer patients have metastases at the time of diagnosis, of which liver metastases are the most common. Surgical resection is the most likely cure for CRLM patients, however, more than 50% of patients will experience recurrence within 2 years after resection of liver metastases. SBRT can be an effective and safe treatment modality, which can not only provide better local control of metastatic lesions, but also has a sensitizing immunotherapeutic effect. SBRT can effectively synergize with anti-PD-1/PD-L1 antibodies to activate the immune microenvironment of CRLM patients and improve survival. However, in CRLM patients after surgery, whether combining SBRT, immunotherapy and adjuvant chemotherapy results in better survival than chemotherapy alone, the evidence is insufficient.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| chemotherapy with radiotherapy and immunotherapy | Experimental | radiotherapy: SBRT of liver lesions; postoperative chemotherapy and immunotherapy: chemotherapy by investigators' choice with sintilimab for 18 weeks |
|
| chemotherapy | Active Comparator | postoperative chemotherapy: chemotherapy by investigators' choice for 18 weeks |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| SBRT | Radiation | postoperative SBRT of liver lesions |
|
| Measure | Description | Time Frame |
|---|---|---|
| Progression free survival | Evaluate the effect of the combination of adjuvant chemotherapy, SBRT and immunotherapy versus observation on progression free survival | From the date of randomization until the date of first documented progression or date of death from any cause, whichever come first, assessed up to 12 months |
| Measure | Description | Time Frame |
|---|---|---|
| Local control rate | To evaluate local control rate after the combination of adjuvant chemotherapy, SBRT and immunotherapy in comparison to observation alone | From the date of randomization until the date of first documented locally tumor recurrence, assessed up to 12 months |
| Overall survival |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Fan Xia, M.D, PH.D | Contact | 13564676623 | 13564676623 | tcxiafan@hotmail.com |
| Name | Affiliation | Role |
|---|---|---|
| Fan Xia, M.D,PH.D | Fudan University | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Fudan University Shanghai Cancer Center | Recruiting | Shanghai | Shanghai Municipality | 200032 | China |
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adjuvant radiotherapy: SBRT; immunotherapy: sintilimab chemotherapy: XELOX
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| Chemotherapy | Drug | XELOX/FOLFOX/FOLFIRI |
|
| PD-1 antibody | Drug | Sintilimab (200mg d1,q3w) |
|
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To evaluate overall survival after the combination of adjuvant chemotherapy, SBRT and immunotherapy in comparison to observation alone |
| From date of randomization until the date of death from any cause, assessed up to 36 months |
| Grade 3-4 adverse effect rate | Rate of chemotherapy, SBRT and immunotherapy related adverse events | From date of randomization until the date of death from any cause, assessed up to 3 years |
| ID | Term |
|---|---|
| D015179 | Colorectal Neoplasms |
| ID | Term |
|---|---|
| D007414 | Intestinal Neoplasms |
| D005770 | Gastrointestinal Neoplasms |
| D004067 | Digestive System Neoplasms |
| D009371 | Neoplasms by Site |
| D009369 | Neoplasms |
| D004066 | Digestive System Diseases |
| D005767 | Gastrointestinal Diseases |
| D003108 | Colonic Diseases |
| D007410 | Intestinal Diseases |
| D012002 | Rectal Diseases |
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| ID | Term |
|---|---|
| D011878 | Radiotherapy |
| D004358 | Drug Therapy |
| C000711728 | spartalizumab |
| C000632826 | sintilimab |
| ID | Term |
|---|---|
| D013812 | Therapeutics |
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