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This is a prospective, open-label, single-center, phase II umbrella trial designed to evaluate the efficacy and safety of neoadjuvant therapy for locally advanced colorectal cancer. Patients will be stratified into four cohorts based on microsatellite instability (MSI) status, KRAS mutation status, and the consensus molecular subtypes (CMS). Six arms are included across four cohorts and each arm will be assigned to a specific treatment regimen. The primary endpoint is the complete response rate. Secondary endpoints include safety, organ preservation rate (for rectal cancer only), R0 resection rate, surgical complications, treatment compliance, 3-year survival, and quality of life (QoL) score.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| MSI-H/dMMR | Experimental |
| |
| MSS-KRAS G12C-Adebrelimab | Experimental |
| |
| MSS-KRAS G12C-cetuximab β | Experimental |
| |
| MSS-KRAS G12D-Adebrelimab | Experimental |
| |
| MSS-KRAS G12D-cetuximab β | Experimental |
| |
| MSS-CMS | Experimental |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| SHR-1701 | Drug | 1800mg d1 q3w |
| |
| SHR-8068 |
| Measure | Description | Time Frame |
|---|---|---|
| Complete response (CR) rate: rate of complete response (CR), including the rate of pathologic complete response (pCR) after surgery and the rate of cCR with W&W strategy. | 1 month after the surgery or 1 year after the decision of W&W. |
| Measure | Description | Time Frame |
|---|---|---|
| Adverse effects rate: proportion of participants with treatment-related adverse events as assessed by NCI-CTCAE v5.0. | From date of stratification to 3 months post-neoadjuvant therapy, an average of 8 months. | |
| Organ preservation rate: proportion of participants who either achieve cCR and choose W&W or achieve cCR/near-cCR and choose local excision, out of the total participants who complete neoadjuvant therapy. |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Zhen Zhang | Contact | 18801735029 | zhen_zhang@fudan.edu.cn | |
| Shujuan Zhou | Contact | 18121297127 | zhoushujuan06@126.com |
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| ID | Term |
|---|---|
| C000723862 | SHR-1701 |
| C519688 | XELOX |
| D000069287 | Capecitabine |
| D000077150 | Oxaliplatin |
| ID | Term |
|---|---|
| D003841 | Deoxycytidine |
| D003562 | Cytidine |
| D011741 | Pyrimidine Nucleosides |
| D011743 | Pyrimidines |
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| Drug |
280mg,C1D1 |
|
| Short-course radiotherapy | Radiation | 25Gy/5Fx |
|
| XELOX (Capecitabine and Oxaliplatin) | Drug | Oxaliplatin: 130mg/m2 d1 q3w Capecitabine: 1000mg/m2 bid d1-14 q3w |
|
| PD-L1 antibody | Drug | 1200mg d1 q3w |
|
| cetuximab β | Drug | 250mg/m2 d1, 500mg/m2 d8 q3w |
|
| HRS-7058 | Drug | 200mg bid |
|
| HRS-4642 | Drug | 500mg d1, 1200mg d8 q3w |
|
This endpoint is applicable only to patients with locally advanced rectal cancer. |
| From date of stratification until the resection of rectum or anus, assessed up to 36 months. |
| R0 resection rate: proportion of surgical resections with negative margins (proximal, distal, and circumferential) on microscopic examination, with CRM negativity defined as > 1 mm from tumor bed. | 1 month after the surgery. |
| Rate of surgical complications: rates of surgical complications such as intraoperative hemorrhage, anastomotic leakage, intestinal obstruction, etc. | within 3 months after the surgery. |
| Treatment compliance: treatment completion rate and delay duration during the treatment period. | From date of stratification to the completion of neoadjuvant therapy, an average of 5 months. |
| 3 year local recurrence free survival rate: proportion of participants with no tumor recurrence in the primary site (e.g., rectum) or other pelvic regions within 3 years from date of surgery or cCR. | From date of surgery or cCR until the date of first documented pelvic failure, assessed up to 36 months. |
| 3 year distant metastasis free survival rate: proportion of participants with no distant metastases (e.g., liver, lung) within 3 years from date of stratification. | From date of stratification until the date of first documented distant metastasis, assessed up to 36 months. |
| 3 year disease free survival rate: proportion of participants with no disease recurrence (including local recurrence and distant metastasis) or death from the disease within 3 years from date of stratification. | From date of stratification 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: proportion of participants who are alive at 3 years from date of stratification. | From date of stratification until the date of death from any cause, assessed up to 36 months. |
| Quality of life (QoL) score: subjective assessment using validated standardized questionnaires. | From date of stratification to 3 years post-neoadjuvant therapy. |
| D006573 |
| Heterocyclic Compounds, 1-Ring |
| D006571 | Heterocyclic Compounds |
| D005472 | Fluorouracil |
| D014498 | Uracil |
| D011744 | Pyrimidinones |
| D003853 | Deoxyribonucleosides |
| D009705 | Nucleosides |
| D009706 | Nucleic Acids, Nucleotides, and Nucleosides |
| D056831 | Coordination Complexes |
| D009930 | Organic Chemicals |