About this trial
To explore the efficacy and safety of an intensified treatment regimen consisting of short-course radiotherapy followed by mFOLFOX6 chemotherapy combined with precise targeted therapy (based on RAS/BRAF status: cetuximab for wild-type, bevacizumab for mutant) and a PD-1 monoclonal antibody, compared with short-course radiotherapy followed by mFOLFOX6 chemotherapy alone, in high-risk locally advanced pMMR/MSS rectal adenocarcinoma through a prospective, randomized controlled phase III clinical study, providing high-level evidence-based medical evidence to establish a superior neoadjuvant treatment strategy for this population.
Eligibility criteria
This trial does not accept healthy volunteersQualifiers
Before conducting procedures related to the research protocol but not part of routine care, written informed consent, voluntarily signed and dated by the subject, must be obtained in accordance with regulations and institutional guidelines.
Age 18-75 years.
Histologically or cytologically confirmed pMMR/MSS rectal adenocarcinoma; all other histological types are excluded.
Distance from the lower margin of the rectal tumor to the anal verge ≤10 cm.
Disqualifiers
Patients with a history of severe drug allergies (including allergies to platinum agents, 5-FU, LV, and 5-HT3 receptor antagonists);
Patients who have participated in or are currently participating in other clinical trials within 4 weeks prior to enrollment;
A history of having received anti-PD-1, PD-L1, PD-L2, CTLA-4, or any other specific T-cell costimulatory or checkpoint pathway-targeted therapy;
Severe electrolyte abnormalities;
Trial design
Parallel
Treatments tested in this trial
Short-Course Radiotherapy
RadiationPatients undergo SCRT at a dose of 5Gy × 5 fractions
PD-1 monoclonal antibody
DrugPatients complete immune therapy with PD-1 monoclonal antibody for 4 cycles.
mFOLFOX6 regimen
DrugPatients complete chemotherapy with mFOLFOX6 regimen for 4 cycles.
Cetuximab
DrugPatients with RAS/BRAF wild-type receive targeting therapy with Cetuximab for 4 cycles.
Bevacizumab
DrugPatients with RAS/BRAF mutations receive targeting therapy with Bevacizumab for 3 cycles. (Bevacizumab is not used in the last cycle of the bevacizumab group)
Surgical resection
Procedure/SurgerySurgery either local excition or total mesorectal excision is performed 8-10 weeks after the completion of short-course radiotherapy.
Treatment groups
Trial outcomes
Primary outcomes
3 years DFS Rate
3 years Disease Free Survival Rate
Secondary outcomes
pCR rate
pathological complete response rate
3 years OS rate
3 years Overall Survival Rate
3 years DMFS Rate
3 years Disease Metastasis Free Survival Rate
3 years RFS Rate
3 years Recurrence Free Survival Rate
Sponsors and contacts
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