Hypofractionated Radiotherapy Plus Immunotherapy Versus Conventional Radiotherapy in Locally Recurrent Rectal Cancer

NCT ID: NCT06928584

Last Updated: 2025-04-15

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

PHASE2

Total Enrollment

221 participants

Study Classification

INTERVENTIONAL

Study Start Date

2025-03-10

Study Completion Date

2030-03-10

Brief Summary

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TORCH-R2 is a prospective, multicenter, randomized, phase II clinical trial. Patients aged 18 years or older with pelvic recurrence rectal cancer without synchronous distant metastases or recent chemo- and/or radiotherapy treatment, Eastern Cooperative Oncology Group performance status of 0-1will be enrolled . Patients will be randomized to receive either hypofractionated radiotherapy (25-40Gy/5Fx irradiation or 15-30Gy/5Fx reirradiation), 18 weeks sintilimab and investigator's choice of first-line chemotherapy +/- target therapy (experimental arm), or conventional radiotherapy (50Gy/25Fx irradiation or 39Gy/30Fx bid reirradiation) and chemotherapy +/- target therapy (control arm). Patiens will be restaged and followed by multidisciplinary team (MDT) for decision: radical surgery, sustained systerm+/- local treatment of non resection.

The primary endpoint was progression-free survival. Secondary endpoints were objective response rate (ORR), complete response rate, R0 resection rate, duration of response (DOR), overall survival (OS), and safety and tolerability of the treatment.

Detailed Description

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Conditions

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Locally Recurrent Rectal Cancer

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Conventional radiotherapy arm

Conventional radiotherapy (50Gy/25Fx irradiation or 39Gy/30Fx bid reirradiation) and investigator's choice of first-line chemotherapy +/- target therapy.

Group Type ACTIVE_COMPARATOR

Conventional Radiotherapy

Intervention Type RADIATION

50Gy/25Fx irradiation or 39Gy/30Fx bid reirradiation (previous pelvic radiation)

Capecitabine

Intervention Type DRUG

1000mg/m2 d1-14 q3w

5-fluorouracil

Intervention Type DRUG

400 mg/m2 (bolus) and 2400 mg/m2 (continuous infusion for 48hr)

folinic acid

Intervention Type DRUG

400 mg/m2 q2w

Oxaliplatin

Intervention Type DRUG

130 mg/m² q3w or 85 mg/m² q2w

Irinotecan

Intervention Type DRUG

180 mg/m² q2w and 200 mg/m² q3w

Cetuximab

Intervention Type DRUG

500 mg/m² q2w

Bevacizumab

Intervention Type DRUG

5 mg/kg q2w or 7.5mg/kg q3w

Hypofractionated radiotherapy plus Immunotherapy arm

Hypofractionated radiotherapy (25-40Gy/5Fx irradiation or 15-30Gy/5Fx reirradiation), 18 weeks sintilimab and investigator's choice of first-line chemotherapy +/- target therapy.

Group Type EXPERIMENTAL

Capecitabine

Intervention Type DRUG

1000mg/m2 d1-14 q3w

5-fluorouracil

Intervention Type DRUG

400 mg/m2 (bolus) and 2400 mg/m2 (continuous infusion for 48hr)

folinic acid

Intervention Type DRUG

400 mg/m2 q2w

Oxaliplatin

Intervention Type DRUG

130 mg/m² q3w or 85 mg/m² q2w

Irinotecan

Intervention Type DRUG

180 mg/m² q2w and 200 mg/m² q3w

Cetuximab

Intervention Type DRUG

500 mg/m² q2w

Bevacizumab

Intervention Type DRUG

5 mg/kg q2w or 7.5mg/kg q3w

Hypofractionated radiotherapy

Intervention Type RADIATION

25-40Gy/5Fx irradiation or 15-30Gy/5Fx reirradiation (previous pelvic radiation)

PD-1 antibody

Intervention Type DRUG

200mg IV q3w

Interventions

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Conventional Radiotherapy

50Gy/25Fx irradiation or 39Gy/30Fx bid reirradiation (previous pelvic radiation)

Intervention Type RADIATION

Capecitabine

1000mg/m2 d1-14 q3w

Intervention Type DRUG

5-fluorouracil

400 mg/m2 (bolus) and 2400 mg/m2 (continuous infusion for 48hr)

Intervention Type DRUG

folinic acid

400 mg/m2 q2w

Intervention Type DRUG

Oxaliplatin

130 mg/m² q3w or 85 mg/m² q2w

Intervention Type DRUG

Irinotecan

180 mg/m² q2w and 200 mg/m² q3w

Intervention Type DRUG

Cetuximab

500 mg/m² q2w

Intervention Type DRUG

Bevacizumab

5 mg/kg q2w or 7.5mg/kg q3w

Intervention Type DRUG

Hypofractionated radiotherapy

25-40Gy/5Fx irradiation or 15-30Gy/5Fx reirradiation (previous pelvic radiation)

Intervention Type RADIATION

PD-1 antibody

200mg IV q3w

Intervention Type DRUG

Other Intervention Names

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Sintilimab

Eligibility Criteria

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Inclusion Criteria

Patient is 18-75 years. ECOG performance status 0-1. MRI/enhanced CT confirmed pelvic recurrence. Without synchronous distant metastases. No prior radiotherapy within 6 month. No prior first-line chemotherapy. Has an investigator determined life expectancy of at least 24 weeks. Demonstrate adequate organ function. Non pregnant or lactating patients. Fully informed and willing to provide written informed consent for the trial.

Exclusion Criteria

Neutrophil\< 1.5×109/L, PLT\< 100×109/L (PLT\< 80×109/L in patients with livermetastasis), or Hb\< 90 g/L.

TBIL \> 1.5 ULN, or TBIL \> 2.5 ULN in patients with liver metastasis. AST or ALT \> 2.5 ULN, or ALT and/or AST \> 5 ULN in patients with liver metastasis.

Cr \> 1.5 ULN, or creatinine clearance\< 50 mL/min (calculated according to Cockcroft Gault formula).

APTT \> 1.5 ULN, PT \> 1.5 ULN (subject to the normal value of the clinical trial research center).

Serious electrolyte abnormalities. Urinary protein ≥ 2+, or 24-h urine protein ≥1.0 g/24 h. Uncontrolled hypertension: SBP \>140 mmHg or DBP \> 90 mmHg. A history of arterial thrombosis or deep vein thrombosis within 6 months; a history of bleeding or evidence of bleeding tendency within 2 months.

A history of heart disease within 6 months. Uncontrolled malignant pleural effusion, ascites, or pericardial effusion. History of checkpoint inhibitor therapy. The presence of a clinically detectable second primary malignancy, or history of other malignancies within 5 years.

A history of liver disease including, but not limited to, HBV infection or HBV DNA positive (≥1×104/mL), HCV infection or HCV DNA positive (≥1×103/mL), and liver cirrhosis.

Pregnant or lactating women or women who may be pregnant have a positive pregnancy test before the first medication, or the female participants themselves and their partners who were unwilling to implement strict contraception during the study period.

The investigator considers that the subject is not suitable to participate in this clinical study due to any clinical or laboratory abnormalities or compliance problems.

Serious mental abnormalities. The diameter of brain metastasis is greater than 3 cm or the total volume is greater than 30 cc. Clinical or radiological evidence of spinal cord compression, or tumors within 3 mm of the spinal cord on MRI.
Minimum Eligible Age

18 Years

Maximum Eligible Age

75 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Fudan University

OTHER

Sponsor Role lead

Responsible Party

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Zhen Zhang

Professor

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Zhen Zhang, MD PhD, PhD

Role: PRINCIPAL_INVESTIGATOR

Fudan University

Locations

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Fudan University Shanghai Cancer Center

Shanghai, Shanghai Municipality, China

Site Status RECRUITING

Countries

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China

Central Contacts

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Zhen Zhang, MD, PhD

Role: CONTACT

86-18801735029

Facility Contacts

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Zhen Zhang, M.D, PH.D

Role: primary

19521280960

Other Identifiers

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FDRT-2024-416-3970

Identifier Type: -

Identifier Source: org_study_id

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