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Neoadjuvant Chemoradiotherapy Plus Tislelizumab Followed by TME for LARC.

Primary Purpose

Colorectal Neoplasms

Status
Recruiting
Phase
Phase 2
Locations
China
Study Type
Interventional
Intervention
long course radiotherapy + capecitabine + PD-1 monoclonal antibody treatment combinations
Sponsored by
Beijing Friendship Hospital
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Colorectal Neoplasms focused on measuring Colorectal Neoplasms, Programmed Cell Death 1 Receptor, Neoadjuvant Therapy

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion criteria:

  • Patients have been fully aware of the content of this study and signed the informed consent voluntarily;
  • Patients with rectal cancers must satisfied all the following conditions: Stage II/III LARC (cT1-3N1-2M0);Tumor distal location ≤10 cm from anal verge (MRI diagnosed);
  • Patients regardless of gender with aged ≥18 years and ECOG score of 0 or 1;
  • Physical and viscera function of patients can withstand major abdominal surgery;
  • Patients are willing and able to follow the study protocol during the study;
  • Patients give consent to the use of blood and pathological specimens for study;
  • Within 28 days prior to enrolment, we must confirm a negative serological pregnancy test for child-bearing age women and they agree to use effective contraception for the duration of drug use and for 60 days after the last dose.

Exclusion criteria:

  • Patients have a present or previous active malignancy except the diagnosis of rectal cancer this time;
  • Patients underwent major surgery within 4 weeks prior to study treatment;
  • Patients have any condition affects the absorption of capecitabine through gastrointestinal tract;
  • Patients have severe uncontrolled recurrent infections, or other severe uncontrolled concomitant diseases;
  • Patients who are allergic to any of the ingredients under study;
  • Patients with severe concomitant diseases with estimated survival ≤ 5 years;
  • Patients with present or previous moderate or severe liver and kidney damage presently or previously;
  • Patients have received other study medications or any immunotherapy currently or in the past;
  • Patients preparing for or previously received organ or bone marrow transplant;
  • Patients who received immunosuppressive or systemic hormone therapy for immunosuppressive purposes within 1 month prior to the initiation of study therapy;
  • Patients with congenital or acquired immune deficiency (such as HIV infection);
  • If patients with a history of uncontrolled epilepsy, central nervous system disease or mental disorder, the investigator will determine whether the clinical severity prevents the signing of informed consent or affects the patient's oral medication compliance;
  • Patients with other factors that may affect the study results or cause the study to be terminated midway, such as alcoholism, drug abuse, other serious diseases (including mental illness) requiring combined treatment and severe laboratory examination abnormalities.
  • Pregnant or lactating women

Sites / Locations

  • Beijing Friendship HospitalRecruiting

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

long course radiotherapy + capecitabine + PD-1 monoclonal antibody treatment combinations

Arm Description

long course radiotherapy + capecitabine + PD-1 monoclonal antibody treatment combinations in patients with locally advanced rectal cancer

Outcomes

Primary Outcome Measures

pathologic complete response(pCR)
All the enrolled patients will receive total mesorectal excision (TME) 7-9 weeks after the end of long course radiotherapy. The rectal specimens will be evaluated by the pathologists who are experienced on the rectal cancer diagnosis according to the 1997 Dworak grading system. The rectal cancer will be classified into 5 grades. Grade 0-3 will be considered as non-pCR while grade 4 represent pCR.

Secondary Outcome Measures

neoadjuvant rectal (NAR) score
The neoadjuvant rectal (NAR) score is a promising indicator of survival after preoperative chemoradiotherapy for rectal cancer. The NAR score was calculated according to the following formula: NAR score = [5pN - 3(cT - pT) + 12]2∕9.61. (clinical tumor (cT) stage, pathologic tumor (pT) stage, pathologic nodal (pN) stage)
objective response rate (ORR)
ORR is evaluated according to Response Evaluation Criteria in Solid Tumors (RECIST) v1.1. The ORR rate is the sum of complete response (CR) and partial response (PR)
R0 resection rate
During the surgical process, the surgeon will evaluate the level of cancer resection. It will be classified as R0, R1, R2 resection. Therefore, we can calculate R0 resection rate.
anal preservation rate
the surgeon will decide whether the anal can be preserved on the basis of the rectal cancer and intraoperative situation. anal preservation rate is the percentage of patients who achieve anal preservation.
3-year local recurrence rate (LRR)
During the 3-year follow-up, the percentage of local recurrence.
3-year disease free survival (DFS)
During the 3-year follow-up, the percentage of the patients who is disease free.
3-year overall survival (OS)
During the 3-year follow-up, the percentage of the patients who is sill survival at the end of follow-up.

Full Information

First Posted
May 23, 2021
Last Updated
February 7, 2022
Sponsor
Beijing Friendship Hospital
Collaborators
Hangzhou New Horizon Health Technology Co., Ltd., Beigene (Beijing) Biotechnology Co., Ltd, Beijing Chao Yang Hospital, Xuanwu Hospital, Beijing, Tianjin Medical University General Hospital, People's Hospital of Tianjin, Tianjin Medical University Cancer Institute & Hospital
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1. Study Identification

Unique Protocol Identification Number
NCT04911517
Brief Title
Neoadjuvant Chemoradiotherapy Plus Tislelizumab Followed by TME for LARC.
Official Title
Rationale and Design of a Prospective, Multicenter Phase Ⅱ Clinical Trial of Safety and Efficacy Evaluation of Long Course Neoadjuvant Chemoradiotherapy Plus Tislelizumab Followed by TME for LARC.
Study Type
Interventional

2. Study Status

Record Verification Date
February 2022
Overall Recruitment Status
Recruiting
Study Start Date
June 1, 2021 (Actual)
Primary Completion Date
December 2022 (Anticipated)
Study Completion Date
December 2024 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Beijing Friendship Hospital
Collaborators
Hangzhou New Horizon Health Technology Co., Ltd., Beigene (Beijing) Biotechnology Co., Ltd, Beijing Chao Yang Hospital, Xuanwu Hospital, Beijing, Tianjin Medical University General Hospital, People's Hospital of Tianjin, Tianjin Medical University Cancer Institute & Hospital

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
No

5. Study Description

Brief Summary
Long course radiotherapy plus neoadjuvant chemotherapy followed by resection total mesorecta excision has accepted widespread recognized in the treatment of locally advanced rectal cancer (LARC). Tislelizumab, an anti-PD1(programmed death 1) humanized IgG4 (Immunoglomin G4) monoclonal antibody, has been demonstrated with clinical activity and is approved for treating recurrent/refractory classical Hodgkin lymphoma and locally advanced/metastatic urothelial carcinoma in China. The aim of This NCRT-PD-1-LARC trial is to evaluate the efficacy and safety of long course neoadjuvant chemoradiotherapy plus tislelizumab followed by total mesorecta excision for LARC. This NCRT-PD-1-LARC trial will be a prospective, multicenter and phase Ⅱ clinical trial designed to evaluate the safety and efficacy of LARC patients treated with long course neoadjuvant chemoradiotherapy plus tislelizumab followed by total mesorecta excision. It will consecutively enroll 50 stage II/III LARC patients (cT3N0M0 and cT1-3N1-2M0) with the tumor distal location ≤ 10cm from anal verge at 7 centers in China. The enrolled patients will receive long course radiotherapy (50 Gy/25 f, 2 Gy/f, 5 days/week) and three 21-day cycles capecitabine (1000 mg/m2, bid, po, day1-14) plus three 21-day cycles tislelizumab (200 mg, iv.gtt, day8), followed by total mesorecta excision 6-12 week after the end of radiotherapy. The primary efficacy endpoint will be the pathological complete response (pCR) rate, which is defined as absence of viable tumor cells in the primary tumor and lymph nodes.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Colorectal Neoplasms
Keywords
Colorectal Neoplasms, Programmed Cell Death 1 Receptor, Neoadjuvant Therapy

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Single Group Assignment
Model Description
The enrolled patients in this NCRT-PD-1-LARC trial will receive long course radiotherapy (50 Gy/25 f, 2 Gy/f, 5 days/week) and three 21-day cycles capecitabine (1000 mg/m2, bid, po, day1-14) plus three 21-day cycles tislelizumab (200 mg, iv.gtt, day8), followed by total mesorecta excision 6-8 week after the end of radiotherapy.
Masking
None (Open Label)
Allocation
N/A
Enrollment
50 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
long course radiotherapy + capecitabine + PD-1 monoclonal antibody treatment combinations
Arm Type
Experimental
Arm Description
long course radiotherapy + capecitabine + PD-1 monoclonal antibody treatment combinations in patients with locally advanced rectal cancer
Intervention Type
Combination Product
Intervention Name(s)
long course radiotherapy + capecitabine + PD-1 monoclonal antibody treatment combinations
Intervention Description
long course radiotherapy + capecitabine + PD-1 monoclonal antibody treatment combinations in patients with locally advanced rectal cancer
Primary Outcome Measure Information:
Title
pathologic complete response(pCR)
Description
All the enrolled patients will receive total mesorectal excision (TME) 7-9 weeks after the end of long course radiotherapy. The rectal specimens will be evaluated by the pathologists who are experienced on the rectal cancer diagnosis according to the 1997 Dworak grading system. The rectal cancer will be classified into 5 grades. Grade 0-3 will be considered as non-pCR while grade 4 represent pCR.
Time Frame
1 year
Secondary Outcome Measure Information:
Title
neoadjuvant rectal (NAR) score
Description
The neoadjuvant rectal (NAR) score is a promising indicator of survival after preoperative chemoradiotherapy for rectal cancer. The NAR score was calculated according to the following formula: NAR score = [5pN - 3(cT - pT) + 12]2∕9.61. (clinical tumor (cT) stage, pathologic tumor (pT) stage, pathologic nodal (pN) stage)
Time Frame
1 year
Title
objective response rate (ORR)
Description
ORR is evaluated according to Response Evaluation Criteria in Solid Tumors (RECIST) v1.1. The ORR rate is the sum of complete response (CR) and partial response (PR)
Time Frame
1 year
Title
R0 resection rate
Description
During the surgical process, the surgeon will evaluate the level of cancer resection. It will be classified as R0, R1, R2 resection. Therefore, we can calculate R0 resection rate.
Time Frame
1 year
Title
anal preservation rate
Description
the surgeon will decide whether the anal can be preserved on the basis of the rectal cancer and intraoperative situation. anal preservation rate is the percentage of patients who achieve anal preservation.
Time Frame
1 year
Title
3-year local recurrence rate (LRR)
Description
During the 3-year follow-up, the percentage of local recurrence.
Time Frame
3 year
Title
3-year disease free survival (DFS)
Description
During the 3-year follow-up, the percentage of the patients who is disease free.
Time Frame
3 year
Title
3-year overall survival (OS)
Description
During the 3-year follow-up, the percentage of the patients who is sill survival at the end of follow-up.
Time Frame
3 year

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion criteria: Patients have been fully aware of the content of this study and signed the informed consent voluntarily; Patients with rectal cancers must satisfied all the following conditions: Stage II/III LARC (cT1-3N1-2M0);Tumor distal location ≤10 cm from anal verge (MRI diagnosed); Patients regardless of gender with aged ≥18 years and ECOG score of 0 or 1; Physical and viscera function of patients can withstand major abdominal surgery; Patients are willing and able to follow the study protocol during the study; Patients give consent to the use of blood and pathological specimens for study; Within 28 days prior to enrolment, we must confirm a negative serological pregnancy test for child-bearing age women and they agree to use effective contraception for the duration of drug use and for 60 days after the last dose. Exclusion criteria: Patients have a present or previous active malignancy except the diagnosis of rectal cancer this time; Patients underwent major surgery within 4 weeks prior to study treatment; Patients have any condition affects the absorption of capecitabine through gastrointestinal tract; Patients have severe uncontrolled recurrent infections, or other severe uncontrolled concomitant diseases; Patients who are allergic to any of the ingredients under study; Patients with severe concomitant diseases with estimated survival ≤ 5 years; Patients with present or previous moderate or severe liver and kidney damage presently or previously; Patients have received other study medications or any immunotherapy currently or in the past; Patients preparing for or previously received organ or bone marrow transplant; Patients who received immunosuppressive or systemic hormone therapy for immunosuppressive purposes within 1 month prior to the initiation of study therapy; Patients with congenital or acquired immune deficiency (such as HIV infection); If patients with a history of uncontrolled epilepsy, central nervous system disease or mental disorder, the investigator will determine whether the clinical severity prevents the signing of informed consent or affects the patient's oral medication compliance; Patients with other factors that may affect the study results or cause the study to be terminated midway, such as alcoholism, drug abuse, other serious diseases (including mental illness) requiring combined treatment and severe laboratory examination abnormalities. Pregnant or lactating women
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Hongwei Yao, Dr.
Phone
+8613611015609
Ext
63139203
Email
yaohongwei@ccmu.edu.cn
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
yaohongwei@ccmu.edu.cn Yao, Dr.
Organizational Affiliation
Department of General Surgery, Beijing Friendship Hospital, Capital Medical University
Official's Role
Study Chair
Facility Information:
Facility Name
Beijing Friendship Hospital
City
Beijing
State/Province
Beijing
ZIP/Postal Code
100050
Country
China
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Hongwei Yao, M.D.
Phone
+8613611015609
Email
yaohongwei@medmail.com.cn

12. IPD Sharing Statement

Plan to Share IPD
Yes
IPD Sharing Time Frame
2025.5-
IPD Sharing Access Criteria
via reasonable email requests
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Neoadjuvant Chemoradiotherapy Plus Tislelizumab Followed by TME for LARC.

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