The Combination of Hypofractionated Radiotherapy and Immunotherapy in Locally Recurrent Rectal Cancer

Recurrent Rectal Cancer Clinical Trial

— TORCH-R  

Official title:

Hypofractionated Radiotherapy Combined With Chemotherapy and Toripalimab for Locally Recurrent Rectal Cancer: a Single-arm, Two-cohort, Phase II Trial (TORCH-R)

Clinical Trial Details — Status: Recruiting

Administrative data

• NCT number: NCT05628038
• Other study ID #: FDRT-2022-289-3006
• Status: Recruiting
• Phase: Phase 2
• Start date: August 18, 2022
• Est. completion date: December 1, 2025

Study information

• Verified date: September 2023
• Source: Fudan University
• Contact: Zhen Zhang, MD PhD
• Phone: 18801735029
• Email: zhen_zhang[@]fudan.edu.cn
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

The study is a prospective, single-center, single-arm, two-cohort, phase II clinical trial. Patients aged 18 years or older who had pelvic recurrence rectal cancer with or without resectable distant metastasis, with treatment naive disease (cohort A) or progressive disease after first-line chemotherapy (cohort B), Eastern Cooperative Oncology Group performance status of 0-1, will receive 25-40Gy/5Fx irradiation or 15-30Gy/5Fx reirradiation (pelvic radiation history), 18 weeks toripalimab and investigator's choice of chemotherapy, and stereotactic ablative radiotherapy (SABR) for all metastatic lesions between chemoimmunotherapy cycles, followed by multidisciplinary team (MDT) for decision:follow-up of complete response (CR), radical surgery, sustained treatment of non resection, or exit. The primary endpoint was local objective response rate. Secondary endpoints were extrapelvic objective response rate, R0 resection rate, duration of response, progression-free survival, overall survival, and safety and tolerability of the treatment. Shanghai Junshi Biomedical Technology Co., Ltd. Provides the first three cycles of toripalimab for free and has purchased liability insurance for clinical trial subjects.

Description:

For patients with locally recurrent rectal cancer (LRRC), response rate of chemoradiotherapy is 40-50% and only approximately 40-50% of patients with recurrent rectal cancer can undergo R0 resection. Recent studies have shown promising synergistic effects of the combination of immunotherapy (PD-1/PD-L1 antibodies) and neoadjuvant chemoradiotherapy (nCRT) in locally advanced rectal cancer (LARC). Thus, for LRRC patients, addition of immunotherapy to CRT is likely to further improve the response rate and prognosis.

Recruitment information / eligibility

• Status: Recruiting
• Enrollment: 93
• Est. completion date: December 1, 2025
• Est. primary completion date: December 1, 2024
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years to 75 Years

Eligibility

Inclusion Criteria:

• Patient is 18-75 years old at the time of signing the informed consent form.
• ECOG performance status 0-1.
• MRI/enhanced CT confirmed pelvic recurrence. According to RECIST 1.1, there is at least one measurable pelvic lesion.
• Distant metastasis lesions are no more than 5 and metastatic organ are no more than 3.
• No prior radiotherapy within 6 month.
• Previous system therapy. Patients Group Cohort A: participants with pelvic recurrence who have not previously been treated with first-line chemotherapy. Cohort B: Patients with disease progression or new lesions after first-line chemotherapy.
• Has an investigator determined life expectancy of at least 24 weeks.
• Demonstrate adequate organ function (bone marrow, liver, kidney and clotting function) within 7 days before the first administration without using blood products or hematopoietic stimulating factors.
• Non pregnant or lactating patients. Effective contraceptive methods should be used during the study and within 6 months of the last administration.
• Fully informed and willing to provide written informed consent for the trial.

Exclusion Criteria:

• Neutrophil < 1.5×10^9/L, PLT < 100×10^9/L (PLT < 80×10^9/L in patients with liver metastasis), or Hb < 90g/L; blood transfusion within 2 weeks before enrollment is not allowed to meet the enrollment criteria.
• 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 < 50ml / 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-hour urine protein =1.0g/24h.
• Uncontrolled hypertension: SBP >140mmHg or DBP > 90mmHg.
• The presence of gastrointestinal diseases such as gastric or duodenal active ulcers, ulcerative colitis or unresected tumours with active bleeding; or other conditions likely to cause gastrointestinal bleeding or perforation; or unhealed gastrointestinal perforation or gastrointestinal fistula after surgical treatment.
• 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 (including congestive heart failure, acute myocardial infarction, severe/unstable angina, coronary artery bypass grafting, cardiac insufficiency = NYHA grade 2 and LVEF<50%).
• Uncontrolled malignant pleural effusion, ascites, or pericardial effusion.
• History of anti-PD-1, PD-L1, PD-L2, CTLA-4 or any other specific T cell co-stimulation or checkpoint pathway targeted therapy.
• The presence of a clinically detectable second primary malignancy, or history of other malignancies within 5 years excluding adequately treated non-melanoma skin cancer, carcinoma in situ of cervix and superficial bladder tumour (non-invasive tumour, or carcinoma in situ, or T1).
• A history of liver disease including, but not limited to HBV infection or HBV DNA positive(=1×10^4/ml), HCV infection or HCV DNA positive(=1×10^3/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 3cm or the total volume is greater than 30cc.
• Clinical or radiological evidence of spinal cord compression, or tumours within 3 mm of the spinal cord on MRI.

Related Conditions & MeSH terms

• Rectal Neoplasms
• Recurrence
• Recurrent Rectal Cancer

Intervention

Drug:
• PD-1 antibody
PD-1 antibody (Toripalimab): 240mg q3w or 160mg q2w
• Capecitabine
Capecitabine: 1000mg/m2 d1-14 q3w
• 5FU
400 mg/m2 (bolus) and 2400 mg/m2 (continuous infusion for 48hr)
• folinic acid
400 mg/m2 q2w
• Oxaliplatin
130 mg/m² q3w or 85 mg/m² q2w
• Irinotecan
180 mg/m² q2w and 200 mg/m² q3w
• Raltitrexed
2 mg/m² q2w and 3 mg/m² q3w

Radiation:
• Radiation
25-40Gy/5Fx irradiation or 15-30Gy/5Fx reirradiation (pelvic radiation history) for pelvic recurrence tumor. 35-60Gy/5-8Fx irradiation for distance metastasis tumor.

Locations

Country	Name	City	State
China	Fudan University Shanghai Cancer Center	Shanghai	Shanghai

Sponsors (1)

Lead Sponsor	Collaborator
Fudan University

Country where clinical trial is conducted

China, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Local objective response rate	the proportion of patients with the best pelvic response of confirmed complete or partial response according to RECIST 1.1, as assessed by the investigator.	up to 1 year
Secondary	Extrapelvic objective response rate	proportion of patients with confirmed extrapelvic complete or partial response per RECIST 1.1.	up to 1 year
Secondary	R0 resection rate	the proportion of patients who achieve R0 resection of pelvic recurrent tumour after therapy.	up to 1 year
Secondary	Duration of response (DOR)	time from the first documented pelvic objective response to pelvic or extrapelvic disease progression in patients with confirmed response.	up to 1 year
Secondary	Progression-Free Survival	time from the date of start treatment until disease progression or censored at last follow-up or death.	up to 3 year
Secondary	Overall Survival	from the date of start treatment until the date of death from any cause or censored at last follow-up.	up to 3 year
Secondary	Safety and tolerability of the treatment	proportion of patients with treatment-related acute toxicities as assessed by NCI CTCAE v5.0, from treatment initiation until 90 days upon completion of immunotherapy.	up to 1 year