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Efficacy and Safety Exploration of Short Course Radiotherapy Followed by Surufatinib and Toripalimab in Neoadjuvant Treatment of Locally Advanced Rectal Cancer (STARS-RC08)

6. november 2026 opdateret af: Pengyu Chang, The First Hospital of Jilin University

Why is this study conducted? The purpose of this study is to improve treatment efficacy, particularly the pathological complete response rate, in patients with high-risk/extremely high-risk locally advanced rectal cancer (LARC). While advances have been achieved with neoadjuvant chemoradiotherapy combined with immunotherapy in recent years, regional recurrence and distant metastasis remain unresolved. New therapeutic strategies for this patient population are therefore urgently needed.

Rectal cancer management typically includes surgery, radiation therapy and chemotherapy. Treatment paradigms are shifting toward neoadjuvant chemoradiotherapy plus immunotherapy, which has demonstrated promising potential in several clinical trials. These data indicate that short-course radiotherapy combined with anti-angiogenic agents and immune checkpoint inhibitors may improve patient prognosis and tumor response. Nevertheless, the efficacy and safety of this regimen in high-risk patients require further validation.

Against this background, the study evaluates a novel regimen of short-course radiotherapy followed by surufatinib and toripalimab (anti-PD-1) to raise the pathological complete response rate. The investigators also explore efficacy-related biomarkers including RAS/BRAF status and gene expression profiles to support personalized treatment. This study aims to optimize therapy for LARC patients and inform future treatment strategies.

Why are participants invited to participate in this study? Participants are considered eligible for enrollment upon diagnosis of high-risk or extremely high-risk locally advanced rectal cancer consistent with study inclusion criteria. Eligibility requires confirmed pathological diagnosis, appropriate tumor location, and absence of severe comorbidities or exclusionary diseases (e.g., recurrent rectal cancer, cardiac dysfunction). Final enrollment decisions are made by study physicians based on individual clinical conditions.

What do participants need to do to participate in this study? Study participation requires adherence to predefined procedures. Participants receive scheduled medical assessments including blood tests, imaging scans and anorectal function evaluation. During the study period, participants may complete questionnaires and provide biospecimens (e.g., blood samples) for efficacy analysis. The study team defines the frequency and content of each follow-up to maintain continuous monitoring throughout treatment. Compliance with study procedures supports evaluation of regimen efficacy.

What are the risks of participating in this study?

This study applies neoadjuvant short-course radiotherapy, anti-PD-1 monoclonal antibody (toripalimab), and anti-angiogenic therapy (surufatinib). Potential risks for participants are listed below:

Risk of neoadjuvant short-course radiotherapy: Participants may develop grade ≥3 adverse events including, but not limited to, severe diarrhea, grade 3 neutropenia and grade 3 radiation dermatitis, which may impair quality of life.

Risk of anti-PD-1 monoclonal antibody: Toripalimab may induce immune-related adverse events (irAEs) across organ systems. Common irAEs include skin toxicity (papules, pruritus; incidence 30%-40%), diarrhea/colitis (8%-19%), fatigue (16%-24%), immune-related hepatitis (5%), hypothyroidism (4%-10%), and hyperthyroidism (4%). Approximately two-thirds of patients receiving immune checkpoint inhibitors develop irAEs of varying severity, and serious adverse events are non-negligible.

Risk of anti-angiogenic therapy: Surufatinib may trigger adverse events related to anti-angiogenic and immunomodulatory effects. Common adverse events (incidence >20%) include proteinuria, hypertension, bleeding, liver dysfunction and diarrhea. Among grade ≥3 adverse events, hypertension (29.7%), proteinuria (14.5%), liver dysfunction (12.8%) and bleeding (4.5%) predominate. Rarely, treatment-related death may occur secondary to gastrointestinal hemorrhage or cerebral hemorrhage.

Handling of research related injuries? This interventional study introduces no extra risks beyond standard clinical care. Any harm arising from study participation will be addressed for compensation and liability in accordance with applicable laws and regulations.

Studieoversigt

Status

Rekruttering

Betingelser

Intervention / Behandling

Detaljeret beskrivelse

Why is this study conducted? The purpose of this study is to improve treatment efficacy, particularly the pathological complete response rate, in patients with high-risk/extremely high-risk locally advanced rectal cancer (LARC). Recent advances have been achieved with neoadjuvant chemoradiotherapy combined with immunotherapy for rectal cancer, yet regional recurrence and distant metastasis remain persistent challenges. Developing novel therapeutic strategies for this patient population is therefore critical.

Rectal cancer management typically consists of surgery, radiation therapy, and chemotherapy. Treatment strategies are gradually shifting toward neoadjuvant chemoradiotherapy plus immunotherapy, which has demonstrated promising potential in multiple clinical trials. These trials indicate that combining short-course radiotherapy, anti-angiogenic agents, and immune checkpoint inhibitors may improve patient prognosis and increase tumor response rates. Nonetheless, the efficacy and safety of such regimens in high-risk patients require further validation.

Against this background, the study aims to evaluate a novel regimen: short-course radiotherapy followed by surufatinib and toripalimab (anti-PD-1), to increase the pathological complete response rate. The investigators also explore efficacy-associated biomarkers including RAS/BRAF status and gene expression profiles to support personalized treatment. This study seeks to optimize therapy for patients with LARC and inform future treatment approaches.

Why are participants invited to participate in this study? Participants are eligible for screening with a diagnosis of high-risk or extremely high-risk locally advanced rectal cancer that satisfies study inclusion criteria. Eligible candidates must have pathologically confirmed disease, appropriate tumor location, and no severe comorbidities or exclusionary illnesses (e.g., recurrent rectal cancer, cardiac dysfunction). Final enrollment decisions are made by study physicians based on individual clinical status.

What do participants need to do to participate in this study? Study participation requires adherence to predefined study procedures. Participants receive scheduled medical assessments, including blood tests, imaging scans, and anorectal function evaluations. During the study period, participants may complete questionnaires and provide biospecimens (e.g., blood samples) for treatment efficacy analysis. The study team defines the frequency and content of each follow-up to maintain continuous monitoring throughout treatment. Compliance with study procedures supports evaluation of regimen efficacy.

What are the risks of participating in this study?

This study applies neoadjuvant short-course radiotherapy, anti-PD-1 monoclonal antibody (toripalimab), and anti-angiogenic therapy (surufatinib). Potential risks for participants are listed below:

Risk of neoadjuvant short-course radiotherapy: Participants may develop grade ≥3 adverse events including, but not limited to, severe diarrhea, grade 3 neutropenia, and grade 3 radiation dermatitis, which may impair patient quality of life.

Risk of anti-PD-1 monoclonal antibody: Toripalimab may induce immune-related adverse events (irAEs) involving any organ system. Common irAEs include skin toxicity (papules, pruritus; incidence 30% to 40%), diarrhea and/or colitis (8% to 19%), fatigue (16% to 24%), immune-related hepatitis (5%), hypothyroidism (4% to 10%), and hyperthyroidism (4%). Approximately two-thirds of patients receiving immune checkpoint inhibitors develop irAEs of varying severity; the risk of serious adverse events cannot be overlooked.

Risk of anti-angiogenic therapy: Surufatinib may trigger adverse reactions related to its anti-angiogenic and immunomodulatory effects. Common adverse events (incidence >20%) include proteinuria, hypertension, bleeding, liver dysfunction, and diarrhea. Among grade ≥3 adverse events, hypertension (29.7%), proteinuria (14.5%), liver dysfunction (12.8%), and bleeding (4.5%) occur most frequently. Rarely, treatment-related death may result from gastrointestinal hemorrhage or cerebral hemorrhage.

Handling of research related injuries? This interventional study introduces no incremental risks beyond standard clinical diagnosis and treatment. Any harm arising from study participation will be reviewed for compensation and liability in accordance with applicable laws and regulations.

Undersøgelsestype

Interventionel

Tilmelding (Anslået)

32

Fase

  • Fase 2
  • Fase 3

Kontakter og lokationer

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Studiekontakt

Studiesteder

    • Jilin
      • Changchun, Jilin, Kina, 130000
        • Rekruttering
        • the first hospital of Jilin University
        • Kontakt:

Deltagelseskriterier

Forskere leder efter personer, der passer til en bestemt beskrivelse, kaldet berettigelseskriterier. Nogle eksempler på disse kriterier er en persons generelle helbredstilstand eller tidligere behandlinger.

Berettigelseskriterier

Aldre berettiget til at studere

18 år til 75 år (Voksen, Ældre voksen)

Tager imod sunde frivillige

Ingen

Køn, der er berettiget til at studere

Alle

Beskrivelse

Inclusion Criteria:

  • Age 18-75 years, male or female
  • Pathologically confirmed rectal tubular adenocarcinoma, Grade 1 (well), Grade 2 (moderate), or Grade 3 (poor) differentiation; pMMR phenotype
  • Mid or low rectal cancer with the lower tumor margin within 10 cm of the anal verge
  • Treatment-naive disease with high-risk features including cT4, cN2, MRF+, or EMVI+; and/or mrLR4 disease with impossible anal preservation or mrLR3 disease with difficult anal preservation at baseline assessment
  • No evidence of distant metastasis
  • ECOG performance status 0-1

Exclusion Criteria:

  • Recurrent rectal cancer
  • ECOG performance status ≥2
  • Other organ diseases that create unacceptable treatment risk (refer to the protocol for full exclusion criteria)

Studieplan

Dette afsnit indeholder detaljer om studieplanen, herunder hvordan undersøgelsen er designet, og hvad undersøgelsen måler.

Hvordan er undersøgelsen tilrettelagt?

Design detaljer

  • Primært formål: Forebyggelse
  • Tildeling: N/A
  • Interventionel model: Enkelt gruppeopgave
  • Maskning: Ingen (Åben etiket)

Våben og indgreb

Deltagergruppe / Arm
Intervention / Behandling
Eksperimentel: short course radiotherapy followed by surufatinib and toripalimab in locally advanced rectal cancer

Short-course preoperative radiotherapy (SCRT) for locally advanced rectal cancer.

Toripalimab 200 mg will be administered intravenously once every 21 days for 4 cycles.

Surufatinib 250 mg will be orally administered once daily during the first 3 cycles concurrently with toripalimab.

Hvad måler undersøgelsen?

Primære resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
Pathologic complete response (pCR) rate
Tidsramme: From baseline up to the time of surgery (approximately 14 weeks after radiotherapy initiation)

Pathologic complete response (pCR) rate is defined as the percentage of patients who achieve pCR after neoadjuvant therapy within the eligible population [15].

Pathologic complete response (pCR) is characterized by the absence of invasive cancer in the primary rectum and negative regional lymph nodes following adequate or complete sampling (ypT0N0, tumor regression grade [TRG] 0 points) [16]. Microscopically, cancer cells in the tumor bed are absent, with possible infiltration of inflammatory cells in the interstitium. Additionally, foamy cells and fibrous tissue proliferation may be observed. (For evaluation criteria, refer to the AJCC 8th Edition: Colorectal Cancer.)

From baseline up to the time of surgery (approximately 14 weeks after radiotherapy initiation)

Samarbejdspartnere og efterforskere

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Sponsor

Datoer for undersøgelser

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Studer store datoer

Studiestart (Faktiske)

16. maj 2025

Primær færdiggørelse (Anslået)

31. december 2028

Studieafslutning (Anslået)

31. december 2028

Datoer for studieregistrering

Først indsendt

15. maj 2025

Først indsendt, der opfyldte QC-kriterier

6. november 2026

Først opslået (Faktiske)

13. november 2026

Opdateringer af undersøgelsesjournaler

Sidste opdatering sendt (Faktiske)

13. november 2026

Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier

6. november 2026

Sidst verificeret

1. juni 2026

Mere information

Begreber relateret til denne undersøgelse

Andre undersøgelses-id-numre

Plan for individuelle deltagerdata (IPD)

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