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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 bijgewerkt door: 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.

Studie Overzicht

Toestand

Werving

Conditie

Interventie / Behandeling

Gedetailleerde beschrijving

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.

Studietype

Ingrijpend

Inschrijving (Geschat)

32

Fase

  • Fase 2
  • Fase 3

Contacten en locaties

In dit gedeelte vindt u de contactgegevens van degenen die het onderzoek uitvoeren en informatie over waar dit onderzoek wordt uitgevoerd.

Studiecontact

Studie Locaties

    • Jilin
      • Changchun, Jilin, China, 130000
        • Werving
        • the first hospital of Jilin University
        • Contact:

Deelname Criteria

Onderzoekers zoeken naar mensen die aan een bepaalde beschrijving voldoen, de zogenaamde geschiktheidscriteria. Enkele voorbeelden van deze criteria zijn iemands algemene gezondheidstoestand of eerdere behandelingen.

Geschiktheidscriteria

Leeftijden die in aanmerking komen voor studie

18 jaar tot 75 jaar (Volwassen, Oudere volwassene)

Accepteert gezonde vrijwilligers

Nee

Geslachten die in aanmerking komen voor studie

Allemaal

Beschrijving

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)

Studie plan

Dit gedeelte bevat details van het studieplan, inclusief hoe de studie is opgezet en wat de studie meet.

Hoe is de studie opgezet?

Ontwerpdetails

  • Primair doel: Preventie
  • Toewijzing: NVT
  • Interventioneel model: Opdracht voor een enkele groep
  • Masker: Geen (open label)

Wapens en interventies

Deelnemersgroep / Arm
Interventie / Behandeling
Experimenteel: 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.

Wat meet het onderzoek?

Primaire uitkomstmaten

Uitkomstmaat
Maatregel Beschrijving
Tijdsspanne
Pathologic complete response (pCR) rate
Tijdsspanne: 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)

Medewerkers en onderzoekers

Hier vindt u mensen en organisaties die betrokken zijn bij dit onderzoek.

Sponsor

Studie record data

Deze datums volgen de voortgang van het onderzoeksdossier en de samenvatting van de ingediende resultaten bij ClinicalTrials.gov. Studieverslagen en gerapporteerde resultaten worden beoordeeld door de National Library of Medicine (NLM) om er zeker van te zijn dat ze voldoen aan specifieke kwaliteitscontrolenormen voordat ze op de openbare website worden geplaatst.

Bestudeer belangrijke data

Studie start (Werkelijk)

16 mei 2025

Primaire voltooiing (Geschat)

31 december 2028

Studie voltooiing (Geschat)

31 december 2028

Studieregistratiedata

Eerst ingediend

15 mei 2025

Eerst ingediend dat voldeed aan de QC-criteria

6 november 2026

Eerst geplaatst (Werkelijk)

13 november 2026

Updates van studierecords

Laatste update geplaatst (Werkelijk)

13 november 2026

Laatste update ingediend die voldeed aan QC-criteria

6 november 2026

Laatst geverifieerd

1 juni 2026

Meer informatie

Termen gerelateerd aan deze studie

Andere studie-ID-nummers

Plan Individuele Deelnemersgegevens (IPD)

Bent u van plan om gegevens van individuele deelnemers (IPD) te delen?

ONBESLIST

Informatie over medicijnen en apparaten, studiedocumenten

Bestudeert een door de Amerikaanse FDA gereguleerd geneesmiddel

Nee

Bestudeert een door de Amerikaanse FDA gereguleerd apparaatproduct

Nee

product vervaardigd in en geëxporteerd uit de V.S.

Nee

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