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NCT Number: NCT07403877

Neoadjuvant Immunotherapy ± Radiotherapy in MSI-H/dMMR Locally Advanced Colorectal Cancer

This phase II clinical trial evaluates the efficacy and safety of three neoadjuvant regimens in patients with locally advanced microsatellite instability-high/mismatch repair-deficient (MSI-H/dMMR) colorectal cancer (CRC): 1) Regimen A: Dual immune checkpoint blockade with nivolumab plus ipilimumab. 2) Regimen B: Nivolumab plus radiotherapy. 3) Regimen C: Nivolumab monotherapy. The primary objectives are to determine whether: 1) Dual immune checkpoint blockade (Regimen A) is superior to nivolumab monotherapy (Regimen C); and 2) Immunotherapy plus radiotherapy (Regimen B) is superior to nivolumab monotherapy (Regimen C). Methods: Participants will be randomized in a 1:1:1 ratio to one of the three arms. For patients with resectable tumors, surgical resection will be performed. In patients with low rectal cancer and poor prospects for sphincter preservation, a watch-and-wait (WW) strategy is an option if a clinical complete response (CR) is achieved following neoadjuvant therapy.

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Key information

Age range

18 year and older

Sex eligibility

All sexes

Study type

Interventional

Phase

Phase 2

Primary location

Fudan University Shanghai Cancer Center

Shanghai, China

Location contact

Fan Xia, MD

SUB_INVESTIGATOR

Fangqi Liu, MD

SUB_INVESTIGATOR

Menglong Zhou, MD

CONTACT

[email protected]

86-18121299608

Sanjun Cai, MD

PRINCIPAL_INVESTIGATOR

Zhen Zhang, MD

PRINCIPAL_INVESTIGATOR

Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

  • Histopathologically confirmed primary colorectal adenocarcinoma.
  • Radiographic assessment showed a stage II-III based on AJCC Stage 8th ed.
  • At least 18 years old.
  • MSI-H or dMMR.
  • The Eastern Cooperative Oncology Group performance status (ECOG PS) score is 0 or 1.
  • Physical state or organ function can tolerate the planned treatment of the study protocol.
  • Agreed to sign written informed consent before recruitment.

Exclusion criteria

  • Previously received any antitumor therapy for the disease under study, including surgery, radiotherapy, chemotherapy, targeted therapy, immunotherapy, etc.
  • Pregnancy or breastfeeding women.
  • History of other malignancies within 5 years.
  • Serious medical illness, such as severe mental disorders, cardiac disease, uncontrolled infection, etc.
  • Immunodeficiency disease or long-term using of immunosuppressive agents.
  • Allergic to any component of the therapy.
  • Any other condition or disease that is not suitable to take the therapy included in the protocol.
  • Concurrent participation in another clinical study, unless participating in an observational (non-interventional) clinical study or in the survival follow-up phase of an interventional study.
  • Received any investigational drug or device treatment within 4 weeks prior to initial administration of the investigational drug.

Treatment and study plan

Nivolumab

Drug

Nivolumab 240 mg every 2 weeks

Ipilimumab (1mg/kg)

Drug

Ipilimumab 1 mg/kg every 3 weeks

PULSAR

Radiation

Irradiation targeted to the primary lesion (5 Gy per fraction, total 4 fractions, delivered every 3 weeks).

Radical surgery

Procedure

Surgical resection will be performed in resectable cases.

Watch & wait

Other

For patients with low rectal cancer who are unable to preserve the anal sphincter, a watch-and-wait (WW) strategy can be considered if a clinical complete response (CR) is achieved.

Primary outcomes

  1. Complete regression (CR) rate

    Time frame: 1 month after surgery or the completion of neoadjuvant therapy

    Proportion of patients achieving either clinical CR (and undergoing WW) or pathological CR (confirmed by pathology) among all evaluable patients.

Secondary outcomes

  1. R0 resection rate

    Time frame: 1 month after surgery

    Proportion of patients who achieve R0 resection.

  2. Objective response rate (ORR)

    Time frame: 6 months after the enrollment of the last subject

    Proportion of patients with complete response (CR) or partial response (PR) to preoperative multimodal therapy. ORR will be evaluated using RESIST1.1 by CT/MRI of the chest, abdomen, and pelvis.

  3. Event-free survival (EFS)

    Time frame: 36 months after the enrollment of the last subject

    The EFS was defined as the time from randomization to the first determination of inoperable disease progression, postoperative local recurrence or distant metastasis, tumor regrowth, or death from any cause, whichever occurs first.

  4. Overall survival (OS)

    Time frame: 36 months after the enrollment of the last subject

    OS is defined as the time interval from enrollment to death of any reason or censoring.

  5. Toxicities

    Time frame: From the time of enrollment, assessed up to 28 days after the last dose of study therapy

    Number of participants with treatment-related adverse events (TrAEs) reported between the first dose and 28 days after the last dose of study therapy as assessed by the National Cancer Institute Common Terminology Criteria for Adverse Events (NCI-CTCAE), version 5.0.

  6. Surgical morbidity

    Time frame: During or one month after surgery

    Surgery related adverse events (SRAEs) refer to complications which happen during or one month after surgery. Severe complications after surgery will be documented and classified by Clavien-Dindo classification, such as abdominal or GI tract bleeding, anastomotic fistula, pancreatic fistula of grade B or above, and incision complications (infection, bleeding, rupture).

  7. Surgical mortality

    Time frame: During or one month after surgery

    Death from any cause within 30 days of the date of surgery will be considered a surgical mortality death.

Study contacts

Contact information is provided by the study sponsor or research team.

Menglong Zhou, MD

CONTACT

[email protected]

86+18121299608

Sponsors and collaborators

Lead sponsor

Fudan University

Other

Registry information

Official study title

A Phase II Randomized Controlled Trial of Neoadjuvant Immunotherapy With or Without Radiotherapy in Locally Advanced Microsatellite Instability-High/Mismatch Repair-Deficient Colorectal Cancer

Acronym: TORCH-OPTIMA

Important dates

Study start
2026
Primary completion
2031
Study completion
2034
First posted
Feb 11, 2026
Registry last updated
Feb 11, 2026

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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