Pd1 Antibody Sintilimab ± Chemoradiotherapy for Locally Advanced Rectal Cancer

Inclusion criteria

• Histologically proven colorectal adenocarcinoma;
• Cohort 1: Biopsy tissues with IHC indicates deficient mismatch repair(dMMR),that is,the loss of at least one of the four proteins ,MSH1,MSH2,MSH6,PMS2;or gene detection implies MSI-H; Cohort 2: Biopsy tissues with IHC indicates proficient mismatch repair(pMMR),that is positivity of all four proteins ,MSH1,MSH2,MSH6,PMS2;or gene detection implies MSS/MSI-L
• Clinical stage for rectal cancer patients is cT3-4N0M0 or cTxN+M0;
• Preoperative staging methods: all patients need to accept digital rectal examination(DRE).Patients with rectal cancer undergo high-resolution MRI±ultrasound colonoscopy/transrectal ultrasound for preoperative staging. Perienteric lymph nodes with short diameter ≥10mm or the shape of lymph nodes and its MRI characteristics are consistent with typical lymph node metastasis. If endoscopic ultrasonography is used in combination, and there is a contradiction between staging methods, the data should be submitted to the evaluation team of our center for the accurate staging;
• No symptoms of ileus; or ileus is alleviated after proximal colostomy.
• No rectal surgery except preventative stoma;
• No chemotherapy or radiotherapy;
• No biotherapy (e.g.monoclonal antibodies), immunotherapy (e.g.anti-PD-1 antibody,anti-PD-L1 antibody,anti-PD-L2 antibody or CTLA-4 antibody),or other clinical trials agents;
• No limit to previous endocrine therapy.
• Age between 18 and 75 years;
• ECOG performance status of 0 or 1;
• Life expectancy: more than 2 years;
• Hematopoietic: WBC>3×109/L;PLT>80×109/L; Hb>90g/L;
• Hepatic: ALT and AST<2 times upper limit of normal (ULN); bilirubin<1.5 times ULN;
• Renal: creatinine <1.5 times ULN or creatinine clearance ≥ 60 mL/min.

Exclusion criteria

• Arrhythmias require antiarrhythmic therapy (with the exception of β-blockers or digoxin), symptomatic coronary artery disease or local myocardial ischemia (myocardial infarction within the past 6 months) or congestive heart failure exceeding NYHA II;
• Severe hypertension with poor control after medication;
• A known history of testing positive for HIV or chronic hepatitis B or C (high copy virus DNA) at active stage;
• Patients with active tuberculosis (TB) are receiving anti-tuberculosis treatment or have received anti-tuberculosis treatment within 1 year before screening;
• Other active severe clinical infections (NCI-CTC5.0);
• Apparent distant metastasis away from the pelvic before surgery;
• Cachexia, organ function decompensation;
• Previous pelvic or abdominal radiotherapy;
• Multiple primary colorectal cancers;
• Epilepsy require medical treatment (such as steroid or antiepileptic therapy);
• Other malignancy within the past 5 years with the exception of effectively treated carcinoma in situ of the cervix or basal cell carcinoma of the skin;
• Drug abuse and medical, psychological or social factors that may interfere with patients' participation in the study or affect the evaluation of the study;
• Patients have any active autoimmune diseases or a history of autoimmune diseases(including but not limited to: interstitial pneumonia, uveitis, enteritis, hepatitis, hypophysitis, nephritis, hyperthyroidism and decreased thyroid function; patients with vitiligo or with complete remission of asthma in childhood and without any intervention in adulthood may be included; patients with asthma requiring bronchodilators intervention are not included.
• Received any anti-infection vaccine (e.g. influenza vaccine, chickenpox vaccine, etc.) within 4 weeks before enrollment;
• Complications require long-term treatment with immunosuppressive drugs, or requiring systemic or local use of immunosuppressive corticosteroids(>10mg/day prednisone or other therapeutic hormones);
• Known or suspected allergy to the study drugs or to any drugs related to this trial;
• Any unstable condition or which endangers the patients' safety and compliance;
• Pregnant or breast-feeding women who are fertile without effective contraception;
• Refuse to sign the informed consent.